Inappropriate state expenditure (e.g. arms instead of housing), policies (e.g. neglecting rural and slum areas) and strategies (e.g. building expensive hospitals without adequate staffing). Corruption, lack of vision and insight, and no political will to make the changes needed. War, civil strife and refugees remain a reality in many poor countries. We know what the problems are and how to correct them; the challenge is to make the changes needed in poor communities. Migration and urbanization lead to the breaking up of families and communities.