The author explains why global problems, both known and unknown and unpredictable, are going to affect the health sector in the next few decades even more than they do today. Five examples are given of global health-related dilemmas that must be faced: (1) the worldwide aging of the population and the changing morbidity trends and physician supply needs this creates; (2) rising worldwide poverty, which has a direct relation to health status and has some new causes in this century; (3) ethical dilemmas, such as those resulting from new reproductive and life-prolonging technologies; (4) the need for adequate and affordable health care systems (the Canadian system is described and several misconceptions about it are clarified); and (5) the need to allocate scarce resources to meet practically infinite health care demands. The author concludes by listing some of the important actions that must be taken if we are to deal effectively with the dilemmas fostered by global problems: (1) people must be taught that their health status is the result of many factors in addition to their health care (e.g., socioeconomic status, lifestyle, the environment); (2) medical education must be refocused to prepare physicians to deal with global challenges; (3) there must be greater international cooperation (e.g., working together to share research and implement strategies to control AIDS); (4) countries must invest in worldwide efforts, such as family planning and primary education; and (5) international partnerships must be created to develop worldwide strategies, such as a global drug strategy.
