During a period of 10 years between 1990 and 2000, life expectancy of over a billion people has gone down by 10 years from 50 to 40. WHO plans to step up its campaigns against poverty-related diseases whilst also intensifying programmes aimed at tackling cardiovascular illnesses, obesity, and other ailments of richer nations, director-general Gro Harlem Brundtland told the annual World Health Assembly (WHA) on May 13.

But as Brundtland set out WHO's priorities, activists criticised the agency for doing too little to further its once vaunted goal of health - and hence medicines - for all.

"The world is living dangerously: either because it has little choice; or because it is making the wrong choices about consumption and activity", Brundtland said in her opening address to the 191-nation WHA, which considered issues ranging from bioterrorism to infant feeding.

She said she wanted to "reinvigorate WHO's work on diet, food safety, and human nutrition, linking basic research with efforts to tackle specific nutrient deficiencies in populations and the promotion of good health through optimal diets". Brundtland said WHO should be proud of putting health firmly on political agendas and for pioneering global initiatives such as Roll Back Malaria, Stop TB, and immunisation partnerships.

But far more was needed, she stressed. "We must further increase the funding for tackling the illnesses of poverty. We must increase the number of people who can access treatments, like antiretrovirals, at the same time as we scale up prevention programmes. We must do all we can to increase access to essential medicines and health technologies", she continued.

As Brundtland was speaking in the elegant assembly hall, Médecins Sans Frontières (MSF) stationed a truck carrying an exhibition entitled "TRAPPED" outside the UN compound in a bid to drive home its concerns that WHO isn't doing enough on this front.

MSF hailed WHO's recognition of generic producers such as Cipla and the recent inclusion of antiretrovirals on its list of essential medicines. But it urged WHO to show more courage in taking on pharmaceutical giants to further lower the price of drugs in poor countries and to take a higher profile in the ongoing debate on free trade and patent protection.

"WHO has been a follower, not a leader; an observer, not an actor", said Ellen 't Hoen, coordinator of the MSF Access Campaign. "Be more active. We need a strong public health voice for those who are silent", she appealed. Bernard Pecoul, an MSF director, lamented the omission of research and development funding from the WHA agenda.

He said WHO was minimising the crisis caused by the chronic lack of industry interest in developing new drugs against "neglected" diseases such as leishmaniasis and Chagas disease and against increasingly resistant strains of malaria which affect millions every year. Of the 1393 new drugs approved between 1975 and 1999, only 13 were specifically indicated for a tropical disease, according to MSF.

A grassroots coalition from developing countries, under the banner of the People's Health Assembly, accused WHO of forgetting its former goal of Health for All by 2000.

"Data on very sensitive health indices including infant, maternal, and under 5 mortality rates, life expectancy at birth, and prevalence of malnutrition show the alarming fall of health standards", the group said. "During a period of 10 years between 1990 and 2000, life expectancy of over a billion people has gone down by 10 years from 50 to 40."