The World Health Report l995: bridging the gaps

4 The World Health Report l995 Bridging the gaps Muthu Subramanian People con increosingly expect to remo in heolthy and active even when they live to on old age. The world community should be jubilant. Globally, !ife expectancy at birth - the average number of years a new born baby can be expected to live if current mortal- ity trends continue- has increased to 65 years in 1993; infant mortality rate has fallen to 62 per 1000 live births; and a rapid deceleration of population growth is projected from 1.7% in 1990-95 to 1.0% in 2020- 2025. The percentage of children immunized by the age of one year against the six vaccine-preventable diseases reached the target of 80% in 1990. It is expected that, by the end of this century, the world can witness the eradication of poliomyelitis and dracunculiasis , the elimination of leprosy, neonatal tetanus and measles , and further efforts in the control of malaria, tuberculosis , hepatitis B, coronary heart disease and cancer. At the other extreme, however, there are widening disparities in health status between countries and among population groups within countries; the gaps between the developing and the !east developed countries in respect of li fe expectancy at birth and infant mor- tality rates have widened during the last ten years. Rapid urbanization has further marginalized the urban poor, and the number of international refugees and internally displaced persons increased by 40% between 1990 and 1993 from 30 million to 43 million. Such changes have substan- tial implications for the management of health and welfare services in recipient countries. Immunization coverage seems to be declining in a number of countries, possibly due to lack of political commitment by countries, to civil unrest and to donor fatigue . The world has been "greying" rapidly ; for many of the elderly, added years to life lack the quality that can enable them to live in dignity. Crippling diseases like bronchitis , asthma, rheumatoid arthritis, diabetes and mental disorders are more prevalent, particularly among the elderly. Developing countries too are experi- encing an epidemiological transition, World Health • 48th Y eor, No. 2, Morch-Aprill995 WHO and the international health community hope ta bring about further improvements in global health status and greater equity in health, thus bridging the health development gap between countries and between different population groups within countries. with an increasing incidence of non- communicable diseases linked to changes in lifestyles. Besides the long-standing problems of communi- cable diseases such as cholera, malaria and tuberculosis, there are worrying trends in mortality from ac- cidents and suicide in young adults, particularly in industrialized countries. The pandemie of HIV in- fection and AIDS is also continuing. Towards a healthier world Nevertheless, despite the political, economie and social changes that are sweeping the world, the international health community hopes to bring about further improvements in global health status and greater equity in health by tackling problems which, at the end of the twentieth century, still characterize the health develop- ment gap between countries and between different population groups within countries. Noting with concern the increas- ing financial constraints that inhibit health improvements in Member States and the social and political implications of inequity among different population groups, the gov- World Health • 48th Y eor, No. 2, Morclr-April1 995 erning bodies of WHO directed the Organization to draw up annual assessments, starting in 1994, of the world health status and needs. They also required WHO to publish, from 1995, an annual publication indicat- ing the Organization's priorities for international action aimed at improv- ing the world health situation and ensuring essential health services and services of acceptable quality. The World Health Report 1995- Bridging the Gaps out! ines four priorities for international action. These are as follows: • Allocating resources to support those countries and population groups where the minimum levels set by the global targets for Healthfor ali by the year 2000 have not yet been reached. Low- income, severely indebted, !east developed countries, mostly in sub-Saharan Africa, should be the focus of an intensive campaign for international funding and technical support to establish and sustain an effective health infra- structure, particularly at the community leve!. • Improving labour productivity by enhancing the health of the work- force and of schoolchildren (the potential workforce) while ensur- ing that the poor, particularly families with young children and the eider! y, have access to primary health care. Special ini- tiatives should be launched to improve the status of women. • Improving equity of access to health and not merely to health care as the basis for public health policy for the future. Long-term strategies should address simulta- neously the emerging double burden of diseases and conditions in the developing world, and in- creased efforts must be made to mobilize contributions from other sectors such as education, agri- culture and the environment for achieving better health for ali. • Strengthening the capabilities of Member States in epiderniologi- cal surveillance and emergency management in the context of sustainable development. s Target offoined: now 80% of ali children ore being immunized ogoinsf six voccine-preventoble diseoses before their firsf birthdoy. This first Annual Report consists of three sections. ( 1) The Status of world health assesses global health at different phases of the li fe cycle- children, adolescents, adults and the elderly- as weil as reporting on general health issues. (2) The Contribution of WHO to world health analyses the identifiable out- cornes and outputs of WHO activities aimed at improving human health. A conceptual framework for clustering various WHO programmes so as to review their contributions to world health at different phases of the !ife cycle has been formulated and used for the purpose. (3) Charting the future indicates possible areas for priority action in international health du ring the remainder of this decade. In addition, a special section on The evolution of WHO reviews his- torical developments in international health and the ways in which WHO has moved to meet the challenges. The World Health Report 1995, published in May 1995, explores the burden imposed by specifie diseases and other health problems through- out the world in ali age groups, from children and adolescents to adults and the elderly. It presents WHO's contributions to improving global health status by providing an outcome-oriented synthesis of the Organization's significant activities and developments during 1994 and Five ma;or health threofs will hove disoppeored from the planet by the lime the bobies of todoy hove become adults. highlighting the resulting achieve- ments and improvements in health status of people in the different age groups. About 110 pages in length, the report is directed to non-medical professionals such as development planners and policy-makers, interna- tional funding institutions and donor agencies as weil as to the public and opinion-makers. • Mr Muthu Subramanian is Programme Manager, Office of World Health Reporfing, World Health Orgonizafion, 1 2 1 1 Genevo 27, Swifzerland.