Here is a PDF of full report for those not patient enough to go through all
the links on the WHO site.
Best wishes
Terrie Agnew
Research & Executive Assistant to Michael Reid
Institute for International Health
144-146 Burren Street, Newtown
Sydney Australia
Tel: +61 2 9351 0030
Facs:+61 2 9475 0838
Email: [log in to unmask]
Mobile: +61 (0)438 373 538
-----Original Message-----
From: Mcdaid,D [mailto:[log in to unmask]]
Sent: Thursday, 31 October 2002 3:34 AM
To: [log in to unmask]
Subject: World Health Report 2002: Reducing risks, promoting healthy
life
Dear Colleagues
The World Health Report 2002, is officially launched today 30/10/02. A
summary of the full report is now available in six languages at
http://www.who.int/whr/en/
The full report is already available in English and will be available in
future in other languages following final translation
Press Release below
(Also at http://www.who.int/mediacentre/releases/pr84/en/)
Best wishes
David McDaid
LSE Health and Social Care
London School of Economics and Political Science
30 October 2002 -- Worldwide, healthy life expectancy can be increased by
5-10 years if governments and individuals make combined efforts against the
major health risks in each region, the World Health Organization (WHO) says
in its new yearly report.
The World Health Report 2002 -- Preventing Risks, Promoting Healthy Life -
breaks new ground by identifying some major principal global risks to
disease, disability and death in the world today, quantifying their actual
impact from region to region, and then providing examples of cost-effective
ways to reduce those risks, applicable even in poor countries.
"This report provides a road map for how societies can tackle a wide range
of preventable conditions that are killing millions of people prematurely
and robbing tens of millions of healthy life," says WHO Director-General Gro
Harlem Brundtland, MD. "WHO will take this report and focus on the
interventions that would work best in each region and on getting the
information out to Member States."
From more than 25 major preventable risks selected for in-depth study, the
report finds that the top 10 globally are: childhood and maternal
underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe
water, sanitation and hygiene; high cholesterol; indoor smoke from solid
fuels; iron deficiency and overweight/obesity. Together, they account for
about 40 per cent of the 56 million deaths that occur worldwide annually and
one-third of global loss of healthy life years.
These leading risks are comparatively much more important than widely
believed. WHO calls the contrast between rich and poor people "shocking."
The burden from many of the risks is borne almost exclusively by the
developing world, while other risks have already become global. Some 170
million children in poor countries are underweight, mainly from lack of
food, while more than one billion adults worldwide - in middle income and
high income countries alike are overweight or obese. About half a million
people in North America and Western Europe die from
overweight/obesity-related diseases every year.
WHO warns that the "cost of inaction is serious." The report predicts that
unless action is taken, by the year 2020 there will be nine million deaths
caused by tobacco, compared to almost five million a year now; five million
deaths attributable to overweight and obesity, compared to three million
now; that the number of healthy life years lost by underweight children will
be 110 million, which, although lower than 130 million now, is still
unacceptably high.
If all of these preventable risks could be addressed as WHO recommends
(which WHO acknowledges is a highly ambitious goal), healthy life spans
could increase as much as 16 plus years in parts of Africa, where healthy
life expectancy now falls as low as just 37 years (in Malawi). Even in the
richer developing countries, such as Europe, the United States, Australia,
New Zealand and Japan, healthy life spans would increase by about five
years.
"Globally, we need to achieve a much better balance between preventing
disease and merely treating its consequences," says Christopher Murray,
M.D., Ph.D., Executive Director of WHO's Global Programme on Evidence for
Health Policy and overall director of World Health Report 2002. "This can
only come about with concerted action to identify and reduce major risks to
health."
WHO has developed a unique framework for using a wide body of scientific
evidence to comparably assess the impact of different risks in a 'common
currency' of lost healthy life years, called the DALY (disability-adjusted
life year). This takes into account the impact of the different risks on
mortality and on morbidity. A DALY is equal to the loss of one healthy year
of life.
Risks that result in death reduce life expectancy. Risks that result in
short or long term morbidity mean that people stay alive, but not in full
health. Healthy life expectancy (HALE) is, therefore, lower than life
expectancy. For example, overall life expectancy in Japan is 84.7 years for
women and 77.5 for men, versus a healthy life expectancy of 73.6 years for
men and women.
The report divides the world into 14 different regions on the basis of
geography and health development (see Annex), then analyzes the risks most
important in each area and the gains in healthy life span that can be
achieved. The top risks vary widely, from being underweight and unsafe sex
in most of Africa to tobacco use and high blood pressure in North America,
Western Europe and developed countries in the Western Pacific such as Japan.
The major risks reviewed in the report are responsible for a substantial
loss in healthy life expectancy - on average about five years in developed
countries and 10 years in developing countries. The amount of lost healthy
life years due to these leading risks varies by region In Canada, the United
States and Cuba (highest ranked group in the Western Hemisphere), healthy
life expectancy can increase by 6.5 years, from their current healthy life
expectancy of Canada, 69.9 years; Cuba, 66.6 years, U.S., 67.6 years. In the
wealthiest countries of Europe, including Germany, France, Italy, Spain and
the United Kingdom, healthy life expectancy can grow by 5.4 years; in most
of Latin America, including Argentina, Brazil and Mexico, 6.9 years; in an
Asian group including China, 6 years; in another Asian group including
India, 8.9 years. (WHO estimates apply to each region as a whole and may not
apply to any given country.)
A considerable part of this burden could be reduced by a set of
cost-effective interventions identified in the report. WHO has developed a
first-ever system of identifying and reporting cost-effective health
interventions consistently across different regions that it calls CHOICE
(CHOosing Interventions that are Cost-Effective). Various CHOICE options are
contained in a new statistical database that is also a part of the World
Health Report 2002, one of the largest research projects ever undertaken by
the World Health Organization. These interventions can be implemented on an
à la carte basis, depending on each country's individual circumstances.
"Although the report carries some ominous warnings, it also opens the door
to a healthier future for all countries - if they're prepared to act boldly
now," says Dr. Murray. "In order to know which interventions and strategies
to use, governments must first be able to assess and compare the magnitude
of risks accurately. Our report gives assessments for each of the major
risks."
Selected Major Risk Factors and What to Do About Them
The report shows that a relatively small number of risks cause a huge number
of premature deaths and account for a very large share of the global burden
of disease. For example, at least 30 per cent of all disease burden
occurring in the highest mortality developing countries, such as those in
sub-Saharan Africa and south-east Asia, results from underweight and
deficiencies in micronutrients like iron and zinc, unsafe sex, unsafe water,
sanitation, and hygiene and indoor smoke from solid fuels, the leading risks
examined in those countries.
"Every country has major risks to health that are known, definite and
increasing, sometimes unchecked," says Anthony Rodgers, M.D., Ph.D., of the
University of Auckland, New Zealand, and a WHO consultant who is one of the
report's main writers. "For each of these risks, we have established
effective, but often underused, interventions."
The report also breaks new ground by assessing avoidable death and
disability at a global scale. By incorporating current knowledge in risk
factor, demographic and mortality trends, an intriguing picture emerges - an
increasingly ageing world facing some major risks globally (such as
tobacco), as well as remaining very high mortality regions, particularly
sub-Saharan Africa.
"This report brings out for the first time that 40 per cent of global deaths
are due to just the10 biggest risk factors, while the next 10 risk factors
add less than 10 per cent," says Alan Lopez, Ph.D., WHO Senior Science
Advisor and co-director of the Report. "This means we need to concentrate on
the major risks if we are to improve healthy life expectancy by about 10
years, and life expectancy by even more."
Given the risks measured in this Report and other known major risks, current
scientific knowledge has clearly identified causes for most death and
disability globally. For example, more than three-quarters of major diseases
such as ischaemic heart disease, stroke, HIV/AIDS and diarrhoea were due to
the combined effects of risks assessed in the Report. WHO emphasizes that
each risk is also a prevention opportunity, and the potential for prevention
from tackling major known risks is clearly substantial, and much greater
than commonly thought. "Since many of these risks are continuous, without a
threshold, the most cost-effective interventions are often those that move
the entire population to a lower risk zone," says Dr. Rodgers. "A good
example would be government- and industry-led reductions of salt in
processed foods, which would have major population-wide benefits."
Underweight/under-nutrition -- Childhood and maternal underweight was
estimated to cause 3.4 million deaths in 2000, about 1.8 million in Africa.
This accounted for about one in 14 deaths globally. Under-nutrition was a
contributing factor in more than half of all child deaths in developing
countries. Since deaths from under-nutrition all occur among young children,
the loss of healthy life years is even more substantial: about 138 million
DALYs, 9.5 per cent of the global total.
Under-nutrition is mainly a consequence of inadequate diet and frequent
infection, leading to deficiencies in calories, protein, vitamins and
minerals. Underweight remains a pervasive problem in developing countries,
where poverty is a strong underlying cause, contributing to household food
insecurity, poor childcare, maternal under-nutrition, unhealthy
environments, and poor health care.
Interventions -- The most cost effective strategy to reduce under-nutrition
and its consequences combines a mix of preventive and curative
interventions. Micronutrient supplementation and fortification - Vitamin A,
zinc and iron - is very cost-effective. It should be combined with maternal
counselling to continue breast feeding, and targeted provision of
complimentary food as necessary. In addition, routine treatment of diarrhoea
and pneumonia, major consequences of under-nutrition, should be part of any
health improvement strategy for children.
Unsafe sex -- HIV/AIDS caused 2.9 million deaths in 2000, or 5.2 per cent of
total. It also causes the loss of 92 million DALYs (6.3 per cent of all)
annually. Life expectancy at birth in sub-Saharan Africa is currently
estimated at 47 years; without AIDS it is estimated that it would be around
62 years. Current estimates suggest that 95 per cent of the HIV infections
prevalent in Africa in 2001 are attributable to unsafe sex. In the rest of
the world the estimated percentage of HIV infections prevalent in 2001 that
are attributable to unsafe sex ranges from 25 per cent in Eastern Europe to
90 per cent or more in parts of South America and the developed countries of
Western Pacific. Interventions -- Most people infected with HIV do not know
they are infected, making prevention and control more difficult. Various
sexual practices contribute to the risk of sexually transmitted infections.
High-risk sex practices include multiple partners, together with lack of
condom use and the type of sex acts involved. Treatments include:
* Population-wide mass media health promotion using the combination of
television, radio and printed media.
* Voluntary counselling and testing.
* School-based AIDS education targeted at youths aged 10-18 years.
* Peer counselling for sex workers.
* Peer outreach for men who have sex with men.
* Treatment of sexually transmitted infections as a way of reducing
transmission of HIV infections.
* Treatment of mothers with HIV infection to prevent maternal to child
transmission.
* Anti-retroviral therapy has also been evaluated.
* Intervention combinations: WHO says that the best way to address the
problem is to apply a combination of the above interventions at a
population-wide level.
High blood pressure and cholesterol -- Worldwide, high blood pressure is
estimated to cause 7.1 million deaths, about 13 per cent of the global
fatality total. Across WHO regions, research indicates that about 62 per
cent of strokes and 49 per cent of heart attacks are caused by high blood
pressure.
High cholesterol is estimated to cause about 4.4 million deaths (7.9 per
cent of total) and a loss of 40.4 million DALYs (2.8 per cent of total),
although its effects often overlap with high blood pressure. This amounts to
18 per cent of strokes and 56 per cent of global ischemic heart disease.
Blood pressure is a measure of the force that the circulating blood exerts
on artery walls. High blood pressure levels damage the arteries that supply
blood to the brain, heart, kidneys and elsewhere. Cholesterol is a fat-like
substance found in the bloodstream that is a key component in the
development of atherosclerosis, the accumulation of fatty deposits on the
inner lining of arteries of the heart and brain.
Interventions - The World Health Report 2002 urges countries to adopt
policies and programs to promote population-wide interventions like reducing
salt in processed foods, cutting dietary fat, encouraging exercise and
higher consumption of fruits and vegetables and lowering smoking. These are
the most cost-effective interventions identified to reduce cardiovascular
disease. This reflects recent evidence that such therapy benefits all groups
at elevated risk, even those with average or below average blood pressure or
cholesterol.
When added to this base, a combination of drugs -- statins (cholesterol
lowering), low-dose blood pressure lowering medications and low-dose aspirin
(blood-thinning) -- given daily to people at elevated risk of heart attack
and stroke, would achieve very substantial additional benefits. This highly
effective drug combination is likely to more than halve stroke and heart
disease incidence and could be widely used in the developed world, and is
increasingly affordable in the developing world.
"Our new research finds that many established approaches to cutting CV
disease risk factors are very inexpensive, so that even countries with
limited health budgets can implement them and cut their CV disease rate by
50 per cent," says Derek Yach, M.D., Executive Director of the Cluster on
Non-communicable Diseases and Mental Health. "In addition, drug treatments
are increasingly affordable in middle and low-income countries, as effective
drugs come off patent."
Tobacco Use -- WHO estimates that tobacco caused about 4.9 million deaths
worldwide in 2000, or 8.8 per cent of the total, and was responsible for 4.1
per cent of lost DALYs (59.1 million). In 1990, it was estimated that
tobacco caused just 3.9 million deaths, demonstrating the rapid evolution of
the tobacco epidemic and new evidence of the size of its hazard, with most
of the increase in developing countries.
Interventions -- Countries that have adopted comprehensive tobacco control
programs involving a mix of interventions including a ban on tobacco
advertising, strong warnings on packages, controls on the use of tobacco in
indoor locations, high taxes on tobacco products and health education and
smoking cessation programs have had considerable success. WHO found that for
every 10 per cent real rise in price due to tobacco taxes, tobacco
consumption generally falls by between 2 per cent and 10 per cent. In
addition to national programs, an effective Framework Convention on Tobacco
Control will address transnational aspects of the issues.
Nicotine replacement therapy (NRT) targeting at all current smokers was less
cost-effective than the other strategies, but affordable in higher income
countries. NRT includes nicotine patches, nicotine chewing gum, nicotine
nasal sprays, lozenges, aerosol inhalers and some classes of
anti-depressants.
Unsafe Water and Sanitation -- Approximately 3.1 per cent of deaths (1.7
million) and 3.7 per cent of DALYs (54.2 million) worldwide are attributable
to unsafe water, sanitation and hygiene. Of this burden, about one-third
occurred in Africa and one-third in south-east Asia. Overall, 99.8 per cent
of deaths associated with these risk factors are in developing countries,
and 90 per cent are deaths of children. Various forms of infectious
diarrhoea make up the main burden of disease associated with unsafe water,
sanitation and hygiene.
Interventions -- The United Nations has adopted a goal of halving the number
of people with no access to safe water and sanitation by 2015. Improved
water supply and basic sanitation, if extended globally, could prevent 1.8
billion cases of diarrhoea (a 17 per cent reduction of the current number of
cases) annually. If universal piped and regulated water supply were
achieved, 7.6 billion cases of diarrhoea (69.5 per cent reduction) would be
prevented annually. Universal piped water is the ideal, but is high cost. In
the short term, the most cost-effective strategy evaluated was disinfection
of unsafe water at the point of use. This is a simple technology, is of very
low cost, and would achieve substantial health benefits.
Iron deficiency -- Iron deficiency is one of the most prevalent nutrient
deficiencies in the world, affecting an estimated two billion people with
consequences for maternal and perinatal health and child development. In
total, 800,000 (1.5 per cent) of deaths worldwide are attributable to iron
deficiency, 1.3 per cent of all male deaths and 1.8 per cent of all female
deaths. Attributable DALYs are even greater, amounting to the loss of about
25.9 million healthy life years (2.5 per cent of global DALYs) because of
the non-fatal outcomes like cognitive impairment.
Interventions -- Iron fortification is very cost-effective in areas of iron
deficiency. It involves the addition of iron usually combined with folic
acid, to the appropriate food vehicle made available to the population as a
whole. Cereal flours are the most common food vehicle, but there is also
some experience with introducing iron to other vehicles such as
noodles,rice, and various sauces.
"We surprised even ourselves in how far-reaching the health benefits can be
if governments and health systems adopt our recommendations," says Dr.
Murray. "WHO believes that the wide distribution of this report should
become a prime goal of all Member States."
For further information please contact:
Dr Christopher Murray, Executive Director, Evidence and Information for
Policy, WHO; Tel: (+41 22) 791 2418; Mobile: (+41 79) 217 3462; E-mail:
[log in to unmask]
Dr Derek Yach, Executive Director, Noncommunicable Diseases and Mental
Health, WHO, Tel: (+41 22) 791 2736; Mobile: (+41 79) 217 3404; E-mail:
[log in to unmask]
Mr Jon Lidén, Communications Adviser, Director-General's Office, Tel: (+41
22) 791 3982; Mobile: (+41 79) 244 6006; E-mail: [log in to unmask]
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