WHO in action

28 WHO in action Calling for a nursing revolution in eastern Europe A s the largest group of health personnel in any country, nurses play a key role in maintaining and improving the ·health of people. In the countries of central and eastern Europe and the newly independent states of the former USSR, there are 2.6 million nursing staff, whose contribution, according to nursing leaders attending the recent meeting of the WHO European Regional Committee in Athens last September, was needed today more than ever, "when the health of our people is under threat because of the serious economic difficulties being faced." The Nursing Declaration of Alma- Ata had been adopted a week earlier in the capital of Kazakhstan, and government Chief Nurses from six new WHO Member States- Armenia, Kazakhstan, Kyrgyzstan, the Russian Federation (Tumen Oblast), Turkmenistan and Uzbekistan- declared that the development of nursing, midwifery and other middle- level health personnel should be a priority for all countries. Various measures were outlined, which must be carried out if nurses are to function effectively. As a starting point, every Ministry of Health was urged to establish a Chief Nurse position, to be occupied by a qualified nurse and supported with appropriate staff and budget. Each country should also develop a national action plan for nursing, as recommended in 1992 by the World Health Assembly. Finally no progress was possible without improvements in the socioeconomic position of nurses, including better pay and working conditions. Nursing leaders also called for closer international links, within the A nurse gives an in;ectian in Tbilisi, Georgia. newly independent states of the former USSR, and with WHO. The WHO Collaborating Centre for Primary Health Care and Nursing in Alma-Ata, Kazakhstan, would continue to play a leading role in maintaining these networks. "This is an extremely important milestone which could revolutionize health care in the former USSR," said Jane Salvage, WHO's European Regional Adviser for Nursing and Midwifery. "Nurses in the newly independent states face enormous difficulties in their professional and personal lives. Nevertheless they are determined to introduce long overdue changes in the role and functions of nurses, midwives andfeldshers (health workers). WHO is proud to be working in partnership with these dynamic leaders at such a critical moment in their countries' health development." The government Chief Nurses will World Health • 46th Year, No. 6, November-December 1993 meet again in Kyrgyzstan in 1994 to review progress towards meeting the aims of the Declaration. For more information, please contact the Nursing and Midwifery Unit, WHO, 8 Scherfigsvej, 2100 Copenhagen 0, Denmark. • International Thyroid Proiect An unprecedented increase in childhood thyroid cancer has been recorded in Belarus since the Chemobyl nuclear power plant accident in April 1986. The Belarusian delegation told WHO's European Regional Committee, which met in Athens in September, that in 1991 there were more than 1 00 cases in children under the age of 15 in the Gomel region - the part of Belarus closest to Chemobyl- and the incidence was increasing in the Brest region. World Health • 46th Yeor, No. 6, November-December 1993 In response to this situation, the WHO Regional Office is launching an International Thyroid Project, aimed at elucidating the origin of the outbreak and its likely extent, both geographically and over time. Its fmdings will have implications for advice on public health measures that should be undertaken following any similar accidents in future. The issue is of particular importance in the European Region, which has the largest concentrations in the world of nuclear activities and facilities - including nuclear weapons, manufacturing and testing sites, nuclear waste disposal and power generation, as well as food irradiation and processing. All these create uncertainty about possible public health implications of exposure. The International Thyroid Project will involve creating a network of international collaborating centres with specific expertise around a collaborating centre in Minsk, from which diagnosis and treatment will be coordinated for the whole country. The network is designed to provide a framework in which collaborative research studies and training can be carried out. For more information, please contact Dr Keith Baverstock, WHO European Centre for Environment and Health, Via Vincenzo Bona 67, 00156 Rome, Italy (fax: (396) 411 66 49) . • One hundred years of international disease classification On 1 January 1993, the Tenth Revision of the International Classification of Diseases (I CD) came into effect, exactly one century after the adoption of the first classification. Two volumes were pu~lished in the course of 1993, and will be followed by a third. The need for classifying diseases and causes of death was clearly perceived centuries ago. The first root of the classification can be found in 18th century work by Fran~ois Bossier de Lacroix, William Cullen, 29 The classification of diseases is a powerful tool for epidemiological research and, ultimately, for health promotion and the father of biological classification systems, Linnaeus. In fact, the statistical study of disease began a century earlier, with John Graunt's analyses ofthe London Bills of Mortality. During the 19th century, people like William Farr of London, Marc D 'Espine of Geneva, and Jacques Bertillon of Paris worked at classifying causes of death in an international perspective. The first edition of the international list of causes of death, presented by Jacques Bertillon at a meeting of the International Statistical Institute in Chicago, was adopted 100 years ago, in 1893. This list was subsequently revised several times, reflecting advances in medical knowledge and changes of emphasis in public health. At the time of the Sixth Revision, in 1948, WHO became responsible for the revisions. The ·classification was considerably expanded over the years to cover the whole spectrum of health data, as it was recognized that classifying sickness and injury was closely linked with the classification of the causes of death. Useful in many fields of medicine, such as hospital and outpatient care, epidemiological research, hospital indexing of medical records, medical audit systems, planning and evaluation of health services, social security, health insurance, health cost and reimbursement for care services, the core classification is intended to be appropriate to all countries, regardless of their state of development. Its structure makes it possible to expand or reduce the number of categories according to need. The ICD is a tool for making comparisons between countries at the same point in time, and within and between countries over time, thus making comparable statistics available for decision- making in disease prevention and the provision of care at all levels. In order to emphasize its statistical purpose and to reflect the widening of its scope, ICD has now received the title of "International Statistical Classification of Diseases and Related Health Problems". Specially adaptations have been produced to include such areas as oncology, neurology, psychiatry, rheumatology and orthopaedi_cs. Another important health-related classification concerns impairments, disabilities and handicaps, which establishes for international acceptance and use uniform definitions in the terminology - often confused and misused - in the field of rehabilitation. •