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Health care systems must be strengthened through
focused action in countries if global health goals agreed by the international
community are to be met, according to a new report published by the World
Health Organisation (WHO). The health care services of most developing
countries require urgent investment and international support, says The
World Health Report 2003 - Shaping the Future.
The renewed focus on health systems and services
involves all areas of WHO work: the "3 by 5" initiative to increase
the availability of antiretroviral treatment for HIV/AIDS; a newly refocused
drive to reduce maternal mortality; and work on chronic diseases and mental
health. All of these initiatives contribute to the development of better
health care in countries - and all require stronger health systems to
succeed.
The urgency of the challenge faced today is illustrated
by the contrasting prospects of baby girls born at the same moment in
Japan and Sierra Leone. While the baby born in Japan can expect to live
for about 85 years, life expectancy for the child in one of Africa's poorest
countries is just 36 years. The Japanese girl will receive some of the
world’s best health care whenever she needs it, but the girl in
Sierra Leone may never see a doctor, nurse or health worker. Health for all remains the goal
"These global health gaps are unacceptable,"
said Dr LEE Jong-wook, Director-General of WHO. “Twenty-five years
ago, the Declaration of Alma-Ata on Primary Health Care challenged the
world to embrace the principles of health for all as the way to overcome
gross health inequalities between and within countries," said Dr
Lee.
“The principles defined at that time remain
indispensable for a coherent vision of global health. Turning that vision
into reality calls for clarity both on the possibilities and on the obstacles
that have slowed and in some cases reversed progress towards meeting the
health needs of all people. This means working with countries - especially
those most in need - not only to confront health crises, but to construct
sustainable and equitable health systems.”
“To lend impetus to this process WHO is now
making the achievement of results in countries its main objective”,
Dr Lee said.
Lessons learned from tackling major health challenges
including SARS, HIV/AIDS, polio eradication and tobacco use demonstrate
that millions of people could be saved from premature death and years
of disability through a combination of financial aid and targeted improvements
in health services, says The World Health Report 2003.
The report confirms that HIV/AIDS has cut life expectancy
by as much as 20 years for many millions of people in sub-Saharan Africa.
Every day in the poorest African countries, 5,000 men and women and 1,000
children die from HIV/AIDS.
Today only 5% of all those people living in the developing
world who require antiretroviral treatment for HIV/AIDS actually receive
it: a treatment gap which WHO declared a global health emergency in September
2003.
“The WHO goal of universal access to HIV/AIDS
treatment, with the concrete target of providing treatment to three million
people in the poorest countries by the year 2005 is a clear demonstration
of how the principle of equitable access can be put into practice,”
said Dr Lee. "Working with our partners, we will show that investments
we make in treating people with AIDS can help to build up health systems
for the benefit of all."
“To meet the major health challenges facing
the world, WHO is fundamentally changing the way we work. We are committed
to combining new technologies with proven approaches to provide better
health care for all." Global health gaps in life expectancy growing
Today’s global health situation raises urgent
questions about justice. In some parts of the world there is a continued
expectation of longer and more comfortable life, while in many others
there is despair over the failure to control disease although the means
to do so exist.
The report points out that even without the impact
of HIV/AIDS, millions of children born in African countries today are
at greater risk of dying before their fifth birthday than they were a
decade ago.
In developing countries, communicable diseases still
represent seven out of the ten major causes of child deaths. Some of the
leading killers in 2002 were:
The gap between developed and developing countries
is also made starkly clear in the shocking statistics on maternal mortality.
The risk for women of dying in childbirth is 250 times higher in poor
countries than in rich ones. More than 500,000 women die each year as
a result of complications during pregnancy. Chronic diseases are the biggest killer
of adults
The report also highlights the spread in developing
countries of epidemics of heart disease, stroke and other chronic diseases,
which in addition to communicable diseases create a “double burden”
of premature death and ill-health. The report proposes a “double
response” to this burden by integrating prevention and control of
both communicable and noncommunicable diseases within a comprehensive
health care system.
Of the 45 million deaths among adults worldwide in
2002, almost three-quarters were caused by noncommunicable diseases. These
are the main cause of death in all regions, except Africa where HIV/AIDS
has become the leading cause of mortality among adults aged 15-59 years.
In this age group, the leading killers in 2002 were:
Neglect of health systems has international
consequences
The continuing HIV/AIDS epidemic, deadly outbreaks
of diseases such as SARS and the challenge of completing the eradication
of polio are all symptoms of a failure to invest in health systems. This
failure can have rapid and devastating international consequences, the
report says. "Even before I took office, I travelled to China to
view the impact of SARS and appreciated the importance of stronger health
systems to deal with this latest epidemic. There will be more to come,
hence the urgency of strengthening our ability to respond to and prevent
epidemics, whether they be local or global," said Dr Lee.
The lessons learnt from such health emergencies are
helping to shape strategies for an urgent health system response to the
prevention and care of HIV/AIDS. This will involve complex health interventions
that WHO recognizes as being not only feasible in resource-poor settings,
but precisely what is needed. "The experience we will gain in responding
to HIV/AIDS will eventually be applicable to the full range of chronic
conditions, from diabetes to stroke," said Dr Lee.
The report suggests ways in which international
support can counter some of the main health care systems weaknesses, including
critical shortages of health workers, inadequate health information, a
lack of financial resources and the need for more government leadership
aimed at improving the health of the poorest members of society. The report
calls for rapid increases in training and employment of health care workforces,
and stronger government-community relationships.
“Effective action to improve population health
is possible in every country but it takes local knowledge and strength
and sustained international support to turn that possibility into reality.
We have learned this through successes such as controlling the SARS epidemic
and major advances in the polio eradication campaign, and we have learnt
it through setbacks as well, such as the continuing rise of AIDS, TB and
malaria. All of these lessons have prepared us for the tasks ahead,"
said Dr Lee.
The World Health Report 2003 - Shaping
the Future, published December 18 2003 in English, French
and Spanish, available through bookorders@who.int
and on the Internet at www.who.int/whr.
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