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of their citizens out of poverty, but in many countries, the benefits of growing wealth have gone to the privileged few. The number of rich countries full of poor people has grown, changing the poverty map. Today, 70 per cent of the world’s poor live in middle-income countries.The consequences of the world’s extreme social inequalities are profound. The January’s World Economic Forum identified growing inequalities in income and wealth as the single most significant trend that will shape global development over the next ten years. In essence, the SDGs are a corrective strategy that looks at the root causes of inequality and aims to transform them. The international systems that govern finance, business relations, trade, and foreign affairs need a corrective strategy. As some critics argue, the long-standing social contract that obliges the privileged few to care for those less fortunate has been broken in a world that has lost its moral compass. As we collectively address these challenges, I ask you to keep in mind four overarching priorities that should guide health policies and programmes. First, tackle inequality. Second, improve information. Third, stimulate innovation. Fourth, and above all, show impeccable integrity.For inequality, the 2030 Agenda for Sustainable Development has the focus right. Leave no one behind. This is not easy, especially in these uncertain times. Decades of experience tell us that this world will not become a fair place for health all by itself. Health systems will not automatically gravitate towards greater equality or naturally evolve towards universal coverage. Economic decisions within a country will not automatically protect the poor or promote their health. Globalization will not self-regulate in ways that ensure the fair distribution of benefits. International trade agreements will not, by themselves, guarantee food security, or job security, or health security, or access to affordable medicines. All of these outcomes require deliberate policy decisions. For information, some 85 countries, representing 65 per cent of the world’s population, do not have reliable cause-of-death statistics. This means that causes of death are neither known nor recorded, and health programmes are left to base their strategies on crude and imprecise estimates. This is totally unacceptable in the current climate that places a premium on transparency, accountability, and independent monitoring of results. For innovation, we know that the supremely ambitious health targets set out in the SDGs cannot be met without powerful new medical tools. We know that new vaccines can prevent infections that currently contribute to the overuse of antibiotics. We know that at least 11 epidemic-prone human pathogens, including the Zika, Lassa fever, and Nipah viruses, have no vaccine to protect populations during outbreaks. We know that R&D incentives preferentially encourage the development of new products for markets that can pay. One strategy that has worked well at WHO is to let the people, working in the field and seeing practical constraints on a daily basis, design the profile of an ideal new product, right down to its price. This was the strategy used so successfully in the Meningitis Vaccine Project, funded by the Bill and Melinda Gates Foundation, and coordinated by WHO and PATH. I encourage others to use a similar approach.Finally, we must all work according to the highest standards of scientific integrity. Like others, I see a number of disturbing trends – let me respond to just one. Regulatory agencies everywhere must resist the push to replace randomized clinical trials, long the gold standard for approving new drugs, with research summaries provided by pharmaceutical companies. As some argue, making this change would speed up regulatory approval, lower the costs to industry, and get more products on the market sooner. This kind of thinking is extremely dangerous. We must not let anything, including economic arguments or industry pressure, lower our scientific standards or compromise our integrity. This is an absolute duty. ■Pictured: Dr Margaret ChanHEALTH 071