Pediatric ear, nose and throat services' demands and resources: a global perspective

Global population trends, health care economics and disease patterns are reviewed. The world's population has doubled twice in the twentieth century, and will grow by at least a further 2 billion before stabilizing in the middle of the next century. There is gross maldistribution of wealth and health care expenditures: 20% of the population control 80% of the gross domestic product, the same 20% of the population spend 87% of the total global health care funds. Extreme poverty facilitates all manner of diseases. Globally, infections remain the most important causes of disease. Of these, upper respiratory infections are an important cause of hearing loss and learning handicap in children world-wide. Epidemic meningitis in Africa and parts of Asia is a preventable major cause of death and deafness. There are about 80,000 otolaryngologists in the world and they too are maldistributed, with most in Europe and the Americas. This is exacerbated when looked at from the standpoint of children, most children live where there are fewest otolaryngologists: the differences are greater than two orders of magnitude. This greatly affects the role and scope of paediatric otolaryngology. The discipline is small and rapidly evolving. Suggestions are made for sharing training.