I believe that we are at a turning point for public health—and that our choices are stark: either we reorient and strengthen public health within both modern and developing societies and institute a resilient system of global governance for health or we will face dire consequences in terms of human, social, and economic development. At present, it is the poorest countries that are paying the price for this negligence—but we have mounting signals that a new health divide is in the making as a large global underclass spreads out around the globe and defies the old definitions of vulnerable groups.

Forceful action at nation state level will not be enough—we need nothing less than a new global social contract on health. I was delighted to see the use of that phrase also by Richard Smith, editor of the British Medical Journal in a recent excellent editorial.¹ The drive for such a contract can only be established politically—developed through an ethical and political debate throughout society initiated by outspoken public health professionals, responsible politicians, and a concerned civil society at national and global levels of governance. And maybe this is the time for the respective journals to make this a joint wake up call to our professional community.

We have reached a point where …