World Bank Estimates Research Articles

Long-term challenges and opportunities in the natural resource sector

New Zealand’s cultural, social and economic prospects are inextricably intertwined with the health and sustenance of our natural capital. New Zealand is wealthy in natural resources. We have plentiful, clean water; clean air; fertile soil and a climate well suited to humans, trees, livestock and agriculture; long coastlines and significant aquaculture resources; significant mineral and petroleum reserves; and extraordinary biodiversity on our land and in our water bodies. The World Bank estimates that New Zealand ranks eighth out of 120 countries and second out of OECD countries in natural capital per capita; we are outranked only by petroleum exporting countries (World Bank, 2011). While it is still substantial, natural capital in New Zealand has been reduced since the arrival of humans, however, including losses to our lowland forest and reductions in native biodiversity.

The wealth (and health) of nations: a cross-country analysis of the relation between wealth and inequality in disease burden estimation

BackgroundGross domestic product (GDP) per capita is arguably the single most predictive determinant of health at the national level, yet such a measure fails to capture the complexity of wealth (and thus health) distribution within a population. Risk factors, health-seeking behaviour, and outcomes at the individual level have been shown to be associated with asset-based measures of wealth, which is more stable and consistently assessed than measured income or expenditure. Despite the potential utility of such estimates, currently existing wealth and inequality measures are not comparable across surveys, across countries, or across time. In this study, we quantify wealth inequality using an asset-based measure by country and year, from 1990 to 2010, and study associations with inequalities between countries in various measures of health. MethodsWe generate a global asset-based wealth index that is comparable across countries and over time using nearly 500 surveys from more than 140 countries, anchoring this scale on assets with low differential item functioning. We then translate this to an international dollar scale for the calculation of a modified Gini coefficient and other traditional measures of inequality, and investigate the relation between such measures and overall and cause-specific mortalities and selected disease incidence. FindingsIncluding the more robust household asset data in estimates of economic status changes the global picture of income inequality. In some countries, our results diverge significantly from the World Bank's estimates. Globally, income inequality has been increasing over the past 20 years and is inversely associated with progress in life expectancy and mortality. InterpretationThe observed associations between income inequality and health inequities add new evidence to the debate around the possible detrimental effects of greater income inequality. Understanding the contribution of income inequality to health over time and across countries is critical for designing policies to improve health outcomes. FundingBill & Melinda Gates Foundation.

Who Shrunk China? Puzzles in the Measurement of Real GDP

The latest World Bank estimates of real GDP per capita for China are significantly lower than previous ones. We review possible sources of this puzzle including substitution bias in consumption, reliance on urban prices, which we estimate are higher than rural ones, and the use of an expenditure-weighted rather than an output-weighted measure of GDP. Taking all these together, we estimate that Chinese real per capita GDP was 30% higher in 2005 than the World Bank estimates. Our empirical procedures have implications more broadly for international comparisons of living standards and real GDP.

Maternal mortality and morbidity: a human rights imperative

Maternal mortality and morbidity continue to be a serious human rights concern—it is estimated that 287 000 women died of maternal causes in 2010. 1 WHOUNICEFUNFPAthe World BankTrends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and the World Bank estimates. World Health Organization, Geneva2012 Google Scholar There is increased understanding that this is a human rights crisis that stems from discrimination against women, which manifests, for example, in violence against women, underprioritisation and underfunding of services and goods that only women require, and lack of accountability mechanisms to respond to maternal deaths and injuries. 2 United NationsReport of the High Commissioner for Human Rights on preventable maternal mortality and morbidity and human rights. A/HRC/14/39. United Nations, New York2010 Google Scholar A human rights-based approach to maternal mortality and morbidity has been advocated by human rights experts for many years, 3 United NationsReport of the Special Rapporteur on the right to the highest attainable standard of health, Mr Paul Hunt. A/61/338. United Nations, New York2006 Google Scholar , 4 Ely Yamin A Towards transformative accountability: applying a rights-based approach to fulfill maternal health obligations. Sur Int J Human Rights. 2010; 7: 95-121 Google Scholar and has also gained traction among public health experts and other professionals. 5 WHOSafe abortion: technical and policy guidance for health systems. World Health Organization, Geneva2012 Google Scholar An important example of this evolution is the 2012 report of the independent Expert Review Group, 6 Independent Expert Review GroupEvery woman, every child: from commitments to action. World Health Organization, Geneva2012 Google Scholar which was mandated to monitor progress on the UN Secretary-General's Global Strategy for Women's and Children's Health and included a specific recommendation on human rights.

Determinants of Rural Poverty: An Empirical Study of Socio-Economic Factors in Jharkhand, India

In India, poverty reduction is one of the major objectives of economic development programmes. Though, India was the first country in the world to define poverty as the total per capita expenditure of the lowest expenditure class, which is required to ascertain a minimum intake of 2400 kcal/day in rural and 2100 kcal/day in urban areas. The same is converted into financial terms and the poverty line is defined as a minimum level of income or expenditure, which is periodically updated. The latest updated poverty line is Rs.356.30 in rural areas and Rs.538.60 in urban areas in 2004-05 (Planning Commission, 2007). There exists a substantial interstate and urban rural differential in the cost of goods and services. One in three Indians lives below the poverty line according to the Tendulkar Committee report which used a measurement of goods and services, rather than calorie intake, to calculate poverty. The World Bank estimates that 80% of India's population lives on less than $2 a day which means a higher proportion of its population lives on less than $2 per day as compared with sub-Saharan Africa. Income based approaches to poverty can not tell more about other forms of deprivations poor go through. Poverty is basically a denial of a range of material needs such as nutritious food, safe drinking water, shelter, healthcare, education, etc. Therefore, multidimensional poverty measures provide better understanding of the nature of poverty-at local, regional, national, and world level. The present study attempts to track and explore some of the important causes of rural poverty in the state of Jharkhand. Socio-economic indicators provide a background to understanding the poverty scenario in a country. These indicators provide data on education, gender, poverty, housing, amenities, employment and other economic indicators. These indicators for the country as well as states will help in identifying the linkages between socio-economic indicators and achievement of health goals. It was found that the rate of decline in poverty is more in agricultural labour class households (27%) than that of farming households (1.9%). Analysis of household data of the sample villages also highlights a high incidence of rural poverty ranging from more than 20 percent in Dubaliya to about 76 percent in Durgapur. Incidence of poverty for four groups of households viz. labour, small, medium and large shows mixed pattern of incidence of poverty. Labour class households and large households were comparatively less poor in most of the villages than that of the other classes i.e., small and medium households. Among various determinants of poverty, obtained by estimating a probit model, considering poor as 1 and non-poor 0, it was found that length of education and number of earning members in family had significant poverty reducing effect, implying that for taking a poor household out of poverty promotion of education and creation of more employment opportunities to provide employment to a large number of household members are essential. It also emanates that big family size and increased dependency on agriculture would induce poverty and it is therefore imperative that family planning policies and alternative non-farm employment programme should receive due priority in any poverty alleviation programme in the state.

Prévalence de l’hypertension artérielle et description de ses facteurs de risque à Lomé (Togo) : résultats d’un dépistage réalisé dans la population générale en mai 2011

BackgroundThe prevalence of hypertension in the Sub-Saharan Africa region is increasing as a manifestation of the epidemiological transition, and this fact will oblige these countries to mobilize significant resources. World Bank estimates cheaper to prevent cardiovascular disease than to treat people once these diseases are established suggesting the need to know the prevalence of hypertension in order to allow prevention programs in our population. However, data in Togolese populations are rare. The purpose of the present study was to determine the prevalence of high blood pressure and its risk factors in Lomé. MethodsWe performed a cross-sectional survey among 2002 unselected respondents of the municipality of Lomé in May 2011. A questionnaire has been filled about family history of hypertension, habits and practices that affect hypertension on behalf of each respondent and anthropometric data and blood pressure has been measured. ResultsThe prevalence of high blood pressure was 36.7% (34.6% of male vs. 38.4% of female, OR=0.85; 95%CI=0.7–1.02; P=0.08); 42.4% of the hypertensive respondents have been diagnosed at the screening. Blood pressure was positively correlated to the age (SBP: r=+0.46; P=0.001; DBP: r=+0.36; P<0.001), the body mass index (SBP: r=+0.7; P<0.001; DBP: r=+0.89; P<0.001) and waist circumference (SBP: r=+0.28; P<0.001; DBP: r=+0.3; P<0.001). There was a significant relationship between arterial hypertension and obesity (OR=1.65; 95%CI=1.47–1.84; P=0.003), salt consumption (OR=1.4; 95%CI=1.13–1.72; P<0.001) and oral contraception (OR=2.1; 95%CI=1.29–3.43; P=0.002). ConclusionThere was a high prevalence and low awareness of arterial hypertension in the municipality of Lomé with a female prevalence. This affection was correlated to age, salt consumption and obesity. This study raises the need for accentuating the prevention in our poor populations which are unable to face adverse outcomes which can occur.

Grain losses in India and government policies

Food grains form an important part of the vegetarian Indian diet. Grain production has been steadily increasing due to advances in production technology, but improper storage results in high losses in grains. Post-harvest losses in India amount to 12 to 16 million metric tons of food grains each year, an amount that the World Bank estimates could feed one-third of India's poor. The monetary value of these losses amounts to more than Rs. 50,000 crores per year (Singh, 2010). Natural contamination of food grains is greatly influenced by environmental factors such as type of storage structure, temperature, moisture, etc. During storage, quantitative as well as qualitative losses occur due to insects, rodents, and micro-organisms. A large number of insect pests have been reported to be associated with stored grains. At any given time 60–70% of grains is stored on the farm in traditional structures like Kanaja, Kothi, Sanduka, earthen pots, Gummi and Kacheri. However, indigenous storage structures are not suitable for storing grains for very long periods. The post-harvest losses in two major food grains, viz. rice and wheat where about 75 per cent of the total post-harvest losses occur at the farm level and about 25 per cent at the market level (Basavaraja et al., 2007). The storage losses at different stages have added up to about 36 per cent of the total post-harvest losses in rice and 33.5 per cent in wheat, while harvesting and threshing operations together account for about 17 per cent of total losses in both the crops. Transit losses at different levels have been an important component of post-harvest losses, contributing to about 20 per cent of the total losses. Educating and training the farmers on post-harvest operations would greatly help in reducing the post-harvest losses in food grains. The establishment of small-size cold storage units in the production centres would help in reducing the storage losses. In this direction, the zero energy cool chambers technology developed by the Indian Council of Agricultural Research needs to be popularized. It is high time that both the Central and state governments should think about the severity of the problem of storage losses. One strategy could be that the Food Corporation of India could keep the stocks with the farmers. An adequate organization needs to be set up at the Centre and in the states to take coordinated action in this direction. We should go in for a systems approach rather than piece meal. Establishment of National Grid of rural godowns as per ecological zones is a must. The ‘Save Grain Campaign’ programme needs to be strengthened. In villages, from primary school through to high school and intermediate level the subject of grain storage should be taught. The subject should also be included in the job card of extension workers. Arrangement for training in grain storage for the framers should be made all over the country- in the villages at farmers’ house where 70–80% grain is stored.

Measuring poverty over time

The conceptualisation and measurement of poverty has been the subject of intense study for more than a century. The adoption of the Millennium Development Goals (MDGs) in 2000 gave additional stimulus to these longstanding efforts, this time at the global level, and the progress made towards reducing world poverty is encouraging. World Bank estimates, for example, suggest that the percentage of the population in the developing world living below $1.25 a day declined from 52% in 1981 to 22% in 2008, bringing the number of people living below $1.25 a day down from 1.94 billion in 1981 to 1.29 billion in 2008. These numbers are now based on over 850 household surveys for almost 130 developing countries, representing 90% of the population of the developing world, compared with only 22 surveys for 22 countries when the first such estimates were reported in the 1990 World Development Report [9]. Alongside improvements to the quantity and quality of data, there have also been significant advances in conceptualizing and measuring poverty. One noticeable shift is the movement away from an exclusive focus on consumption-poverty, with attention now often also given to non-income dimensions of well-being, such as literacy achievements, nutritional and health status and individual empowerment. This has led to lengthy debate concerning the way in which various dimensions of well-being are best combined into a single multi-dimensional poverty measure: see, for example, the discussion in the Journal of Economic Inequality 2011, Volumes 9–2 and 9–3, regarding the weights assigned to shortfalls across each of these dimensions, and the question of complementarity as well as substitutability across the indicators of well-being.

Coffee: A Cultural and Media Focussed Approach

Coffee: A Cultural and Media Focussed Approach

Secular trends in female adult stature in relationship to gross domestic product around time of birth

Average adult height is a commonly used indicator of biological standard of living. The secular increases in height observed for many developed countries are believed to result from improved health and nutrition in early childhood. Evidence from developing countries is less thorough and consistent. We characterized the relationship between secular trends in adult female height and real gross domestic product per capita (GDP) at the time of the woman's birth by country and region using Demographic and Health Survey data and World Bank estimates. The overall change in adult height in women born between 1945 and 1980 was 0.77 cm. Average slopes differed (t=7.0, p&lt;0.001) between 23 African countries (−0.004 cm/year) and 17 other countries (0.062 cm/year). African countries also differed from non‐African countries in the relationship between adult height and GDP in early life. The relationship was nonsignificant for African countries (coefficient=−0.39 cm/lnGDP, p=0.3), but significantly positive for non‐African countries (coefficient=1.59 cm/lnGDP, p&lt;0.001). The relationship between adult female height and economic conditions is inconsistent and modified by other factors in the developing world context.

Participatory Poverty Assessment through Livelihood Analysis: An Indian Case

Participatory Poverty Assessment through Livelihood Analysis: An Indian Case

Socio-Economic Determinants of Rural Poverty: An Empirical Exploration of Jharkhand State, India

Poverty has become a general phenomenon that is perceived to mean different things to different people at different times and places. India was the first country in the world to define poverty as the total per capita expenditure of the lowest expenditure class, which is required to ascertain a minimum intake of 2400 kcal/day in rural and 2100 kcal/day in urban areas. However, there exists a substantial interstate and urban rural differential in the cost of goods and services. One in three Indians lives below the poverty line according to the Tendulkar Committee report which used a measurement of goods and services, rather than calorie intake, to calculate poverty. The World Bank estimates that 80% of India's population lives on less than $2 a day which means a higher proportion of its population lives on less than $2 per day as compared with sub-Saharan Africa. World Bank identified Jharkhand as one of the most poverty-stricken state in the country with a sharp contrast between rural and urban poverty. Jharkhand is a tribal state which has high incidence of poverty. A majority of OBC, SC and ST population fall under BPL category due to a number of agro-climatic and socio-economic factors. BPL households often live misery and face poor quality of life as they lack the basic amenities. Poverty in the region leads to migration and both migration within the state and out-side state is common. Youth prefers to migrate out-side state but with increase in age within state migration picks up. A good proportion of rural households has connection with the commercial banks, cooperative banks and other financial institutions. The commercial banks have better reach among the rural households and they can be instrumental in poverty alleviation programmes. The important causes/determinants of rural poverty in Jharkhand can be summarized as; lack of education, poor land base with small and marginal land holdings. Lack of employment opportunities at local level and poor infrastructure compounds the problem. In addition to these factors, poor quality of natural resources like; acidic, laterite and red soils, water scarcity leading to mono-cropping in the state have also contributed towards rural poverty. With changing climatic scenario, and undulating terrain lacking capacity to retain rain water forces the farmers to take a single crop in the state, thereby reducing the opportunities to a better livelihood. Information and communication technologies can play a pivotal role as it the common means of seeking information for improved farming practices. People are using modern technologies like mobile phone for the linkage between people and institution for use of agriculture-related technology, knowledge, skills and information. Hence, the technological interventions can integrates farmers, agricultural scientists, extension workers, input dealers and the private sectors to harness the knowledge and information from various sources for better farming and improved livelihoods. There is a considerable potential for establishment of forest based processing units in state, can provide employment to local people and will reduce the migration phenomenon thereby enhancing the livelihoods of rural poor.

Affordable Energy Solutions for Developing Communities

The World Bank estimates that roughly 1.6 billion people?nearly one out of every four people on the planet?do not have regular access to electricity. This form of energy poverty disproportionately afflicts people living in developing countries. For example, in sub-Saharan Africa excluding South Africa, 75 percent of households, some 550 million people, have no access to network electricity. In South Asia, 700 million are similarly not connected to the electricity grid.

Damascus Theatre Festival (review)

Reviewed by: Damascus Theatre Festival Edward Ziter Damascus Theatre Festival. Presented by the Syrian Ministry of Culture. Various venues, Damascus. 27 November 2010-5 December 2010. Looking back, it is hard not to read the performances at the 15th Damascus Theatre Festival in light of the demonstrations that would begin less than a month later in Tunisia and eventually spread through much of the Arab world. Since the biennial festival was revived in 2004 (after a fourteen-year hiatus), it has featured a number of well-known political theatre-makers from the Arab world, such as Tawfiq al-Jabali, Touria Jabrane, and Naila al-Atrash. The 2010 festival lacked such famously controversial voices; however, as in past years, there were a large number of younger performers whose work addressed both the aspirations and frustrations of Arab youth. The World Bank estimates that 36 percent of the population in the Middle East and North Africa is less than 15 years of age, and that a quarter of young, working-age people are unemployed. Theatre practitioners are very much aware of the Arab youth explosion and are examining how underfunded and hierarchical national theatre institutions can accommodate new generations of theatre-makers, the role of the growing number of new independent companies, and theatre's ability to address the needs and concerns of the burgeoning Arab youth population. At the last two festivals, round-tables and lectures were devoted to the new generation of theatre-makers, and at the 2010 festival two of the three lecture sessions took up the issue of "Theatre and Youth." As a speaker at one of these sessions, the work and concerns of young theatre-makers were very much on my mind when attending the festival, and this informed the shows I chose to see from the thirty-four that were mounted. In recent years, the organizers have attempted to provide broad representation from the Arab world, and they were particularly successful this year, with companies from fourteen Arab countries staging productions. The festival also featured productions from Cyprus, Turkey, and the UK. The increase in the number of Arab countries taking part meant that several countries with more limited theatre traditions sent companies. This fact may have accounted for what I perceived to be a greater number of weak productions than I had seen in the previous two festivals; however, it also meant that a much greater number of young theatre-makers attended as guests of the festival, many of whom have limited opportunities to see theatre in their home countries. Since the festival's inception in 1969, the Syrian Ministry of Culture has cited the festival both as evidence of and spur to Arab unity, and so the greater inclusion of young people from throughout the Arab world clearly served the festival's mission. If any one show seemed to identify the complexities of the youth explosion, it was Laila Soliman's adaptation of Frank Wedekind's Spring Awakening. The production followed three months of research that included interviews with teenagers from the Delta region and the outlying neighborhoods of Cairo, followed next by workshops in Cairo schools and a process of improvised rehearsals, all of which contributed to the final text. Later, when the company Click for larger view View full resolution Salma Said (Rasha/Wendla) in Spring Awakening. (Photo: Salam Yousry.) [End Page 623] Click for larger view View full resolution Sherin Hegazy (Lola/Ilse) and Ahmed El Gendy (Yousef/Moritz) in Spring Awakening. (Photo: Salam Yousry.) took the production to Beirut after the performance at the festival, it again staged a workshop, this time with Palestinian teenagers from a refugee camp in Tripoli, Lebanon. All of this information is present on the production's blog, and it is worth noting that the production also features its own Facebook page. As in the United States, young Egyptian theatre-makers who work without government patronage rely on social media both to publicize their work and to create ongoing relations with their audiences. Moreover, like other young theatre-makers throughout the Middle East, the company for Spring Awakening combines its artistic research with a program promoting health and education to underserved Arab communities. The Spring...

Global Health Funding at the Crossroads: 2012 and Beyond

AbstractSlow global economic recovery is affecting health and access to care by an ever‐increasing number of individuals globally. International health organizations are advocating increased attention to fighting and preventing non‐communicable disorders and equitable access to health. World Bank estimates that an additional annual contribution of 10 billion USD will be required to improve populations' health and minimize disparities. Global health policy was one of the major issues addressed at the November 2011 Group of 20 Presidential Summit. It is hoped that the Summit will also include recommendations for improving the training of additional health care workers necessary to achieve the Millennium Developmental Goals. Rapidly evolving and low cost information technology should provide a temporary solution to the severe global health care workforce shortages.

Changing perceptions: of pandemic influenza and public health responses.

According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.

WHO Examines Disabilities Worldwide

WHO Examines Disabilities Worldwide

The Current and Future Trends in Chinese Environmental and Energy Law and Policy

In the period from 1979 to 2003, the yearly average growth rate of Gross Domestic Product (GDP) in China was 9.4 percent, and at the same time sixteen of the world's twenty most air-polluted cites were in China, according to the World Health Organization. China recently moved into second place (behind the United States) among the world's largest energy consumers. China is by far the world's largest coal consumer, devouring almost 40 percent of total global coal production annually. Oil demand is also surging within this decade. Now, China has become the third largest oil importer in the world (after the U.S. and Japan). China's current greenhouse gas emissions rank second in the world, lagging only behind the United States. The World Bank estimates that China's greenhouse gas emissions will surpass the U.S. by the year 2015, ranking China first in the world. Also, according to the U.S. Energy Information Administration (EIA), China's emission of carbon dioxide, the main by-product of fossil fuel combustion, which is regarded as the chief pollutant implicated in global warming, is likely to surpass the U.S. as the world's number one carbon dioxide emitter within two decades. As a responsible country, China is the contracting party of UN Framework of the Convention of Climate Change (UNFCCC ) and The Kyoto Protocol. The trends of China's environmental and energy law and policy have attracted and will continue to attract the attention of the countries around the world. Therefore, I would like to offer the following ideas on how to judge the current and future development trends of China's environmental and energy law and policy.

Reducing the Global Burden of Ischemic Heart Disease and Stroke

Noncommunicable diseases (NCDs), which include cardiovascular diseases (CVD), cancer, diabetes mellitus, and chronic pulmonary disease, are the leading cause of global mortality accounting for 36 million (63%) of the 57 million deaths worldwide in 2008.1 Recognizing the global pandemic and burden of NCDs in a landmark decision, the United Nations has scheduled a high-level meeting on September 19 and 20, 2011 to determine priority actions and interventions in response to this crisis. The greatest increase in NCDs is in low- and middle-income countries whose resources for surveillance, prevention, and treatment are severely limited. Among NCDs, CVD is the leading cause of death, and ischemic heart disease (IHD) and stroke are the major contributors to CVD. Worldwide, 80% of deaths from CVD now occur in low- and middle-income countries.1 Thus, there is a special and urgent need for data and treatment strategies concerning CVD in low- and middle-income countries. Article see p 314 Although IHD and stroke are major contributors to global mortality, causing 7.2 and 5.7 million deaths, respectively, in 2004,2 and have 9 established risk factors in common,3,4 the relative contributions of stroke and IHD to mortality on a country-to-country basis and the relative contribution of the various risk factors are not well documented. In the current issue of Circulation , Kim and Johnston5 report an analysis of mortality and disability adjusted life year loss rates from stroke and IHD from 192 World Health Organization member countries, along with national estimates of risk factors and national income data from World Bank estimates. In …

Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease

Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P<0.001) and burden of disease (P=0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required.