Who cares? WHO cares - United Nations World Health Organization

UN Chronicle, Spring, 1999

What will life be like in the twenty-first century?

As it looks towards the early twenty-first century, the World Health Organization (WHO) predicts that the world - already free of small pox - should also be free of poliomyelitis, measles and neonatal tetanus.

Some other infectious and parasitic diseases will be eliminated, and the burden of many more which currently afflict tropical regions should be further reduced.

Most children should be protected from vaccine-preventable diseases through well-established and sustainable immunization programmes, and deaths among small children would be reduced.

At the same time, however, the world is expected to confront an increase in deaths of adults in the age range of 20 to 64 years, while major health problems by the year 2025 are expected to be diseases of the circulatory system, cancers, infectious and parasitic diseases, and external causes. Available data suggests that in some countries, deaths from circulatory diseases are falling, while cancer deaths are increasing.

WHO estimates that about two thirds of global cancer deaths, cancer incidence during 1997 and cancer prevalence in 1997 can be clustered according to four risk factors: diet-related (stomach, colon-rectum, liver, mouth-pharynx and prostate); tobacco-related (lung); infection-related (lymphoma and cervix); and hormone-related (breast). WHO foresees that the overall global situation in respect of cancers of the stomach, liver, mouth and pharynx, the cervix and the breasts will improve in the early 21st century, while those related to the lung, trachea, bronchus, colon and rectum, and prostate, as well as lymphoma, will worsen.

Other aspects of our current lifestyles will continue to have a negative impact on our health. Sedentary living, excessive or ill-balanced diets, smoking and a deteriorating environment will result in an increase in crippling chronic diseases such as diabetes, rheumatoid arthritis and lower back pain. Many will continue to suffer from mental disorders, from the relatively minor to the incurable and life-threatening.

It is also forecast that the 21 million-odd deaths of people under 50 years of age, which are due to infectious diseases, can be prevented through cost-effective interventions such as immunizations and essential clinical care management, personal hygiene, public health and sanitation practices, and the safe processing, preparation and handling of foods. For the first quarter of the century, WHO foresees that worldwide "every individual should enjoy his or her full health potential throughout the life span and be socially, economically and mentally productive and be able to have a better quality of life". That general picture of optimism is balanced by the reality of the number, range and seriousness of the diseases that continue to confront us.

The benefits of scientific and technological developments will continue to contribute significantly to the provision of health care. Further investment in basic and applied science is expected to pay off. An integral part of those developments must be properly planned-schemes for technology transfer, which should make it possible for developing countries to capitalize, for health, on advances in other countries.

The increased use of information technology in health will enable doctors to keep closer track of patients' progress. Globally, it will enable the surveillance and monitoring of diseases and facilitate rapid international responses to epidemics. In the face of concern for the widening gap between the developed and developing countries, international organizations will continue to facilitate the information flow towards developing countries so that poorer nations can obtain information at affordable cost and build their own information infrastructures. The Internet is expected to continue to contribute to the increase in, and availability of, knowledge of health issues.

The WHO Report stresses that "health policy cannot be developed in a vacuum", because all the actors involved shape the politics of health and health care. The commitments and interests of international agencies, foreign aid, nongovernmental and community organizations shape the politics of health and health care. "Satisfying the health demands of women, the aged, ethnic minorities, children, the disabled and those with certain diseases such as AIDS involves politics related to ideology, ethics and the lack of political influence of these groups."

The search for equity remains at the heart of attempts to achieve health for all, in WHO's view. Governments need to address health-care needs through the arrangement of healthcare systems. Recently, in some countries, the core public functions of ensuring equity have weakened, as individual States reduce emphasis on social areas and transfer some responsibilities to the private sector and to local levels where mechanisms to safeguard equity may be lacking or weak.

Governmental reforms have affected the State's role as designer, financier, and regulator of policies. WHO calls for a shift to a new paradigm focussed on the poor, including specific targeting strategies and equity, with the premise of "treating equally those who are socially and economically unequal". The emphasis on the need to reduce poverty lies in the belief that there is a risk that the accelerated global evolution will leave more than half a billion people in poverty in the year 2020. However, it is noted that in spite of increasing globalization, national policies remain of paramount importance in determining levels of employment and labour standards, for example. National governments have a role to play in policy setting and legislation, especially in the social sector. They cannot abdicate their responsibilities.