National Institutes of Health, Bethesda, Md. — At the opening of the 21^st century, when the new genomics and biomedical research promise so much for this country, two-thirds of the world's population in the poor and middle-income countries bear a disproportionate burden of illness and premature death. Indeed, their health needs have never been as formidable; hence the search for solutions has become an imperative. Lewis Thomas, in his book "The Fragile Species," said, "We have an obligation to assure something more like fairness and equity in human health. We do not have a choice, unless we plan to give up being human." Today, on World Health Day 2001, we urge renewed commitment to ensuring that the benefits of good health, including mental health, are available to all people everywhere, not just to those who live in countries that enjoy the vast advantages of prosperity.

Scientific research and research capacity building, which are critical to supporting viable and effective public health systems in developing countries, are often overlooked in the haste to address immediate needs. Yet, strong public health systems depend on a vibrant, sustained research underpinning to ensure that interventions are not only developed but also evaluated and fine-tuned to meet local needs. America plays an essential role in such research and capacity building for the development of important new drugs, diagnostics, vaccines, and intervention strategies for poor countries. These studies often contribute to the scientific foundation for medical advances and treatment here as well. For example, research on the use of oral rehydration for cholera in Bangladesh has led to its adoption in the developing world and as the preferred treatment for dehydrating diarrheal disease in the United States. More recently, collaborations with U.S.-trained Ugandans on a landmark study demonstrated the efficacy of a single dose of the relatively inexpensive drug nevirapine in reducing mother-to-child transmission of HIV, and this regimen is now useful for HIV-positive women presenting at birth without prior antiretroviral therapy.

This year's World Health Day theme is Mental Health: Stop Exclusion — Dare to Care. This is especially appropriate since over the next two decades, an increasing proportion of ill health in the developing world, by some estimates more than 60 percent of the world's burden of disease, will be from chronic, non-communicable causes. Our considerable investment in research and capacity building in emerging infectious diseases such as AIDS, tuberculosis, and malaria is not matched by a similar effort to build research infrastructure, expertise, and new knowledge that will enable people in the developing world to address their growing burden of mental illness. Shortages of trained mental health care workers at all levels, and use of inappropriate therapies as well as lack of access to effective treatment, lead to the neglect of social and mental health crises such as depression, psychosis, suicide, substance abuse, violence, breakdown of the family, disintegration of communities, and the stigmatization of the afflicted — further isolating those who need help the most.

Working with other U.S. agencies, the World Health Organization, lending institutions, and non-governmental groups, the National Institutes of Health (NIH) is committed to advancing research and training to address mental illness. The Fogarty International Center, the National Institute on Mental Health (NIMH), and other partners at NIH are using all available means to develop much-needed interventions in this field. The role of stigma in preventing people with mental illness from seeking diagnosis and treatment, or from participating in research to identify beneficial interventions, is a particular area of focus, and one that will be considered at a NIH-sponsored international conference on stigma as it pertains to global health this coming September.

World Health Day 2001 provides us with an excellent opportunity to remember that the pursuit of health through international scientific cooperation is an inherently global enterprise. Individuals and nations share an inherited and acquired sense of social altruism — an understanding of our common fate and a shared set of social obligations. Working together, the world can be healthier, happier, more productive and more stable. NIH will play its role and advocate for improved world mental health.

Gerald T. Keusch, M.D., is NIH Associate Director for International Research and Director of the Fogarty International Center (FIC), the international component of the NIH.

FIC promotes and supports scientific discovery internationally to reduce disparities in global health. NIH is an agency of the U.S. Department of Health and Human Services. Fact sheets, press releases, and other FIC-related materials are available at: http://www.nih.gov/fic.