PHA-Exchange> World Health Report: YEARS OF HEALTHY LIFE CAN BE INCREASED 5-10 YEARS, WHO SAYS

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YEARS OF HEALTHY LIFE CAN BE INCREASED 5-10 YEARS, WHO SAYS

Worldwide, healthy life expectancy can be increased by 5-10 years if
governments and individuals make combined efforts against the major health
risks in each region, the World Health Organization (WHO) says in its new
yearly report.
> >>
 The World Health Report 2002 -- Preventing Risks, Promoting Healthy
Life -breaks new ground by identifying some major principal global risks to
disease, disability and death in the world today, quantifying their actual
 impact from region to region, and then providing examples of
 cost-effective ways to reduce those risks, applicable even in poor
countries.
> >>
> >> "This report provides a road map for how societies can tackle a wide
range
of preventable conditions that are killing millions of people prematurely
and robbing tens of millions of healthy life," says WHO Director-General
Gro Harlem Brundtland, MD. "WHO will take this report and focus on the
interventions that would work best in each region and on getting the
 information out to Member States."
> >>
 From more than 25 major preventable risks selected for in-depth study, the
 report finds that the top 10 globally are: childhood and maternal
 underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe
 water, sanitation and hygiene; high cholesterol; indoor smoke from solid
 fuels; iron deficiency and overweight/obesity. Together, they account for
 about 40 per cent of the 56 million deaths that occur worldwide annually
 and one-third of global loss of healthy life years.
 >>
> These leading risks are comparatively much more important than widely
 believed.
> >>
>> WHO calls the contrast between rich and poor people "hocking." The burden
 from many of the risks is borne almost exclusively by the developing
 world, while other risks have already become global. Some 170 million
 children in poor countries are underweight, mainly from lack of food,
 while more than one billion adults worldwide - in middle income and high
 income countries alike are overweight or obese. About half a million
 people in North America and Western Europe die from
 overweight/obesity-related diseases every year.
 >>
> >> WHO warns that the "cost of inaction is serious." The report predicts
that
 unless action is taken, by the year 2020 there will be nine million deaths
 caused by tobacco, compared to almost five million a year now; five
 million deaths attributable to overweight and obesity, compared to three
 million now; that the number of healthy life years lost by underweight
 children will be 110 million, which, although lower than 130 million now,
 is still unacceptably high.
> >>
> If all of these preventable risks could be addressed as WHO recommends
 (which WHO acknowledges is a highly ambitious goal), healthy life spans
 could increase as much as 16 plus years in parts of Africa, where healthy
 life expectancy now falls as low as just 37 years (in Malawi). Even in the
 richer developing countries, such as Europe, the United States, Australia,
 New Zealand and Japan, healthy life spans would increase by about five
 years.
> >>
> "Globally, we need to achieve a much better balance between preventing
 disease and merely treating its consequences," says Christopher Murray,
 M.D., Ph.D., Executive Director of WHO's Global Programme on Evidence for
 Health Policy and overall director of World Health Report 2002. "This can
 only come about with concerted action to identify and reduce major risks
 to health."
> >>
> WHO has developed a unique framework for using a wide body of scientific
 evidence to comparably assess the impact of different risks in a 'common
 currency' of lost healthy life years, called the DALY (disability-adjusted
 life year). This takes into account the impact of the different risks on
 mortality and on morbidity. A DALY is equal to the loss of one healthy
 year of life.
> >>
> Risks that result in death reduce life expectancy. Risks that result in
 short or long term morbidity mean that people stay alive, but not in full
 health. Healthy life expectancy (HALE) is, therefore, lower than life
 expectancy.  For example, overall life expectancy in Japan is 84.7 years
 for women and 77.5 for men, versus a healthy life expectancy of 73.6 years
 for men and women.
 >>
>> The report divides the world into 14 different regions on the basis of
 geography and health development [see Annex (WHRrelease Oct 24 annex.doc)
 attached], then analyzes the risks most important in each area and the
 gains in healthy life span that can be achieved. The top risks vary
 widely, from being underweight and unsafe sex in most of Africa to tobacco
 use and high blood pressure in North America, Western Europe and developed
 countries in the Western Pacific such as Japan.
> >>
> The major risks reviewed in the report are responsible for a substantial
 loss in healthy life expectancy  - on average about five years in
 developed countries and 10 years in developing countries.
> >>
> The amount of lost healthy life years due to these leading risks varies by
 region In Canada, the United States and Cuba (highest ranked group in the
 Western Hemisphere), healthy life expectancy can increase by 6.5 years,
 from their current healthy life expectancy of Canada, 69.9 years; Cuba,
 66.6 years, U.S., 67.6 years. In the wealthiest countries of Europe,
 including Germany, France, Italy, Spain and the United Kingdom, healthy
 life expectancy can grow by 5.4 years; in most of Latin America, including
 Argentina, Brazil and Mexico, 6.9 years; in an Asian group including
 China, 6 years; in another Asian group including India, 8.9 years. (WHO
 estimates apply to each region as a whole and may not apply to any given
 country.)
> >>
> A considerable part of this burden could be reduced by that of
 cost-effective interventions identified in the report.  WHO has developed
 a first-ever system of identifying and reporting cost-effective health
 interventions consistently across different regions that it calls CHOICE
 (CHOosing Interventions that are Cost-Effective). Various CHOICE options
 are contained in a new statistical database that is also a part of the
 World Health Report 2002, one of the largest research projects ever
 undertaken by the World Health Organization.  These interventions can be
 implemented on an à la carte basis, depending on each country's individual
 circumstances.
 >>
>> "Although the report carries some ominous warnings, it also opens the
door
 to a healthier future for all countries - if they're prepared to act
 boldly now," says Dr. Murray. "In order to know which interventions and
 strategies to use, governments must first be able to assess and compare
 the magnitude of risks accurately. Our report gives assessments for each
 of the major risks."
 >>
 Selected Major Risk Factors and What to Do About Them

 The report shows that a relatively small number of risks cause a huge
 number of premature deaths and account for a very large share of the
 global burden of disease. For example, at least 30 per cent of all disease
 burden occurring in the highest mortality developing countries, such as
 those in sub-Saharan Africa and south-east Asia, results from underweight
 and deficiencies in micronutrients like iron and zinc, unsafe sex, unsafe
 water, sanitation, and hygiene and indoor smoke from solid fuels, the
 leading risks examined in those countries.
>>
>> "Every country has major risks to health that are known, definite and
 increasing, sometimes unchecked," says Anthony Rodgers, M.D., Ph.D., of
 the University of Auckland, New Zealand, and a WHO consultant who is one
 of the report's main writers. "For each of these risks, we have
 established effective, but often underused, interventions."
 >>
>> The report also breaks new ground by assessing avoidable death and
 disability at a global scale. By incorporating current knowledge in risk
 factor, demographic and mortality trends, an intriguing picture emerges -
 an increasingly ageing world facing some major risks globally (such as
 tobacco), as well as remaining very high mortality regions, particularly
 sub-Saharan Africa.
>>
>> "This report brings out for the first time that 40 per cent of global
 deaths are due to just the10 biggest risk factors, while the next 10 risk
 factors add less than 10 per cent," says Alan Lopez, Ph.D., WHO Senior
 Science Advisor and co-director of the Report. "This means we need to
 concentrate on the major risks if we are to improve healthy life
 expectancy by about 10 years, and life expectancy by even more."
 >>
>> Given the risks measured in this Report and other known major risks,
 current scientific knowledge has clearly identified causes for most death
 and disability globally. For example, more than three-quarters of major
 diseases such as ischaemic heart disease, stroke, HIV/AIDS and diarrhoea
 were due to the combined effects of risks assessed in the Report. WHO
 emphasizes that each risk is also a prevention opportunity, and the
 potential for prevention from tackling major known risks is clearly
 substantial, and much greater than commonly thought.
> >>
> "Since many of these risks are continuous, without a threshold, the most
 cost-effective interventions are often those that move the entire
 population to a lower risk zone," says Dr. Rodgers. "A good example would
 be government- and industry-led reductions of salt in processed foods,
 which would have major population-wide benefits."
>>
>> Underweight/under-nutrition -- Childhood and maternal underweight was
 estimated to cause 3.4 million deaths in 2000, about 1.8 million in
 Africa. This accounted for about one in 14 deaths globally.
 Under-nutrition was a contributing factor in more than half of all child
 deaths in developing countries. Since deaths from under-nutrition all
 occur among young children, the loss of healthy life years is even more
 substantial: about 138 million DALYs, 9.5 per cent of the global total.
>>
>> Under-nutrition is mainly a consequence of inadequate diet and frequent
 infection, leading to deficiencies in calories, protein, vitamins and
 minerals. Underweight remains a pervasive problem in developing countries,
 where poverty is a strong underlying cause, contributing to household food
 insecurity, poor childcare, maternal under-nutrition, unhealthy
 environments, and poor health care.
>>
 >> Interventions -- The most cost effective strategy to reduce
 under-nutrition and its consequences combines a mix of preventive and
 curative interventions. Micronutrient supplementation and fortification -
Vitamin A, zinc and iron - is very cost-effective.  It should be combined
 with maternal counselling to continue breast feeding, and targeted
 provision of complimentary food as necessary. In addition, routine
 treatment of diarrhoea and pneumonia, major consequences of
 under-nutrition, should be part of any health improvement strategy for
 children.
>>
 >> Unsafe sex -- HIV/AIDS caused 2.9 million deaths in 2000, or 5.2 per
cent
 of total. It also causes the loss of 92 million DALYs (6.3 per cent of
 all) annually. Life expectancy at birth in sub-Saharan Africa is currently
 estimated at 47 years; without AIDS it is estimated that it would be
 around 62 years. Current estimates suggest that 95 per cent of the HIV
 infections prevalent in Africa in 2001 are attributable to unsafe sex.  In
 the rest of the world the estimated percentage of HIV infections prevalent
 in 2001 that are attributable to unsafe sex ranges from 25 per cent in
 Eastern Europe to 90 per cent or more in parts of South America and the
 developed countries of Western Pacific.
 Interventions -- Most people infected with HIV do not know they are
 infected, making prevention and control more difficult. Various sexual
 practices contribute to the risk of sexually transmitted infections.
 High-risk sex practices include multiple partners, together with lack of
 condom use and the type of sex acts involved. Treatments include:
>
 *    Population-wide mass media health promotion using the combination of
 television, radio and printed media.
 *    Voluntary counselling and testing.
 *    School-based AIDS education targeted at youths aged 10-18 years.
 *    Peer counselling for sex workers.
 *    Peer outreach for men who have sex with men.
 *    Treatment of sexually transmitted infections as a way of reducing
 transmission of HIV infections.
 *    Treatment of mothers with HIV infection to prevent maternal to child
 transmission.
 *    Anti-retroviral therapy has also been evaluated.
 *    Intervention combinations: WHO says that the best way to address the
problem is to apply a combination of the above interventions at a
 population-wide level.
 >>
 >> High blood pressure and cholesterol -- Worldwide, high blood pressure is
 estimated to cause 7.1 million deaths, about 13 per cent of the global
 fatality total. Across WHO regions, research indicates that about 62 per
 cent of strokes and 49 per cent of heart attacks are caused by high blood
 pressure.
> >>
 >> High cholesterol is estimated to cause about 4.4 million deaths (7.9 per
 cent of total) and a loss of 40.4 million DALYs (2.8 per cent of total),
 although its effects often overlap with high blood pressure. This amounts
 to 18 per cent of strokes and 56 per cent of global ischemic heart
 disease.
> >>
>> Blood pressure is a measure of the force that the circulating blood
exerts
 on artery walls. High blood pressure levels damage the arteries that
 supply blood to the brain, heart, kidneys and elsewhere. Cholesterol is a
 fat-like substance found in the bloodstream that is a key component in the
 development of atherosclerosis, the accumulation of fatty deposits on the
 inner lining of arteries of the heart and brain.
>>
>> Interventions - The World Health Report 2002 urges countries to adopt
policies and programs to promote population-wide interventions like
 reducing salt in processed foods, cutting dietary fat, encouraging
 exercise and higher consumption of fruits and vegetables and lowering
 smoking. These are the most cost-effective interventions identified to
 reduce cardiovascular disease. This reflects recent evidence that such
 therapy benefits all groups at elevated risk, even those with average or
 below average blood pressure or cholesterol.
>>
>> When added to this base, a combination of drugs -- statins (cholesterol
 lowering), low-dose blood pressure lowering medications and low-dose
 aspirin (blood-thinning) -- given daily to people at elevated risk of
 heart attack and stroke, would achieve very substantial additional
benefits. This highly effective drug combination is likely to more than
 halve stroke and heart disease incidence and could be widely used in the
 developed world, and is increasingly affordable in the developing world.
>>
 >> "Our new research finds that many established approaches to cutting CV
 disease risk factors are very inexpensive, so that even countries with
 limited health budgets can implement them and cut their CV disease rate by
 50 per cent," says Derek Yach, M.D., Executive Director of the Cluster on
 Non-communicable Diseases and Mental Health. "In addition, drug treatments
 are increasingly affordable in middle and low-income countries, as
 effective drugs come off patent."
 >>
 >> Tobacco Use -- WHO estimates that tobacco caused about 4.9 million
deaths
 worldwide in 2000, or 8.8 per cent of the total, and was responsible for
 4.1 per cent of lost DALYs (59.1 million). In 1990, it was estimated that
 tobacco caused just 3.9 million deaths, demonstrating the rapid evolution
 of the tobacco epidemic and new evidence of the size of its hazard, with
 most of the increase in developing countries.
>>
 >> Interventions -- Countries that have adopted comprehensive tobacco
control
 programs involving a mix of interventions including a ban on tobacco
 advertising, strong warnings on packages, controls on the use of tobacco
 in indoor locations, high taxes on tobacco products and health education
 and smoking cessation programs have had considerable success. WHO found
 that for every 10 per cent real rise in price due to tobacco taxes,
 tobacco consumption generally falls by between 2 per cent and 10 per cent.
 In addition to national programs, an effective Framework Convention on
 Tobacco Control will address transnational aspects of the issues.
>
>> Nicotine replacement therapy (NRT) targeting at all current smokers was
 less cost-effective than the other strategies, but affordable in higher
 income countries. NRT includes nicotine patches, nicotine chewing gum,
 nicotine nasal sprays, lozenges, aerosol inhalers and some classes of
 anti-depressants.
> >>
>> Unsafe Water and Sanitation -- Approximately 3.1 per cent of deaths (1.7
 million) and 3.7 per cent of DALYs (54.2 million) worldwide are
 attributable to unsafe water, sanitation and hygiene. Of this burden,
 about one-third occurred in Africa and one-third in south-east Asia.
 Overall, 99.8 per cent of deaths associated with these risk factors are in
 developing countries, and 90 per cent are deaths of children. Various
 forms of infectious diarrhoea make up the main burden of disease
 associated with unsafe water, sanitation and hygiene.
>>
>> Interventions -- The United Nations has adopted a goal of halving the
 number of people with no access to safe water and sanitation by 2015.
 Improved water supply and basic sanitation, if extended globally, could
 prevent 1.8 billion cases of diarrhoea (a 17 per cent reduction of the
 current number of cases) annually. If universal piped and regulated water
 supply were achieved, 7.6 billion cases of diarrhoea (69.5 per cent
 reduction) would be prevented annually. Universal piped water is the
 ideal, but is high cost.  In the short term, the most cost-effective
 strategy evaluated was disinfection of unsafe water at the point of use.
 This is a simple technology, is of very low cost, and would achieve
 substantial health benefits.
> >>
>> Iron deficiency -- Iron deficiency is one of the most revalent nutrient
 deficiencies in the world, affecting an estimated two billion people with
 consequences for maternal and perinatal health and child development. In
 total, 800,000 (1.5 per cent) of deaths worldwide are attributable to iron
 deficiency, 1.3 per cent of all male deaths and 1.8 per cent of all female
 deaths. Attributable DALYs are even greater, amounting to the loss of
 about 25.9 million healthy life years (2.5 per cent of global DALYs)
 because of the non-fatal outcomes like cognitive impairment.
> >>
>> Interventions -- Iron fortification is very cost-effective in areas of
 iron deficiency.  It involves the addition of iron usually combined with
 folic acid, to the appropriate food vehicle made available to the
 population as a whole. Cereal flours are the most common food vehicle, but
 there is also some experience with introducing iron to other vehicles such
 as noodles,rice, and various sauces.
 >>
>>  "We surprised even ourselves in how far-reaching the health benefits can
 be if governments and health systems adopt our recommendations," says Dr.
 Murray. "WHO believes that the wide distribution of this report should
 become a prime goal of all Member States."