Over the past few months, yet another epidemic has come to trouble our unhappy world. Shortly after SARS was identified, the entire globe was put on notice. Although the new illness is not as deadly as many other infectious diseases (compare the 500 or so confirmed dead of SARS with the 8,500 who die each day of AIDS), it has sent ripples throughout the world economy. It's perhaps easier to notice from my HIV clinic in Haiti that SARS was so quickly seen as a crisis because it affects areas of high economic traffic, whereas AIDS and tuberculosis mostly affect populations deemed irrelevant to the global economy.

In 1946 the new constitution of the World Health Organization (WHO) warned that "unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger." The world is now even more divided between medical haves and have-nots, and infectious pathogens still exploit these social inequalities. They are why we have not eradicated polio, measles or malaria; why AIDS is disappearing among American children even as it claims the lives of more and more children in Africa and Asia.

Inequity has already shaped SARS. The disease emerged at the border between a low-income area with rapidly privatizing health services (China) and a high-income area with good public health (Hong Kong). Weak surveillance systems--a symptom of declining public health infrastructures--make it impossible to know when SARS first emerged or how big a problem it is. Many sick with SARS were saved by intensive care delivered in excellent hospitals, while SARS patients without access to such care faced worse outcomes.

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