The World Health Report 1998

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Muthu Subramanian, Director of the Office of World Health Reporting; Paul Kleihues, M.D., Director, International Agency for Research on Cancer; and David Brandling-Bennett, M.D., Deputy Director, Pan American Health Organization., will be available for interviews in Washington, DC, on Monday, May 4. Please call 703-820-2244 to schedule time.

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GLOBAL LIFE EXPECTANCY REACHES NEW HEIGHTS, BUT 21 MILLION FACE PREMATURE DEATH THIS YEAR, WARNS WHO

THE WORLD HEALTH REPORT 1998 OFFERS AN OPTIMISTIC PICTURE OF THE 21ST CENTURY

Life in the 21st century should be healthier and better as well as longer for more people than ever before, the World Health Organization says in a major report published today. It predicts that worldwide, premature deaths – defined as occurring before the age of 50 years – will be cut by half by the year 2025. But it warns that in 1998 over 7 million adults will die before reaching this age, and 10 million children will die before their fifth birthday.

In The World Health Report 1998: Life in the 21st century – a vision for all, WHO says global life expectancy at birth, now 66 years, is projected to reach 73 years by 2025. Many thousands of people born at the end of the 20th century will live throughout the 21st and see the advent of the 22nd century. For example, France is projected to have 150,000 centenarians by the year 2050, compared to only 200 in 1950.

However, Hiroshi Nakajima, MD, Director-General of WHO, points out that the extra years are unequally shared among rich and poor. “Tragically, while average life expectancy has been increasing throughout the 20th century, 3 out of 4 people in the least developed countries today are dying before the age of 50 – the global life expectancy figure of half a century ago,” he says.

“This year, 21 million deaths – 2 out of every 5 worldwide – will be among the under-50s, including those of 10 million small children who will never see their fifth birthday.

“Over seven million will be among men and women in what should be some of the best and most productive years of their lives. Reducing these premature deaths is one of the greatest challenges facing humanity at the dawn of the 21st century.”

The World Health Report 1998 uses data gathered in the past 50 years since the Organization was founded, combined with WHO’s latest assessment of global health, to project health trends to the year 2025. In general, the report offers an optimistic view of the future. It says that five decades of socio-economic development and major advances in health have benefited people in most countries, and are likely to continue in the 21st century, unless a major economic crisis arises.

“The most important pattern of progress now emerging in general is an unmistakable trend towards healthier, longer life,” it says.

Trends towards better health

  • More people than ever before now have access to at least minimum health care, to safe water supplies and sanitation facilities. Most of the world’s children are now immunized against the six major diseases of childhood. The late 20th century has seen overall socio-economic progress accompanied by steady and sometimes dramatic advances in the control and prevention of diseases, the development of vaccines and medicines, and countless medical and scientific innovations.
  • Spectacular progress in reducing deaths among children under 5 in the last few decades is projected to continue. There were 21 million such deaths in 1955, about 10 million in 1997, and that figure should decline to 5 million by 2025.
  • Gaps between the richest and poorest countries remain huge, but are gradually closing, at least in terms of premature deaths. For example, in 1995, 76% of people who died in WHO’s African region were under 50. By 2025, the proportion will fall to 57%.
  • In the European region, only 15% of those who died in 1995 were under 50, and that proportion will fall to just 7% in 2025. The gap between African and European populations in their respective proportion of premature deaths will thus narrow from 61% to 50%.
  • For developing countries, the good news is that by 2025, infectious diseases such as poliomyelitis, leprosy, guinea-worm disease, filariasis and hepatitis B, which together afflict and disable hundreds of millions of people, will have been eliminated or reduced to very low prevalence levels.
  • In the industrialized world, where population aging is a major concern, declines in disability from heart disease and some cancers among older people are already evident in a number of countries, largely due to prevention programs, education and improved treatment.
  • Technological advances in general, and more progress in medical research, treatment, care and rehabilitation should further enhance quality of life, especially for older people.
  • The prospect of a healthy and extended old age is becoming a reality for more people than ever, according to the report. They are not only living longer; research shows that in some countries they are also living more healthily, with their rates of disability going down at the same time as their life expectancy goes up.

For example, long-term care surveys in the United States show significant declines in disability prevalence among the aged between 1982 and 1994. Heart disease deaths have been dramatically reduced in Australia, Canada, Finland, France, New Zealand and the United States and some other countries. In Finland, noncommunicable disease prevention programs in the last 25 years were the main contributory factor in the six extra years of life expectancy gained during that time. In the same period, the number of people in Finland on disability pensions because of cardiovascular disease fell by about 25%.

However, progress has been far from universal. “While health globally has steadily improved over the years, great numbers of people have seen little if any improvement at all,” Dr. Nakajima says. “The prime concern of the international community must be the plight of those most likely to be left furthest behind as the rest of the world steps confidently into the future.

“These are the many hundreds of millions of men, women and children still trapped in the grimmest poverty. They live mainly in the least developed countries, where the burdens of ill-health, disease and inequality are heaviest, the outlook is bleakest, and life is shortest.”

Some gaps in health between rich and poor are at least as wide as they were half a century ago, and are becoming wider still. While people in most countries are living longer, life expectancy is actually decreasing in some others. Between 1975 and 1995, 16 countries with a combined population of 300 million experienced such a decrease. Many of them were African countries.

The report says high death rates among adults under 50 in developing countries are particularly serious because they occur in the working populations upon which poor countries depend to escape from poverty.

In developing countries in 1996, while the proportion of pregnant women receiving prenatal care was 65%, only 40% of live births were delivered in health facilities and only 53% had a skilled attendant at delivery.

Over one-third of the global population lacks access to essential drugs; an average of only 50% of patients take their medicines correctly, and up to 75% of antibiotics are prescribed inappropriately, even in teaching hospitals.

Leading causes of death in 1997

In 1997, of a global total of 52.2 million deaths, 17.3 million were due to infectious and parasitic diseases; 15.3 million were due to circulatory diseases; 6.2 million were due to cancer; 2.9 million were due to respiratory diseases, mainly chronic obstructive pulmonary disease; and 3.6 million were due to perinatal conditions.

The leading killers among infectious diseases were acute lower respiratory infections (3.7 million), tuberculosis (2.9 million), diarrhoea (2.5 million), HIV/AIDS (2.3 million), and malaria (1.5-2.7 million). Most deaths from circulatory diseases were coronary heart disease (7.2 million), and cerebrovascular disease (4.6 million). Leading causes of death from cancers were those of the lung (1.1 million), stomach (765,000), colon and rectum (525,000), liver (505,000), and breast (385,000).

Snapshots of the future

In a series of snapshots of the future, the report predicts that by the year 2025:

  • In industrialized countries, heart disease, stroke and cancer will remain the leading causes of death. As deaths from heart disease and stroke decline, deaths from some cancers will increase.
  • In developing countries, these noncommunicable diseases will become more prevalent, largely due to the adoption of “western” lifestyles and their accompanying risk factors – smoking, high-fat diet, and lack of exercise. But infectious diseases will still be a major burden, none more so than HIV/AIDS and possibly tuberculosis.
  • The population will reach 8 billion compared to 5.8 billion in 1997. Although women will be having fewer babies – an average of 2.3 compared to 2.9 in 1995 and 5.0 in 1955 – the world will never have been so densely populated; however the under 20 population will be only 32% of the total compared to 40% now.
  • Fewer babies and small children will die from infectious diseases and malnutrition – but there will still be about 5 million deaths a year in children under 5.
  • More people will be living longer. About 800 million people – one in 10 – will be over 65. Four out of 10 people dying in 2025 will be 75 or over.
  • More people will live in cities than ever before. About 59% will live in urban areas and only 41% in rural areas. In 1995 the ratio was 55% rural and 45% urban. In 1955, 68% of the global population was rural.

Population aging

In the next 25 years, the population aged 65 and above is likely to grow by 88% – almost a million people a month – compared to an increase of 45% in the working age population.

This implies that a relative decline in the number of people in the productive age group will have to provide for an expanding number of older dependants, not merely in the form of direct support to older relatives, but also through taxation for the provision of health and social services, and social security. Most countries are now seeking alternative types of welfare packages, such as combinations of public sector and private sector health insurance and pension schemes, funded by direct or indirect taxation and voluntary contributions, that will ensure long-term care for older people.

“Maintaining health and quality of life in aging populations will be vitally important, socially and economically. In the 21st century, postponing the adverse effects of old age for as long as possible will be a major political and personal preoccupation. Health-related policies are needed for those already in old age and those who will be the older people of the future,” the report says.

“As people live longer they must plan throughout life to take better care of themselves, on the assumption that a large proportion of their lives will extend beyond what have traditionally been regarded as their most productive years.

“Individuals therefore must take greater responsibility for their health at the earliest opportunity. This means adopting habits such as a healthy diet, adequate exercise and avoidance of tobacco early in life and maintaining them for the rest of their years.”

The report gives special emphasis to women’s health. “Today, the social status and well-being of countless millions of women worldwide remains tragically low. As a result, human well-being in general also suffers, and the prospects for future generations are dimmed,” it says. As the global population ages, there will be more females among the older population.

To ensure that longer lives for women are also years of quality, policies aimed at ensuring the best possible health for women as they age should be geared to the problems that begin in infancy or childhood, and should cover the whole lifespan, through adolescence and adulthood into old age.

The report says the vision of the 21st century that it presents should prompt governments, international agencies and organizations towards radical reorientation of health systems in the early years of the 21st century.

Dr. Nakajima says: “The progress and achievements of the past 50 years are solid foundations for a healthier and better world. It is already time to build on them. Life in the 21st century could and should be better for all. We can pass no greater gift to the next generation than a healthier future.”

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Thomson Prentice
Health Communications and Public Relations
WHO, Geneva, Switzerland
Tel. (41 22) 791 4224, Fax (41 22) 791 4870, E-mail: prenticet@who.ch

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