16 January 1998
101st SESSION OF THE WHO EXECUTIVE BOARD OPENS ON MONDAY
The 101st session of the World Health Organization's (WHO) Executive Board opens on Monday, 19 January 1998 under the chairmanship of Professor Abdelhamid Aberkane of Algeria.
The 32-strong Executive Board* comprises nationals of Algeria, Angola, Argentina, Australia, Bahrain, Barbados, Benin, Bhutan, Botswana, Brazil, Burkina Faso, Burundi, Canada, Cook Islands, Croatia, Cyprus, Egypt, Germany, Honduras, Indonesia, Ireland, Japan, Republic of Korea, Netherlands, Norway, Oman, Peru, Poland, Sri Lanka, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, and Zimbabwe.
The Board will have a heavy agenda to go through in the next two weeks, the most important items being consideration of the draft global health policy for the 21st century, WHO reform, and nomination of a new WHO Director-General. The nomination, voted in closed session, is expected to be announced on Tuesday, 27 January. The Executive Board nomination will be considered by the World Health Assembly in May 1998.
The new global health policy for the 21st century "Health for All in the 21st Century" builds on past achievements, guides action and policy for health at all levels, and identifies global priorities and targets. Most of all, it takes account of the dramatic global changes of the past 20 years. It is the result of extensive consultations with, and within, WHO Member States - a process essential to creating ownership of the policy. While the world has seen considerable gains in health in recent decades (life expectancy has increased to 65 years in 1995 from 46 years in the 1950s; control and prevention of diseases have greatly reduced childhood mortality), certain health gaps between and within countries have widened. There are alarming trends in the incidence of a number of diseases. A host of environmental and social problems continue to add to the burden of disease and ill-health. Poverty remains a major cause of undernutrition and ill-health. It contributes to the spread of disease, undermines the effectiveness of health services and slows population control.
Among other items for the Board's consideration are:
Emerging and other communicable diseases: Antimicrobial resistance
While dealing with emerging and other communicable diseases the Board will examine the global issue of antimicrobial resistance which is rapidly becoming a leading cause of concern for public health. The wide and increasing use of antibiotics in man and animals, and in agriculture has led to the development of microorganisms' resistance at an unprecedented rate. Antimicrobials used for any condition, real or feared, are not reserved for human medicine alone: more than half of the total use of antimicrobials in some countries is utilized in animal and fish farming and in other aspects of agriculture, increasing further the likelihood of emergence of antimicrobial resistance. Bacteria are extremely efficient at increasing resistance. In some countries, low-quality antibiotics (poorly made or past their sell-by date) are still sold and used for medication. Physicians, under pressure from patients, prescribe antimicrobials even in the absence of appropriate indications. Patients often fail to comply with the prescriptions and forget their treatment or interrupt it prematurely, creating an ideal environment for microbes to adapt and survive.
Noncommunicable disease prevention and control
The Board is to discuss the "global burden" of noncommunicable diseases which were responsible for nearly a half of the total estimated 52 million deaths in 1996. Noncommunicable diseases are not only a problem of the rich; they cause 40% of all deaths in developing countries. The "epidemiological transition", with its double burden of infectious and noncommunicable diseases, is common to many developing countries, where about two-thirds of the deaths due to circulatory diseases (64%), cancers (60%) and chronic obstructive lung diseases (66%) occur. Numerous studies over the past 40 years, in different parts of the world, have clearly identified multiple risk factors in the development of major noncommunicable diseases and traced their origins in unhealthy lifestyles and polluted environments.
Strategy on sanitation for high-risk communities
Among environmental matters to be discussed by the Board, is a new strategy on sanitation for high-risk communities. Sanitation is universally accepted as a foundation for good health but nearly two-thirds of all people in developing countries do not have sanitary excreta disposal, and the number without adequate services is growing. Rapid population growth, urbanization, and over-crowding, in the absence of sanitation services, results in increasingly polluted environments and higher risk of disease epidemics: witness epidemics of cholera and plague in recent years. Through good sanitation services, together with safe and ample water supply, hygienic behaviour and safe food, this risk can be reduced to nearly zero.
Climate change and human health - WHO participation in the interagency climate agenda
Another environmental item on the agenda concerns climate change and human health. The impact of increased climate variability will place additional strains on public health programmes in most countries. The geographical range of infectious and vector-borne diseases could expand. A reduction in greenhouse gas emissions will lead to immediate public health gains as air pollution levels caused by combustion of fossil fuels are reduced. WHO is to contribute to the "climate agenda" adopted by the World Climate Programme in 1996. The "climate agenda" addresses the need for coordinated scientific and technical programmes to assist countries in coping better with climate-related matters affecting health, environment and development.
The Board will consider progress towards elimination of two major tropical diseases, namely leprosy and Chagas disease. Since 1991, when the World Health Assembly targeted leprosy for global elimination by the year 2000, significant progress has been achieved throughout the world, including a 76% reduction in the number of registered cases. The number of endemic countries has shrunk from 122 in 1985 to 55 in 1997. During 1995-1997, WHO procured and supplied drugs for multidrug treatment to more than 2.3 million patients in 52 endemic countries.
From a global perspective, Chagas disease is the world's third tropical disease burden after malaria and schistosomiasis. It is caused by a parasite, Trypanosoma cruzi, transmitted to humans by insects. The geographical distribution of infection extends from Mexico to the south of Argentina. The disease affects 16-18 million people, and some 100 million, a quarter of the population of Latin America, are at risk of contracting the disease. The economic loss for the continent due to early mortality and disability amounts to US$ 8 200 million a year. Countries of Central and Latin America are working together towards elimination of transmission of Chagas disease by the end of 2010.
The Board will also be discussing infant and young child nutrition, tuberculosis, prevention of violence and cooperation with nongovernmental organizations.
* Members of the Board are designated by their own countries for a three-year term in their personal capacity. Each year one-third of the Board's membership is replaced.
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