| New directions
for health into the 21st century have been released
that could save millions of lives and have a major
impact on global well-being and poverty reduction
within a decade. The main aim of organizations such
as The World Health Organization (WHO) is to increase
health life expectancy for all - while ensuring
a better deal for the world's poorest people.
The World Health Report 1999: Making a Difference
was published on the opening day of the World
Health Assembly in Geneva. In the introduction
to the Report, Dr. Brundtland, Director-General
of WHO, says:
"Working together, we have the opportunity
to transform lives now debilitated by disease
and fear of economic ruin into lives filled with
realistic hopes. I have pledged to place health
at the core of the global development agenda.
This is where it belongs. Wise investments in
health can prove to be the most successful strategies
to lead people out of poverty."
The 20th century revolution in health has led
to a drop in birth rates and dramatic gains in
life expectancy - transforming the structure of
populations and contributing to economic growth.
But not everyone has benefited. Over a billion
people have entered the 21st century without having
participated in the health revolution.
"Despite the long list of successes in health
achieved globally during the 20th century, the
balance sheet is indelibly stained by the unnecessary
burden of disease and malnutrition that the world's
disadvantaged populations continue to bear…
Reducing the burden of that inequality is a priority
in international health. Furthermore, it can be
done - that means already exist."
Policy-makers in the early decades of this century
must confront the challenges of a double burden
of disease: first, emerging epidemics of noncommunicable
diseases and injuries, which are becoming more
prevalent in both developed and developing countries,
and second, the 'unfinished agenda' of infectious
diseases, malnutrition and complications of childbirth
which disproportionately affect the poor. However,
while cost-effective interventions exist to tackle
the 'unfinished agenda', the prevention and treatment
of noncommunicable diseases is likely to be more
difficult and less cost-effective. In particular,
malaria and the prevention of tobacco deaths are
singled out for concerted global action.
Total malaria deaths could be halved - preventing
500,000 deaths a year - for about US$1 billion
a year of additional spending to strengthen health
systems, according to WHO. The disease accounts
for one in four of all childhood deaths in Africa
- both directly and indirectly in conjunction
with other causes of ill-health, such as respiratory
infections, diarrhoeal disease and malnutrition.
Several forces have combined to bring about a
resurgence of malaria: civil conflict and large-scale
human migrations, climatic and environmental change,
inadequate and deteriorating health systems, and
increasing resistance to insecticides and antimalarial
drugs. According to Dr. Brundtland:
"Even with growing resistance, an estimated
20% reduction in child deaths in Africa could
be achieved if health systems were funded, organized
and managed to bring today's knowledge and techniques
within the reach of whole populations."
There is a call for a worldwide ban on all tobacco
advertising and promotion, for regular and sustained
tax increases on cigarettes, for wider access
to tobacco substitutes such as nicotine patches,
and for the establishment of tobacco-control coalitions.
Consequently, such a global commitment to tobacco
control could avert millions of premature deaths.
Recent studies suggest that as many as one in
two long-term smokers die from their habit. If
current trends continue, by 2030 tobacco could
kill 10 million people a year - over 70% of them
in developing countries, where information on
tobacco-related disease is often weakest. Half
of the deaths will occur during the productive
middle years, involving an average loss of 20-25
years of life. The toll is more than the total
deaths from malaria, maternal and major child
conditions, and tuberculosis combined.
Ultimately, noncommunicable diseases are likely
to account for an increasing share of disease
burden - rising from 55% in 1990 to 73% by 2020.
Therefore, the two main challenges confronting
health systems in all countries are how to ensure
efficiency, and how to achieve - and maintain
- universal coverage. Many countries need to increase
overall spending on health if they are to make
even the most inexpensive and effective health
measures available to the whole population.
One way of improving efficiency is through the
extended use of integrated packages of interventions,
such as immunization programs, the Integrated
Management of Childhood Illness, the adult lung
initiative, syndromic treatment of sexually-transmitted
infections, and through integrating mental health
care with other priority interventions.
Making a Difference
Four main challenges exist for international
governments, the international community and civil
society to make a major difference to the quality
of life worldwide:
- Focusing health systems on delivering a limited
number of interventions that would have the
greatest impact on reducing the excessive disease
burden suffered by the poor. This includes focuses
on malaria and tuberculosis control, maternal
and child nutrition, and the revitalization
of immunization programs.
- Enabling health systems to counter proactively
the potential risks to health resulting from
economic crises, unhealthy environments or risky
behavior. In particular, tobacco control, the
global eradication of polio, and the promotion
of healthy lifestyles (cleaner air and water,
adequate sanitation, healthy diets, and safer
transportation).
- Developing health systems that provide universal
access to clinical service with no (or small)
fees. This will require public finance, government
mandated social insurance, or both, provided
in order of cost-effective priority. Governments
must therefore take responsibility for leadership,
regulation and solidarity in financing health
care for all.
- Encouraging health systems to invest in expanding
the knowledge base that made the 20th century
revolution in health possible, and providing
the tools to continue in the 21st century. Most
critically, the need for research and development
on infectious diseases, and establishment of
an information base to help countries develop
their own health systems.
For further information, contact The World Health
Organization (WHO) at: www.who.int
With thanks to The World Health Organization
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