From the Editors

Numbers about human tragedy often elicit only a dulled response and a rueful shake of the head: In 2008, 9.2 million children died from vaccine-preventable disease. In 2004, 2.2 million people worldwide succumbed to diarrheal diseases. Are we surprised that in that same year, 99% of maternal deaths occurred in developing countries? Or that the child mortality rate in Africa was four times the adult mortality rate?

That's a lot of numbers and a lot of ratios. Yet because of the size, a casual reader does not, perhaps cannot or will not, take in the specifics. After all, what does "9.2 million children" mean, this slaughter of innocents? It may be that the abstract quality of large numbers allows us to insulate ourselves against the monstrousness of the human suffering they represent.

In this issue of Race/Ethnicity, we invite our readers to consider whether there is anything "natural" about human suffering of this magnitude, so marked by race, class, gender and geography, with special attention to the social, economic and political foundations of health inequity. We begin with some carefully chosen numerical data, followed by a classic piece and five articles focused on public health issues from around the globe. Some of the questions we asked ourselves as we did the groundwork for this issue included the following:

• • How and why do race, ethnicity, gender, class, place, and nationality matter in shaping population health?

• • In what ways does globalization shape health outcomes?

• • What is the relationship between social, political, and/or economic inequalities and the distribution of health out-comes within and across countries and regions?

• • What roles do multinational corporations play in the distribution of health outcomes within and across countries?

• • What roles are played by governmental and intergovernmental policies, practices, and social ideologies around the production and distribution of medicine, food, weapons, patents, health care infrastructure, and so on?

• • What kinds of reforms—at the international, national, and sub-national levels—would be needed to significantly reduce the rates of sickness and early death among the world's most marginalized populations?

In her figures showing public health data, Elsadig Elsheikh, a Research Associate at the Kirwan Institute for the Study of Race and Ethnicity, has compiled some World Health Organization (WHO) facts and figures that we find especially telling. Should it be a matter of indifference that violence is predicted to trend upwards as a leading cause of death worldwide (Figure 3) and that the United States and Russia do a brisk business in small arms sales? (Figure 4). We think not. Malaria, eminently treatable in the twenty-first century, nonetheless killed nearly one million people in 2006 per WHO.¹ If Kenya can grow and ship flowers to Berlin and London, we must at least ask why drug manufacturers based in Europe and North America do not supply more anti-malarial medicines to the many places in Africa and South Asia devastated by the disease and suffering the loss of untold numbers of children, teachers, and community leaders every year.

The sickness and subsequent death of large numbers of people reduces the possibility for a functioning society. The President's Emergency Plan for AIDS Relief, for example, describes the challenges to social well-being in Botswana:

HIV/AIDS threatens the many developmental gains Botswana has achieved since its independence in 1966, including economic growth, political stability, a rise in life expectancy, and the establishment of functioning public educational and health care systems. At the household level, families face increasing health expenditures to meet the needs of family members with HIV/AIDS. At the same time, they are experiencing loss of income as productive family members become sick and die.²

Investigators and researchers are able to provide even more detail on what happens to the fabric of society when too many people are ill:

Botswana's workforce is being depleted as many productive adults develop AIDS and are no longer able to work. High levels of HIV/AIDS among teachers reduced both the quality of education and the number of hours taught. School enrollment is expected to fall as children drop out of school to...