In order to prepare for meaningful change, we have to look at both sides of the problem. We need to examine the output of our political system, which is often very hostile to the poor abroad and hostile also to the poor and middle class domestically. And we must also look at the procedures through which this output is produced.

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.

It is perfectly consistent - and also true - to say that the world poverty problem today is smaller (relative to world population) than before and yet also a much graver injustice.

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 we offer a prize, so to speak, to anyone who manages to bring a country under his physical control - namely, that they can then sell the country's resources and borrow in its name - then it's not surprising that generals or guerrilla movements will want to compete for this prize. But that the prize is there is really not the fault of the insiders. It is the fault of the dominant states and of the system of international law they maintain.

Over the period from 1988 to 2005, the income share of the top five percent has grown by about 3.5 percent of global household income, and the shares of all the other groups have diminished. The greatest relative reduction was in the bottom quarter, which lost about one third of its share of global household income, declining from 1.155 to 0.775 percent, and now is even more marginalized.

America is run by the rich and powerful in their own interest. To an extent that I think is hard to exaggerate, the intellectuals - academics, journalists and so on - are bought off. And that's a big change that happened in the United States in the last 30 or 40 years.