The collective income of all these people - the bottom half - is less than three percent of global household income, and so there is a grotesque maldistribution of income and wealth.

For the present system to work, poor people must be excluded from the innovation, because if they could get access at an affordable price, then affluent people would find ways to buy it cheaply as well - and then the innovator would be poorly rewarded and introductions of new medicines would decline.

Poverty persists, essentially, because the people at the bottom - the bottom quarter and also the bottom half - see the gains from the rising global average income wiped out by severe declines in their relative share.

Competing companies evolve toward efficiency as the more efficient ones profit and expand while those who fall behind fail. And companies being efficient and profiting under the Health Impact Fund, this is exactly what we want, because the company's profit is directly driven by the health impact its registered products achieve.

Because present procedures by design favor the affluent, the poor are being increasingly marginalized. And because the poor are so marginalized, they can exert little influence on institutional design decisions. We need to break out of this vicious spiral and create momentum in the opposite direction.

If the Health Impact Fund were to be instituted, a single company would be in charge of a medical product all the way from its conception to the health improvements realized by actual patients. The company would be paid for health impact, and it would have to arrange the entire pipeline in between - all the steps of invention, of clinical testing, of getting marketing approval in many different countries, of wholesalers and retailers and prescriptions and so on - in a holistically optimal way.

Countries compete in offering easy working conditions to their banks. In many jurisdictions, you can deposit money anonymously with no questions asked, even if the accepting bank knows that it derives from criminal activities.