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World Health Organization Report English 1998 PDF

226 Pages·1998·1.8 MB·English
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The World Health Report 1998 Life in the 21st century A vision for all Report of the Director-General World Health Organization Geneva 1998 i WHO Library Cataloguing in Publication Data The world health report 1998 – Life in the 21st century: a vision for all 1.World health 2. Public health – history 3. Public health - trends 4.Health status 5. Forecasting 6. World Health Organization I. Title: Life in the 21st century: a vision for all ISBN 92 4 156189 0 (NLM Classification: WA 540.1) ISSN 1020-3311 The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, Geneva, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © World Health Organization 1998 All rights reserved. The designations employed and the presentation of the material in this publication, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Information concerning this publication can be obtained from: Office of World Health Reporting World Health Organization 1211 Geneva 27, Switzerland Fax: (41-22) 791 4870 Design and layout by WHO Printed in France 98/11891 – Sadag – 20000 ii Contents Message from the Director-General v Introduction 1 Chapter 1 Leading and responding 9 Chapter 2 Measuring health 39 Chapter 3 Health across the life span 61 Chapter 4 The changing world 113 Chapter 5 Achieving health for all 139 Chapter 6 WHO worldwide 165 Chapter 7 Global partnerships for health 191 Chapter 8 Health agenda for the 21st century 201 Annex 1 Members and Associate Members of WHO 213 Annex 2 Statistics 215 Index 233 iii Synopsis of the report Chapter 1 (Leading and responding) examines the origins of WHO and its history from 1948 to 1998, and describes how the Organization works and what it does. Chapter 2 (Measuring health) summarizes the main trends in mortality since 1955, and gives an overview of disease trends during the same period. Chapter 3 (Health across the life span) looks at the health problems encountered and progress made in the past 50 years for all age groups – infants and small children under 5, older children of school age and adolescents (5-19), adults (20-64 years) and older people (over 65). Chapter 4 (The changing world) discusses the three main global trends that affect health: economic trends, popu- lation trends and social trends. Chapter 5 (Achieving health for all) reports on the evolution of health systems and health care, including primary health care, since the launching of the global strategy for Health for All at the Alma-Ata Conference in 1978. Chapter 6 (WHO worldwide) summarizes health trends since 1948 for each of the six WHO regions, as well as current activities or problems. Chapter 7 (Global partnerships for health) gives examples of cooperation since 1948 with the United Nations and other entities within the system, as well as with NGOs, international and national research institutions and collaborating centres. Chapter 8 (Health agenda for the 21st century) considers the unfinished agenda and shows the way to enhance health potential worldwide in the future. iv Message from the Director-General The desire for a healthier and Issued as the World Health Or- better world in which to live ganization marks its 50th anniversary, our lives and raise our children The World Health Report 1998 offers is common to all people and all gen- a cautiously optimistic vision of the erations. Now, as we near the end of future up to the year 2025. It gives us one century and enter the next, our hope that longer life can be a prize past achievements and technological worth winning. We are slowly learning advances make us more optimistic Based on a review of health trends about our future than perhaps at any in the past 50 years, it finds that over- stage in recent history. all, remarkable improvements in health one of life’s most Despite being threatened by two have been due to socioeconomic devel- devastating world wars in the first half opment, the wider provision of safe of this century, and by many other con- water, sanitation facilities and personal important lessons: flicts and catastrophes in the second, hygiene, and the establishment and humanity has, in general, not merely expansion of national health services. not just how to live survived; it has thrived. Today, at least Major infectious diseases, such as 120 countries (total population above poliomyelitis, leprosy, guinea-worm 5 billion) have a life expectancy at birth disease, Chagas disease and river longer, but also of more than 60 years; the global aver- blindness, are steadily being defeated. age is 66 years compared to only 48 There have been spectacular advances years in 1955; it is projected to reach in the development of vaccines and how to stay longer 73 years in 2025. medicines, and countless other inno- However, one of the main mes- vations in the investigation, diagnosis sages of The World Health Report and treatment of illness, in the reduc- in good health with 1997 was the need to recognize that tion of disability and in rehabilitation. increased longevity without quality of Tragically, however, while average life is an empty prize – that health ex- life expectancy has been increasing less dependence pectancy is more important than life throughout the 20th century, 3 out of expectancy. It is therefore particularly 4 people in the least developed coun- encouraging to show evidence in this tries today are dying before the age on others. year’s report of remarkable declines in of 50 – the global life expectancy fig- disability over periods of time among ure of half a century ago. This year, older people in some populations. 21 million deaths – 2 out of every 5 In an era of global population age- worldwide – will be among the un- ing, this is not just good news for the der-50s, including 10 million small individuals concerned and the socie- children who will never see their fifth ties in which they live. It may be a vi- birthday though most children world- tal signal for us all. It suggests that we wide are now immunized against are slowly learning one of life’s most major childhood killers. Over 7 mil- important lessons: not just how to live lion will be men and women in what longer, but also how to stay longer in should be some of the best and most good health with less disability, and productive years of their lives. Reduc- therefore, less dependence on others. ing these premature deaths is one of v the greatest challenges facing human- and poor, and keeping it there. It is ity at the dawn of the 21st century. time to realize that health is a global There are others challenges. For issue; it should be considered as an while health globally has steadily im- essential component of the continu- proved over the years, great numbers ing globalization process that is re- of people have seen little if any im- shaping our world; it should be in- provement at all. The gaps between cluded in the growing interaction be- the health status of rich and poor are tween countries that currently exists at least as wide as they were half a cen- in terms of world trade, services, for- tury ago, and are becoming wider still. eign investment and capital markets. The prime concern of the inter- With the help of instant interna- national community must be the tional communications and informa- plight of those most likely to be left tion technologies, and global surveil- furthest behind as the rest of the lance systems to detect problems, world steps confidently into the fu- prepare for them and respond to ture. These are the many hundreds them, a wonderful opportunity now of millions of men, women and chil- exists to build the new international dren still trapped in the past by the partnerships for health, based on so- grimmest poverty. They live mainly in cial justice, equity and solidarity, that the least developed countries, where the world of the 21st century will so the burdens of ill-health, disease and urgently need. inequality are heaviest, the outlook is They are partnerships involving all bleakest, and life is shortest. countries, their governments, their civil Worldwide, the majority of pre- societies, and their individuals. All can mature deaths are preventable. At be partners who are willing to share and least 2 million children a year die from exchange the life-enhancing informa- diseases for which there are vaccines. tion and technology that is already at The report gives encouraging evi- the fingertips of the rich but as yet be- dence that premature deaths among yond the reach of the poor. Such a po- adults, too, can be significantly re- litical vision is fundamental to ensure a duced. Deaths from heart disease participatory approach to peace and have been dramatically reduced in development at local, national and in- many countries which are experienc- ternational levels and thus enhance the ing a transition from high incidence welfare of the individual and society. of circulatory diseases to low inci- The progress and achievements of dence, mainly due to the adoption of the past 50 years are solid foundations healthier lifestyles. It is imperative for a healthier and better world. It is that such a favourable shift, condu- already time to build on them. Life cive to further reductions in the inci- in the 21st century could and should dence of these diseases, should be be better for all. We can pass no sustained and if possible accelerated. greater gift to the next generation Infectious diseases, meanwhile, than a healthier future. That is our remain leading causes of premature vision. Together, the people of the death among adults in much of the world can make it a reality. developing world. Reducing these tolls depends largely on the political will and commitment of individual governments, and the active support Hiroshi Nakajima, M.D., Ph.D. of the international community. Director-General This means putting health high World Health Organization on the agenda of all countries, rich vi Introduction Introduction Looking forward to health world this year can be considered pre- mature, in that more than 20 million The 21st century offers a bright people a year are dying before the age vision of better health for all. of 50, while average life expectancy It holds the prospect not has risen to 66 years. Ten million of merely of longer life, but superior these deaths are among children un- quality of life, with less disability and der 5 years; 7.4 million others are The most important disease. As the new millennium ap- among adults aged 20-49. proaches, the global population has Even so, the most important pat- pattern of progress never had a healthier outlook. tern of progress now emerging is an Weighing the evidence of the past unmistakable trend towards healthier, and the present, The World Health longer life. Supported by solid scien- now emerging is an Report 1998 shows that humanity has tific evidence of declines in disability many good reasons for hope in the among older people in some future. Such an optimistic view must populations, this has considerable unmistakable trend be tempered by recognition of some implications for individuals and for harsh realities. Nevertheless, unprec- societies. edented advances in health during the The explanation for this trend lies towards healthier, 20th century have laid the founda- in the social and economic advances tions for further dramatic progress in that the world has witnessed during the years ahead. the late 20th century – advances that longer life. This report provides the latest ex- have brought better living standards pert assessment of the global health to many, but not all, people. The situation, and uses that as a basis for world saw a golden age of unparal- projecting health trends to the year leled prosperity between 1950 and 2025. Examining the entire human 1973, followed by an economic slump life span, and sifting data gathered in that lasted 20 years. A global eco- the past 50 years, it studies the well- nomic recovery has been under way being of infants and children, adoles- since 1994. The long-term benefits cents and adults, older people and the are now becoming apparent. While “oldest old”, and identifies priority ar- they are most evident in the industri- eas for action in each age group. alized world, they are slowly but Women’s health is given special em- surely materializing in many poorer phasis. The future of human health countries, too. in the 21st century depends a great For example, food supply has deal on a commitment to investing in more than doubled in the past 40 the health of women in the world to- years, much faster than population day. Their health largely determines growth. Per capita GDP in real terms the health of their children, who are has risen by at least 2.5 times in the the adults of tomorrow. past 50 years. Adult literacy rates have The report’s most disturbing find- increased by more than 50% since ing is that, despite increasing life ex- 1970. The proportion of children at pectancy, two-fifths of all deaths in the school has risen while the proportion 1 The World Health Report 1998 of people chronically undernourished sanitation facilities. Most of the has fallen. world’s children are now immunized These trends are changing the against the six major diseases of child- world. Without question, the world of hood – measles, poliomyelitis, tuber- 2025 will be significantly different culosis, diphtheria, pertussis and from today’s, and almost unrecogniz- neonatal tetanus. able from that of 1950. The stunning During the same period there technological advances of recent have been steady and sometimes years, particularly in global telecom- spectacular advances in the control munications, have made the planet and prevention of other diseases, the seem smaller than ever before. By the development of vaccines and medi- year 2025, it is likely to seem smaller cines, and countless other medical still – and, with continuing population and scientific innovations. The past growth, it will certainly be much more decades have seen the final defeat of In many ways, crowded. In many ways, the face of smallpox, one of the oldest diseases humanity is being rapidly reshaped. of humanity, and the gradual reduc- Two main trends – increasing life tion in several others, including lep- the face of humanity expectancy and falling fertility rates rosy and poliomyelitis. – mean that by 2025: ● Worldwide life expectancy, cur- Crossing the threshold is being rapidly rently 66 years, will reach 73 years – a 50% improvement on the 1955 Together, these and related achieve- average of only 48 years. ments should help humankind to step reshaped. ● The global population, about 5.8 confidently across the threshold into billion in 1997, will increase to the new century. However, the future about 8 billion. Every day in 1997, will pose many new as well as con- about 365 000 babies were born, tinuing challenges. and about 140 000 people died, The war against ill-health in the giving a natural increase of about 21st century will have to be fought 220 000 people a day. simultaneously on two main fronts: ● There will never have been so infectious diseases and chronic, many older people and so relatively noncommunicable diseases. Many few young ones. developing countries will come under ● The number of people aged over greater attack from both, as heart dis- 65 will have risen from 390 million ease, cancer and diabetes and other in 1997 to 800 million – from 6.6% “lifestyle” conditions become more of the total population to 10%. prevalent, while infectious illnesses ● The proportion of young people remain undefeated. Of this latter under 20 years will have fallen group, HIV/AIDS will continue to be from 40% in 1997 to 32% of the the deadliest menace. total population, despite reaching This double threat imposes the 2.6 billion – an actual increase of need for difficult decisions about the 252 million. allocation of scarce resources. Expe- These demographic trends, which rience shows that reduced spending have profound implications for hu- on controlling infectious diseases can man health in all age groups, follow cause them to return with a venge- on the many positive changes that ance, while globalization – particu- have occurred in the past 50 years. larly expanding international travel More people than ever before now and trade, including the transporta- have access to at least minimum tion of foodstuffs – increases the risks health care, safe water supplies and of their global spread. At the same 2 Introduction time, the stealthy onset of chronic deaths among children under 5 – conditions also saps a nation’s 97% of them in the developing strength. This trend will increasingly world, and most of them due to be the main focus of attention in in- infectious diseases such as pneu- dustrialized countries which, how- monia and diarrhoea, combined ever, must not lower their guard with malnutrition. against infectious diseases. ● Most of these under-5 deaths are The past few decades have seen preventable. At least 2 million a the growing impact on health of pov- year could be prevented by exist- erty and malnutrition; widening ing vaccines. health inequalities between rich and ● Some 25 million low-birth-weight poor; the emergence of “new” dis- babies are born every year. They eases such as HIV/AIDS; the grow- are more likely to die early, and ing problem of antibiotic-resistant those who survive may suffer ill- infections; and the epidemic of to- ness, stunted growth or other HIV/AIDS could bacco-related diseases. health problems, even as adults. These are only some of the prob- ● While most premature and low- lems representing the unfinished birth-weight babies are born in the reverse some of agenda of public health actions at the developing world, many born in end of one century and requiring ur- industrialized countries owe their gent action at the beginning of the survival to high-technology the major gains next. neonatal care. Such care may have This report looks at the health increasingly complex ethical impli- implications for all age groups – in- cations. achieved in child fants and small children under 5; ● Tomorrow’s small children face a older children of school age and ado- “new morbidity” of illnesses and health over lescents (5-19 years); adults (20-64 conditions that are linked to social years); and older people (65 and and economic changes, including over). Some of the main findings of rapid urbanization. These include the last 50 years. the report, as they apply to each age neglect, abuse and violence, espe- group, are summarized below. cially among the growing numbers of street children. Infants and small children ● One of the biggest hazards to chil- dren in the 21st century will be the ● Spectacular progress in reducing continuing spread of HIV/AIDS. under-5 mortality achieved in the In 1997, 590 000 children aged un- past few decades is projected to der 15 became infected with HIV. continue, and could even acceler- The disease could reverse some of ate. There were about 11 million the major gains achieved in child deaths among children under 5 in health over the last 50 years. 1995 compared to 21 million in ● Better prevention and treatment of 1955; there will only be 5 million some hereditary diseases in small deaths in 2025. children is likely. ● The infant mortality rate per 1000 live births was 148 in 1955; 59 in Older children and adolescents 1995; and is projected to be 29 in 2025. Traditionally regarded as enjoying the ● The under-5 mortality rates per healthiest phase of life, these young- 1000 live births for the same years sters have tended to receive insuffi- are 210, 78 and 37 respectively. cient public health attention. But to- ● In 1997, there were 10 million day theirs is a “prime time” for health 3 The World Health Report 1998 promotion to encourage them to es- Adults tablish healthy patterns of behaviour that will influence their development Globally, adults are now surviving and health in later years. longer, largely because during the ● There will be an even greater need past half century, when they were than at present for education and children, epidemics of infectious dis- advice on unhealthy diet, inad- eases such as tuberculosis and respi- equate exercise, unsafe sexual ac- ratory disease were being better con- tivity and smoking, all of which trolled. The continuing gains in the provoke disease in adulthood but survival of infants and young children have their roots in these early means that the adult population is formative years. increasing. ● Research suggests that stress, poor ● Currently, just over half the popu- physical surroundings and an inad- lation is of working age, 20-64; by The continuing gains equate care-giving environment 2025 the proportion will have during early childhood are related reached 58%. to violent and criminal behaviour ● The proportion of older people re- in the survival of at later ages. More children than quiring support from adults of ever are growing up in such cir- working age will have increased cumstances. from 10.5% in 1955 and 12.3% in infants and young ● The transition from childhood to 1995 to 17.2% in 2025. adulthood will be marked for many ● The health of the adult population in the coming years by such poten- of working age will be vitally im- children means that tially deadly “rites of passage” as portant if this age group is to sup- violence, delinquency, drugs, alco- port growing numbers of depend- hol, motor-vehicle accidents and ants, both young and old. the adult population sexual hazards. For many, espe- ● However, more than 15 million cially those growing up in poor ur- adults aged 20-64 are dying every ban areas, adolescence will repre- year. Most of these deaths are pre- is increasing. sent the most dangerous years of ventable. life. ● Among the most tragic of these ● Sexuality and sexual activity, key as- deaths are those of 585 000 young pects of affirming maturity and women who die each year in preg- adulthood, are becoming more nancy or childbirth. dangerous due to HIV and other ● 2-3 million adults a year are dying sexually transmitted diseases, of tuberculosis, despite the exist- while globally there is still enor- ence of a strategy that could effec- mous ignorance about sex among tively cure all cases. young people, particularly adoles- ● About 1.8 million adults died of cent males. AIDS in 1997 and the annual death ● In 1995, girls aged 15-19 gave birth toll is likely to rise. to 17 million babies. That number The successes achieved in the past 50 is expected to drop only to 16 mil- years against microbial and parasitic lion in 2025. Pregnancy and child- diseases stem from the creation of a birth in adolescence pose higher healthier environment, with improve- risks for both mother and child. ments in hygiene and sanitation; Earlier sexual activity increases treatment with effective and afford- health hazards for women. able antibiotic and antiparasitic drugs; and the availability of vaccines. Un- fortunately, these types of drugs can- not be relied on to the same extent in 4

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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.