The World Health Organization says in its annual report that the gap in health care between developed and developing countries is widening and that health-care systems need urgent reshaping if global health goals agreed by the international community are to be met. The authors of the report also talk to RFE/RL about the growing threat of HIV/AIDS in Eastern Europe and the former Soviet Union and the task of rebuilding health-care networks in Iraq and Afghanistan.
Prague, 18 December 2003 (RFE/RL) -- The World Health Organization today highlighted the major global health challenges in its annual report, pointing to the need for focused action to rethink and strengthen health care throughout the world.
The World Health Report 2003 says the key task of the world health community is to reverse the current widening gap in health care between rich and poor countries.
The study, launched today in Geneva, says a new drive to reform health-care systems must focus on major challenges, such as an ongoing initiative to increase the availability of anti-retroviral treatment for 3 million HIV/AIDS patients by 2005, reducing the incidence of non-communicable diseases, and decreasing the rate of maternal mortality.
It warns that WHO has only partially fulfilled the so-called Millennium Development Goals (MDGs) -- adopted at the Millennium Summit of the United Nations in September 2000. Those goals call for a dramatic reduction in poverty and marked improvements in the health of the poor.
Robert Beaglehole, editor in chief of the report, explains: "It says that in some parts of the world, we are on target to reach some of the indicators. But for some other very important targets -- for example, reductions in child mortality, children under the age of 5 -- at the current rate of progress we won't reach that until the middle of the next century, and that we say is unacceptable."
The report says life expectancy is lowest in Africa, where decades of conflict and an HIV/AIDS epidemic have led to a plunge of up to 20 years in life spans over the past half-century.
Sierra Leone is the country with the lowest life expectancy in the world -- 34 years -- while Japan has the highest, at 81.9 years.
Beaglehole also told RFE/RL that the current war on terrorism and the conflict in Iraq have also been hampering progress in health care.
"I think [the war on terrorism and the war in Iraq] has made it more complex and more difficult, and for some situations -- the situation in Iraq, for example -- the health infrastructure, already weak, has been destroyed. So you could say that the conflict over the last two or three years has actually made the achievement of the millennium goals more difficult. It's also made them much more important and, as a global community, we have to keep focused on these millennium goals," Beaglehole said.
But he says that, despite the conflicts, WHO has been actively involved in rebuilding health-care systems: "In Afghanistan, for example, I would say that WHO and other partners are putting a huge effort into rebuilding the health system in Afghanistan, and I would be pretty confident certainly, in the areas of dense population, the situation has improved. I think there's still much, much more to be done, but a good start has been made, and now we have to do the same thing -- and WHO is very serious about helping health systems in Iraq."
The report says that in 2002, HIV/AIDS remained the leading killer in the world, with 2.3 million deaths. In Africa, AIDS kills 5,000 adults and 1,000 children daily.
Alec Irwin, one of the authors of the report, says the spread of HIV/AIDS in Eastern Europe and the former Soviet Union is also extremely grave. Irwin told RFE/RL that the epidemic is spreading rapidly in the region and that urgent measures must be taken.
"Current estimates suggest that in a country like Ukraine, for example, the adult HIV infection rate is now around 1 percent of the population of adults between the ages of 15 and 49. That's a percentage that is extremely worrying. In the Russian Federation, there is also a large and growing epidemic. Estonia, for example, [is] another country that it's been very, very strongly affected. But we can say broadly that throughout Eastern Europe and the former Soviet space, there are HIV epidemics that are threatening to explode," Irwin said.
The World Health Organization is spearheading, along with UNAIDS, a major global initiative called "3 By 5" aimed at getting 3 million HIV/AIDS patients on antiretroviral treatments by 2005.
Irwin says that, besides Africa, the "3 By 5" campaign is also focusing on Eastern Europe:
"We're going to be working very, very closely with Eastern European and CIS countries to make sure that these countries also are active participants in this effort and that the citizens and people in that part of the world are also able to benefit. We're working very, very closely now, for example, with Ukraine, there'll be a '3 By 5' mission going to Ukraine to help support efforts there to expand treatment. And that work will be addressing all aspects of expanding HIV/AIDS treatment that includes procurement of antiretroviral medicines at affordable prices," Irwin said.
The report says that more than half-a-million women die each year as a result of complications during pregnancy. It also points to the spread in developing countries of epidemics of cardiovascular diseases, tobacco-induced diseases, and what it calls the "hidden epidemics" -- direct and indirect -- resulting from the growth in road traffic.
Almost 75 percent of the 45 million deaths among adults worldwide in 2002 were caused by non-communicable diseases, which are the main cause of death in all regions, except Africa.
Beaglehole says Eastern Europe has the highest rate of deaths caused by non-communicable diseases.
"The chronic diseases of adults -- the heart diseases, the strokes, the lung cancers -- are the major causes of death now, and the countries of Eastern Europe have the highest death rates in the world. And they haven't benefited from the knowledge that we have. Twenty years ago, the highest death rates were in countries like the United States and parts of the United Kingdom. Death rates in the U.S. have fallen by two-thirds in 20 years, but the people of Eastern Europe haven't benefited from this knowledge. And it's pretty basic knowledge. It's tobacco control. It's weight control. It's the outdoors activity."
Beaglehole singled out smoking as the most readily preventable cause of the chronic diseases. He said WHO has the means to help in the fight against smoking but that more political will is needed throughout the region to achieve tobacco control.
"If you wanted to do something which would make a difference tomorrow to the health of people in Eastern Europe, it would be, for sure, getting much, much serious about tobacco control. Helping people stop, preventing young people starting. And we know how to do it, but it needs leadership, it needs will, some resources, not a lot of resources, but mostly leadership -- political will, community involvement, community mobilization," Beaglehole said.
The report said that what it calls a "double response" is needed to integrate prevention and control of communicable and non-communicable diseases within a comprehensive health-care system.
(The WHO report and other materials are available on the Internet at www.who.int/whr/2003/en/)