Columbia International Affairs Online: Policy Briefs

CIAO DATE: 01/2012

Global Health and the New Bottom Billion: How Funders Should Respond to Shifts in Global Poverty and Disease Burden

Amanda Glassman, Denizhan Duran, Andy Sumner

January 2012

Center for Global Development


After a decade of rapid economic growth, many developing countries have attained middle-income status. But poverty reduction in these countries has not kept pace with economic growth. As a result, most of the world’s poor—up to a billion people—now live in these new middle-income countries (MICs), making up a “new bottom billion.” As the new MICs are home to most of the world’s poor, they also carry the majority of the global disease burden. This poses a challenge to global health agencies, in particular the GAVI Alliance and the Global Fund, which are accustomed to disbursing funds on the assumption that the majority of poor people live in poor countries.