World Health Organization Warns Of Growing “Crisis Of Suffering”

Released from Washington, D.C. and Geneva, Switzerland

HUMAN AND SOCIAL COSTS OF CHRONIC DISEASES WILL RISE UNLESS CONFRONTED NOW, WHO DIRECTOR-GENERAL SAYS

Cancer, heart disease and other chronic conditions which already kill more than 24 million people a year will impose increasing burdens of suffering and disability on hundreds of millions of others, the World Health Organization warns in its annual report published today.

The World Health Report 1997: Conquering suffering, enriching humanity says the number of cancer cases is expected to at least double in most countries during the next 25 years. There will be a 33 percent rise in lung cancers in women and a 40 percent increase in prostate cancers in men in European Union countries alone by 2005. The incidence of some other cancers is also rising rapidly, especially in developing countries.

Heart disease and stroke, already the leading causes of death in richer nations, will become much more common in poorer countries. Globally, diabetes cases will more than double by 2025, and there will be a huge rise in some mental disorders, especially dementias.

WHO is calling for an “intensified and sustained” global campaign to encourage healthy lifestyles and attack the main risk factors largely responsible for many of the diseases — unhealthy diet, inadequate physical activity, smoking and obesity. Such a campaign requires top-level international collaboration and multisectoral cooperation, involving governmental institutions, health authorities, the community, mass media, non-governmental organizations, medical and voluntary organizations and the private sector.

“The outlook is a crisis of suffering on a global scale,” Dr. Hiroshi Nakajima, Director-General of WHO, says. “There is an urgent need to improve our ability to prevent, treat and, where possible, to cure these diseases, and to care for those who cannot be cured.”

The report shows that at present:

  • Circulatory diseases such as heart attacks and stroke together kill 15.3 million people a year.
  • Cancer in all its forms kills 6.3 million people a year.
  • Chronic obstructive pulmonary disease kills 2.9 million people a year.

These add up to 24.5 million deaths, or 47 percent of the annual global total of deaths from all causes.

Of the remainder, infectious and parasitic diseases account for 17.3 million, or 33 percent; deaths from perinatal and neonatal causes account for 3.5 million; there are 585,000 maternal deaths; and 6 million deaths from other and unknown causes, including accidents, violence, homicide and suicide.

The report says that tobacco-related deaths, primarily from lung cancer and circulatory disease, already amount to 3 million a year, or 6 percent of total deaths. Smoking accounts for one in 7 cancer cases worldwide: “If the trends of increasing consumption in many countries continues, the epidemic has many decades to run, and will surely be judged by future generations to have been one of the greatest health tragedies that has ever occurred in the history of mankind.”

In 2020, at least 15 million people worldwide will develop cancer, compared to about 10 million cases annually now. A doubling of new cases will occur in developing countries, with about a 40 percent increase in industrialized countries. Between 1995 and 2025, the number of people in the world with diabetes is expected to rise from about 135 million to 300 million.

The projected increases in these and other disabling conditions such as arthritis and the bone involutive condition osteoporosis, are due to a combination of factors. The most important are population aging, which puts more people at risk of developing chronic conditions late in life; global population growth; and the rising prevalence of unhealthy lifestyles — characterized particularly by inappropriate diet, inadequate physical exercise and smoking.

A steadily aging global population means there are more opportunities over time for these diseases to progress to a deadly or disabling stage in a larger number of people. Half a century ago, the great majority of the global population died before the age of 50. Today, most survive well beyond that age. Average life expectancy at birth globally reached 65 years in 1996. In many countries, it is now well over 70 years, and is approaching 80 years in a few others.

There are today an estimated 380 million people aged 65 years or more. By 2020, that number is expected to rise to more than 690 million. Also by then, it is predicted that chronic diseases will be responsible for a large proportion of deaths in the developing world. Cancers and circulatory diseases are already major causes of death in South-east Asia, one the world’s most populous regions.

The report says that many countries will increasingly come under the “double burden” of both infectious and non-communicable diseases. Industrialized nations are already facing bigger risks from infectious diseases, partly because of the globalization of travel, tourism and trade. Simultaneously, developing countries with fast-growing economies are becoming increasingly exposed to conditions sometimes labeled as “diseases of affluence” while struggling to control their own, still continuing, infectious epidemics.

“In the battle for health in the 21st century, infectious diseases and chronic diseases are twin enemies that have to be fought simultaneously on a global scale,” Dr. Nakajima says.

“We dare not turn our backs on infectious diseases, for they will return with a vengeance if we do. But neither can we ignore the growing burden in ill-health and disability imposed by non-communicable diseases. This, too, is the plight of hundreds of millions.” Dr. Nakajima calls for global efforts aimed at preventing, treating and curing non-communicable diseases, and reducing disability caused by them. But such efforts must not mean a switch away from fighting infectious diseases, he says. Infectious agents play important roles in the development of some non-communicable diseases, notably cancers of the cervix, liver and stomach.

“People in poorer countries are now acquiring many of the unhealthy lifestyles and behaviors of the industrialized world: sedentary occupations, inadequate physical activity, unsatisfactory diets, tobacco, alcohol and drugs. Populations in richer countries continue to live with all these risks.”

Referring to dramatic increases in life expectancy in recent decades, Dr. Nakajima points out: “In celebrating our extra years, we must recognize that increased longevity without quality of life is an empty prize, that is, that health expectancy is more important than life expectancy.”

“The majority of chronic diseases are preventable but cannot as yet be cured. The emphasis must therefore be on preventing their premature onset, delaying their development in later life, reducing the suffering they cause, and providing the supportive social environment to care for those disabled by them.”

Dr. Nakajima continues: “In identifying priorities for action, this report is looking towards key areas of chronic diseases that are major causes of death or avoidable ill-health and disability. These are areas in which actions or interventions that have a direct and tangible effect on individual health — that make a difference and make it sooner, rather than later — are possible.”

Cancer

According to the report, the eight most common cancers worldwide in terms of incidence are also the eight which cause most deaths. These are cancers of the lung, stomach, breast, colon/rectum, mouth, liver, cervix, and esophagus. Together they accounted for about 60 percent of the 6.3 million cancer deaths and 10.3 million cancer cases in 1995/1996.

The number of cases and deaths for each is as follows:

SiteCases FemaleCases MaleCases Both SexesDeaths Total
Lung330,000990,0001,320,000989,000
Stomach380,000635,0001,015,000776,000
Colon/Rectum430,000445,000875,000495,000
Liver165,000375,000540,000386,000
Breast910,000910,000376,000
Esophagus160,000320,000480,000358,000
Mouth190,000385,000575,000324,000
Cervix525,000525,000247,000

(Note: The number of deaths from a disease in any year do not relate only to new cases of the disease occurring in that year, but also to cases occurring in previous years).

In all of these cancers, at least one lifestyle factor plays an important role. The most worrying trend is the increasing number of women developing either lung cancer or breast cancer.

Lung cancer: Incidence rates of lung cancer in men are increasing in most countries. In countries where the smoking epidemic first began, and has now passed its peak, they are beginning to fall — for example in Finland, the United Kingdom and the United States. Among women, incidence rates are rising briskly in countries where female smoking is long established. Lung cancer is now the commonest cause of death from cancer in women in the U.S. In the European Union countries, a 33 percent increase in female lung cancer cases is predicted by 2005. Worldwide, about 85 percent of lung cancers in men and 46 percent in women are tobacco-related. The ratios in developed countries are 91 percent and 62 percent. There is no effective treatment for lung cancer. Only 7 percent-12 percent of patients are alive five years after diagnosis.

Stomach cancer: The steady decline in cases in most industrialized countries during the last 30 years is attributed to nutrition richer in vitamins from fresh fruits and vegetables, and less consumption of preserved, cured and salted foods. But the disease is the second most common cancer worldwide, and almost two-thirds of all cases are in developing countries. Infection with the bacterium Helicobacter pylori contributes to the risk of the cancer. Only about one patient in five survives longer than 5 years after diagnosis.

Colorectal cancer: Studies show a higher risk of colorectal cancer in people eating a diet low in vegetables, legumes and whole cereals. Frequent consumption of red meat increases the risk. Although it is more common in richer countries, incidence of the disease is rising in some developing countries. Incidence increases rapidly in the first generation of migrants moving from a low-risk country, such as Japan, to a high-risk country, such as the United States. If diagnosed at an early stage, 90 percent of patients survive at least 5 years, compared to no more than 8 percent of those diagnosed at an advanced stage.

Liver cancer: A major problem in developing countries, with China alone accounting for 55 percent of all cases. The risk is twice as high in men as in women everywhere; 83 percent of all cases are attributable to infection with the hepatitis B virus. Most other cases are linked to excessive alcohol consumption. Only about 6 percent of patients survive more than 5 years.

Breast cancer: More than half of all cases are in industrialized countries. Incidence is increasing in most parts of the world, particularly in regions which previously had low rates. Studies show that the incidence in women who migrate from low- to high-risk regions slowly rises, over two or three generations, to the rates of the host country. This illustrates the importance of lifestyle as well as hormonal risk factors in the development of the disease. Other risk factors are obesity after menopause, and diet, in particular too high a consumption of animal fats. At least half of breast cancer sufferers survive five years or more after diagnosis.

Esophageal cancer: Tobacco and alcohol are the most important risk factors, particularly in combination. Smoking accounts for 45 percent of cases in men worldwide, but only 11 percent of female cases. About 85 percent of cases are in developing countries. About 75 percent of patients die within a year of diagnosis: only 5-10 percent survive for 5 years.

Mouth cancer: Tobacco and alcohol consumption are again major risk factors. Three out of four cases worldwide are in developing countries. Studies indicate a protective effect of a diet rich in vegetables and fruit. Five-year survival from the disease ranges between 80 percent in its early stages to as low as 5 percent in advanced cases.

Cervical cancer: Eighty per cent of cases occur in developing countries, where it is often the most common cancer in women. Cases and deaths have declined markedly in many industrialized countries, mainly because of extensive screening programs. The sexually-transmitted human papilloma virus is found in more than 95 percent of cases. A vaccine against the virus is being developed. Survival depends on the stage of the disease at diagnosis, with 90 percent of localized cases surviving 5 years compared to less than 10 percent with distant spread.

Circulatory diseases

Heart attacks, stroke and other circulatory diseases together kill more than 15 million people a year, or 30 percent of the annual total of deaths from all causes. Many of these deaths are both premature — occurring in people under 65 years — and preventable.

Circulatory diseases are emerging rapidly as a major public health concern in most developing countries, where they now account for about 25 percent of all deaths, compared to about half of all deaths in developed countries.

Once, these diseases were regarded as affecting exclusively industrialized nations, but this is no longer true. As developing countries modernize, they are more able to control communicable diseases, and the life expectancy of their populations increases. Unfortunately, so do their risks of circulatory conditions. This is partly because of their adoption of lifestyles similar to those in industrialized countries, and the accompanying risk factors — high blood pressure, smoking, high blood cholesterol levels, unhealthy diet, physical inactivity and obesity.

In the industrialized countries themselves, meanwhile, deaths rates from coronary heart disease have declined dramatically in the last 30 years. This is largely because of better medical treatment and preventive measures including health education on smoking and diet.

High blood pressure is a leading risk factor for heart disease and stroke, and affects about 20 percent of adults in most countries. Blood pressure increases progressively with age.

Cigarette smoking is the most readily preventable risk factor for both heart disease and stroke.

High blood cholesterol levels are also a major risk factor. The causes can be genetic, but are commonly related to a diet rich in animal fats.

Lack of physical activity is the most prevalent, modifiable risk factor for heart disease in many industrialized countries. Similar levels of inactivity are becoming more common in newly-industrialized countries.

Obesity is a risk factor in itself for heart disease, and is related to inappropriate nutrition and inactivity.

Diabetes

The projected rise in the number of diabetes sufferers from about 135 million now to almost 300 million by the year 2025 is due to population aging, unhealthy diets, obesity and a sedentary lifestyle.

Developing countries will bear the brunt of the diabetes epidemic in the 21st century. Up to 90 percent of all cases of diabetes worldwide are non-insulin-dependent. Insulin-dependent diabetes develops most frequently in children and adults.

Diabetes is an under-recognized and under-recorded cause of death. Its long term complications include heart disease, predominantly in industrialized countries, kidney failure, blindness, and, particularly in developing countries, foot infections, gangrene and amputation of the limbs. It adversely affects the outcome of pregnancy, negates the protection from heart disease which pre-menopausal women without diabetes experience, and can lead to male impotence.

Mental disorders

Dementia, particularly Alzheimer disease, are likely to become one of the leading causes of disability in the elderly worldwide. Already an estimated 29 million people suffer from dementia, and the risk of developing the condition rises steeply with age in people over 60 years. By the year 2025, Africa, Asia and Latin America between them could have more than 80 million sufferers.

At least 400 million people suffer from other mental disorders, ranging from mood and personality disorders to neurological conditions such as epilepsy, which alone is estimated to affect 40 million people.

Priorities for action

The World Health Report 1997 indicates priorities for action that are intended to improve mankind’s ability to prevent, treat, rehabilitate, and where possible, cure major non-communicable diseases and to reduce the enormous suffering and disability that they cause. It says that as many of the diseases share a relatively small number of crucial risk factors, an integrated, coordinated approach to their prevention is therefore necessary. There is also an urgent need to raise awareness of, and motivation for, healthy lifestyles.

The report’s top priorities for international action are summarized as follows:

  1. Integration of disease-specific interventions in both physical and mental health into a comprehensive chronic disease control package that incorporates prevention, diagnosis, treatment and rehabilitation and improved training of health professionals.
  2. Fuller application of existing cost-effective methods of disease detection and management, including improved screening, taking into account the genetic diversity of individuals.
  3. A major intensified but sustained global campaign to encourage healthy lifestyles, with an emphasis on the healthy development of children and adolescents in relation to risk factors such as diet, exercise, and smoking.
  4. Healthy public policies, including sustainable financing, and legislation on pricing and taxation, in support of disease prevention programs.
  5. Acceleration of research into new drugs and vaccines, and into the genetic determinants of chronic diseases.
  6. Healthy public policies, including sustainable financing, and legislation on pricing and taxation, in support of disease prevention programs.
  7. Acceleration of research into new drugs and vaccines, and into the genetic determinants of chronic diseases.
  8. Alleviation of pain, reduction of suffering and provision of palliative care for those who cannot be cured.

“Inevitably, each human life reaches its end,” the report concludes. “Ensuring that it does so in the most dignified, caring and least painful way that can be achieved deserves as much priority as any other. This is a priority not merely for the medical profession, the health sector or the social services. It is a priority for each society, community, family and individual.”

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Contact: Thomson Prentice, Health Communications and Public Relations, WHO, Geneva, Switzerland. Tel. (41 22) 791 4224. Fax (41 22) 791 4870.

All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.ch/ [/sws_grey_box]

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