With the tsunami that killed several hundred thousand Southeast Asians came the world’s sudden and intense interest in international health—for a time. The cast of characters that compose the international community, from nongovernmental organizations to secretaries of state, from academics to cable news networks, descended on Southeast Asia to restore hope, dispense aid, and even promote peace among formerly warring parties in the Indonesian province of Aceh. Heads of wealthy states seemed to engage in a reverse bidding war for the mantle of most generous country; when the United States announced its US$350 million relief pledge on the last day of 2004, Japan topped the US offer on the first day of 2005, pledging fully US$500 million.

Although the sick kept suffering as the situation stabilized, media attention soon turned elsewhere. By late January, international health was already fading from the front pages. Yet to say the crisis had suddenly grown less important for the thousands whose lives still hung in the balance would be, put mildly, a curious thing. Nor did some aid agencies, recognizing that fact, leave the region. Instead, they stayed to address less critical but no less imperative needs, such as the mental health of survivors. They stayed to do in the background, out of the spotlight, what practitioners of international health do in like fashion every day.

It is this fractured, episodic characterization of global health crises and public emergencies that today shapes common perceptions of international health. Serious considerations of international health all too frequently wax and wane with the whims of localized media coverage. A tradition of focus on specific health crises in specific countries—Severe Acute Respiratory Syndrome in China, “Mad Cow” disease in Great Britain, cholera in the Democratic Republic of Congo, anthrax in the United States—has painted international health as a disjointed and periodic issue of concern that, by extension, states should address individually.

But international health is far bigger, far more constant and global in scope. Thanks to what many see as the irrepressible forces of globalization, formerly disparate regions of the world are now so interconnected that changing demographics and increasing cultural interactions have altered the medical challenges the world faces. As people cross national borders, so do the microbes they carry. So too, then, do issues of health, rendering many of these challenges truly global in nature.

Overcoming these new challenges is an ongoing process, dependent on sound organization of resources and the day-to-day advancements of health workers and researchers across the globe. Because developed states have thus far led the fight, and probably must continue to do so given their near monopoly on wealth and talent, they must address the both ethically and logistically difficult problem of meeting third-world needs with first-world means. If the world is to move into a healthier era, the public focus must shift away from periodic crises toward the underlying conditions whose improvement appears to hold out the only hope of long-term progress.

This issue’s symposium explores these little reported “background” conditions, centered not on particular crises but rather on the structural environment in which global health is practiced, that together mean life or death for billions around the world. In the first article, Flora Katz and Karen Hofman explore the viability of genetics research in the developing world, highlighting recent successes of interconnected third world efforts in partnership with the first world. Next, in a discussion of the recent explosion and commercialization of the biotech revolution, Jeremy Rifkin maintains that ethical considerations of genetic technology should not be overshadowed by its alluring scientific promise. Richard Cash, calling for a shift in the contemporary health research paradigm, also advocates an international integration of research efforts and interconnectedness—both of which are crucial to long term capacity and research success. Garrett Mehl, Peter Winch, and Healther Wipfli contend that the world’s first public health treaty, the World Health Organization’s Framework Convention on Tobacco Control, will need to engage communities at the local level in order to be globally effective. Ronald Waldman examines trends in warfare and appraises the extent, limited in his view, to which public health efforts can mitigate the ravages of war. Then, Laurie Garrett and Scott Rosenstein critique the international community’s once optimistic campaign to combat infectious disease the world over, arguing for the aforementioned neccessity of interconnectedness both among those fighting against disease and in how they view the diseases they are fighting. Finally, exploring the notion of an optimal level of health care expenditure, Alistair McGuire and Victoria Serra weigh the potential returns to investment in health care against the immediate costs, determining that even developing countries have much to gain from a revived focus on health.

These articles are noteworthy not only for their analytical arguments but also, taken together, for their attitudinal balance. They portray not only realism about the current, sometimes dismal state of global health, but also optimism about the potential of scientific and medical advancement to build a future era of health and security both personal and collective.