The editorial reflects on the contemporary problems that tropical medicine has to face, predominantly in Africa: human displacement, an emerging epidemic of non-communicable disease, collapsing health systems, the desperate need for palliative care as the tidal wave of HIV-AIDS continues, and the denial of access to vital medicines. The ability of globalisation to resolve these problems has been thwarted by unparalleled global mismanagement-namely, by undemocratic supranational agencies and undemocratic transnational corporations.
Four priorities are outlined: 'First, there must be a commitment to creating in-country capacity, notably a human capacity that can determine for itself problems to be addressed instead of having a westernised impression of those problems imposed from outside. When judging the success of tropical medicine programmes, one must ask: who benefits most? Too often, the answer is those western academics who lead, organise, and conduct most tropical medicine research.'
'Second, there must be a commitment to listen to local voices. At last, for example, the Global Fund to Fight AIDS, Tuberculosis, and Malaria is launching a "partnership forum" three years after opening its doors to announce yet another opaque system of rich-world patronage. Third, physicians should protest against policies that hurt efforts to improve the health of the poor, such as the discriminatory US trade embargo on science editing (see p 1160). And finally, research must be put at the heart of policy development. While we accept experimental approaches to determine the effectiveness of clinical practices (see p 1093), we too often allow ideology to govern matters of political practice.'
The editorial concludes: 'Tropical medicine is indeed changing. The intersecting lines of disease and public health are being radically redrawn. Globalisation has made us all more aware-and horrified-at the disturbing mix of indifference and intervention that is being perpetrated in all our names. Doctors must not let the starry robes of democracy conceal the flagrantly immoral project of naked imperialism now before us. We must not allow the righteous excuse of strengthening state security to sugar the poison of state violence. Tropical medicine's future remains rooted in the lives, communities, conditions, and diseases of the tropics. But its context is explicitly and urgently political, economic, and social. Is 21st century tropical medicine prepared for these, its most critical, predicaments?'
Journal
The Lancet