In recent weeks, there has been magic in the air, and the previously impossible seemed possible. Following the election of Obama, in the wake of the financial crisis, some 400 international health academics, activists and officials recognised the possibility of a new economic order in which social justice is taken seriously.

The group had gathered at a meeting in London (hosted by the UK Department of Health) to discuss how to realise the recommendations from the recent report from the Commission on the Social Determinants of Health (CSDH).

Opening the conference, UK Prime Minister Gordon Brown impressed the audience with his stated commitment to global health equity, emphasising the need to strengthen, not weaken, our ambitions on global health in light of the current financial crisis.

This message, together with those of the CSDH report, offer clear directions for other G20 global leaders, including Kevin Rudd.

Participants at the conference were clear that the current review of the global financial system must go beyond mere financial damage limitation to encompass a fundamental reorientation of the entire system, to allow us to achieve health equity and genuine poverty reduction, whilst controlling global warming.

This requires a new economic order. But this can only be achieved with a broad agenda, and a genuinely global and participatory process, including ALL countries on an equal basis, and not just the G20.

The CSDH report identifies a number of structural drivers in the global economy which undermine health and health equity, particularly in the developing world.

It demonstrates that developing countries have suffered far more from the failings of the international financial system for the last 30 years than are the developed countries now through the credit crunch and looming recession.

On-going debt and financial crises, coupled with now discredited “structural adjustment” and “health sector reform” programmes have seriously undermined health and health equity. The CSDH concluded that health equity requires a system of global governance which places “fairness in health at the heart of the development agenda and genuine equality of influence at the heart of its decision-making”.

We are now at a critical moment in human history. We are faced with the possibility of transforming the dysfunctional, corrupt and unfair global economic system so we can tackle the extraordinary global challenges of the 21st century. The danger is that our leaders will betray billions of our fellow global citizens, as well as our children and grandchildren, by opting merely to paper over the cracks.

We can only achieve the changes required if civil society and community groups engage with these issues and demand that our governments take account of the long-standing grievances of the developing world and pay serious attention to the profound and urgent global challenges of health, poverty and climate change.

Failure to do so would bring the whole system of global economic governance into even greater disrepute, further threatening political and economic stability at the global level.

*Fran Baum (professor of public health, Flinders University), David Woodward (consultant in the UK) and Dave McCoy (University College London) are members of the People’s Health Movement