World Health Organization Report English 1998

226 Pages·1998·1.8 MB·English

by  World Health Organization (WHO)

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
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© World Health Organization 1998
All rights reserved.
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not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization
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Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
Information concerning this publication can be obtained from:
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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