For many developing countries, investments in health have proved a great success. The Lancet Commission “Global health 2035: a world converging within a generation” and the 2014 Gates annual letter envision the possibility of a “grand convergence” by which more countries will have a child mortality rate as low as 15 per 1000 livebirths in 20 years time. We wish to draw attention to the special case of the least developed countries, which on present evidence are likely to be excluded from such a convergence. To start a discussion we will focus on the Sahel (the 1 million square-mile semi-arid zone of Africa stretching from the Atlantic to the Red Sea) where the clash of uniquely rapid population growth and some of the harshest effects of climate change are likely to have the greatest overall effects on health.
Published in the Lancet Global Health 2014; 2: e253-54.