We should not think of poverty eradication as a matter of collecting money and giving it to the poor so much as of reforming the global rules that are disadvantaging the poor and making it impossible for them to fend for themselves.

I think that many citizens understand how our system works, or rather, fails to work, for structural reasons. But who has the capacity and the incentives to bring change? The banks and other corporations love the system because it allows them to buy legislation that serves their own interests even at the expense of the vast majority of citizens. Incumbent politicians love the system because it allows them to raise millions of dollars toward defending their seats.

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.

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.

The bottom half of humanity is living in severe poverty; not all of them are malnourished or severely deprived now, but they are extremely vulnerable to even small upsets in their income or in the prices they face of basic necessities, and when something like this happens, they can be thrown off kilter in terms of a disease of a family member or a change in food prices; anything like that can throw them into destitution.

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.

I think one big improvement would be if we somehow made it cheaper and easier for developing countries to learn from the sad experience of some of the developed countries, and also from some of the positive experiences we have of building good transportation systems, like high-speed rail.