It’s been a peculiar century so far. It started off with the great and lofty thoughts that accompany centennial change. Millennium summits, domes, and plans for a peaceful century in which human health and wellbeing blossomed. With amazing rapidity, in the wake of 11 September 2001, it deteriorated into a century of fundamentalisms, acute fear of terrorism, and an unprovoked attack on a sovereign state that was not backed by the United Nations or the majority of citizens of the countries going to war. The aftermath of the war in Iraq has become a public health nightmare¹ and there are few signs of the flourishing of democracy that was meant to justify the war. Meanwhile the deeper causes of global instability persist and the USA spends more on war than it does on tackling extreme poverty. Sachs estimates that eight million people die each year because they are too poor to stay alive.² The 21st century, then, is proving to be a disaster for Africa and many other post-colonial states who face economic disaster under the burden of crippling debt and the onslaught of both old (such as malaria) and new infectious diseases (most notably HIV/AIDS). Life expectancy in Africa is going backwards for the first time in over a century.³ Meanwhile the populations of OECD countries are experiencing growth in wealth and prosperity, albeit with increasing inequities between the rich and poor.⁴

IMPORTANCE OF VISIONARY LEADERSHIP

It is against this background …