WHO Issues Wake-up Call

Lists top 10 risks to human health

By Peter Capella, Agence France Presse

GENEVA

Governments worldwide can improve the health of their citizens and significantly raise life expectancy by tackling the top 10 health risks identified by the World Health Organization in its 2002 world health report.

    After three years of research, the WHO found for the first time that as many as 40 percent of the 56 million deaths around the world every year are due to the 10 biggest risk factors. These are lack of food, unsafe sex, high blood pressure, smoking, alcohol, unsafe water or sanitation, high cholesterol, nutritional deficiencies such as lack of iron, and obesity. Indoor smoke from cooking or heating fires, predominantly in Africa and the Indian subcontinent, is also in the top 10.

    "The potential improvements in global health are much greater than generally realized-extra years of healthy life expectancy could be gained for populations in all countries within the next decade," the report said.

    Of the 191 countries listed in the report, WHO data indicate that the average number of years spent in good health ranges from 28.7 in Angola to 73.6 years in Japan. In most west European countries people can expect to spend about 70 years in good health.

    The 2002 world health report, entitled Reducing Risks, Promoting Healthy Life, tries to quantify the reasons for poor health. "Although the report carries some ominous warnings, it also opens the door to a healthier future in all countries-if they're prepared to act boldly now," Christopher Murray, one of the authors of the report, said.

    WHO director general Gro Harlem Brundtland said in London she hoped to "spur a global reassessment of the way we look at disease." "This report provides a road map for how societies can tackle a wide range of preventable conditions that are killing millions of people prematurely," she said.

    The WHO says that by reducing the top risks by about a quarter, people could on average expect to live 10 more years in perfect health, with even bigger gains for poorer countries.

    Said Alan Lopez, the WHO's senior science adviser: "These are massive gains and this report is a wake-up call to ministries of health to act now to reduce exposure so they can realise these gains. Not only is poverty an underlying cause of many of these risk factors, but it's also in the poorer groups of the population where most of the disease burden worldwide, not just in poor countries, is concentrated."

    The list of top 10 risks in each region or country varies. But worldwide, the WHO listed lack of food as the number one health risk, causing 3.4 million deaths in the world in 2000.

    Unsafe sex ranked second with HIV infections and death from AIDS pushing the average life expectancy in the most affected areas of sub-Saharan Africa down to 47 compared to an estimated 62 years without the disease.

    Some 170 million children in poor countries are underweight, because of lack of food, while more than one billion adults in North America, Europe, and middle income countries are thought to be obese or overweight, according to WHO.

    Lopez said that in emerging countries, mainly Asian states such as China and Thailand, the major risks were much more diverse, ranging from lifestyle problems such as smoking or excessive cholesterol to lack of food. "The leading cause of disease burden in this middle income group of countries is actually alcohol. This is a surprise to us," Lopez said.

    The report advocates "cost-effective" measures to tackle major health risks including improved clean water supply, action to reduce salt and fat in processed foods, curbs on smoking or tobacco taxes, or better HIV/AIDS prevention.

    High blood pressure is third in the WHO's list of the most important controllable threats to a healthy life. In most parts of western and eastern Europe, central Asia, and the Arabian peninsula it is even the leading threat, ahead of problems such as smoking, unsafe water supply, or illicit drug consumption.

    "Population-wide salt reduction" is the most cost-effective way of tackling problems with blood pressure, alongside cutting fatty foods and eating more fruit and vegetables, according to the WHO. But voluntary salt reduction will hardly make a dent on the problem because of excessive amounts of salt in some processed foods, an issue gradually being broached in tense talks with the food industry.

    "Invariably, even if people were to cut down on salt added at the table, they will be taking too much salt in their food because of the content of salt in the food they buy in the shops," Shanthia Mendis, coordinator of the WHO's cardiovascular disease unit, said.

    So, the WHO urges governments to resort to legislation to cut the amount of salt in processed foods instead of just encouraging people to leave aside the salt shaker.

    The WHO believes the amount of salt added to industrially-produced foods or pre-prepared foods such as bread or meat dishes is a big problem in wealthier countries, where a "large majority" of people are abandoning more healthy fresh food because of their hectic urban lifestyles.

    "Legislation is potentially more cost-effective than voluntary agreements with industry-this effect is due to the assumption that legislation with enforcement will lead to a larger reduction in salt intake in the diet than voluntary agreements," the report said, although the situation might vary from country to country.

Tobacco Ad Ban Gains Ground

GENEVA

Support for a total ban on tobacco advertising strengthened as another round of talks on a global antitobacco treaty ended late October in Geneva.

    "The expression of interest in the direction of a ban has been very strong, but that doesn't mean that a text in any way is ready," said WHO director general Gro Harlem Brundtland.

    Over 100 countries, in particular African, southeast Asian, and European nations, support a complete ban on tobacco advertising, according to a source familiar with the negotiations. More than 160 countries participated in the fifth round of talks aimed at creating global rules to curb advertising, marketing and sales of tobacco products.

    The WHO has set a May 2003 deadline for adopting the Framework Convention on Tobacco Control (FCTC), and is trying to get the negotiations wrapped up by February.

    Said Brundtland: "On the advertising question, I don't think one can make some kind of conclusion at this moment about exactly where we are. What we have seen, however, is that very many delegations have had very strong opinions on that question, maybe more than many would have believed."

    The extent of the advertising ban has been one of the key sticking points in two years of talks on the treaty, along with compensation for smoking victims and financial adjustments for tobacco farmers in developing countries that shift to other crops.

    The WHO is pushing for a strong treaty putting public health needs first to curb an estimated 4.9 million smoking-related deaths per year worldwide.

    Brazilian ambassador Luis Felipe da Seixa Correa, who chairs the negotiations, said they were moving forward largely as expected, despite persisting differences on a limited number of issues. "We are now closer than ever before to our final goal, not only in time but in substance," he said.

    Antismoking campaign groups said they were happy to see the talks heading towards a total ban on advertising, promotion, and sponsorship.

    "In other key areas, however, the US, Japan, and Germany succeeded in throwing the treaty progress off-track," Kathyrn Mulvey of Infact, a US corporate watchdog group, said. Mulvey pinpointed the sticky issue of legal liability for the tobacco industry, in particular the difficulty of getting a future international convention to not collide with other agreements on free trade if measures aimed at individuals, families, and communities," he added. AFP