World health report

Executive summary

Health of adults

WHO activities broadly seek to improve and maintain the economic and social productivity of adults by promoting health and reducing premature morbidity and mortality.

As far as the major communicable diseases are concerned, efforts are being made to mobilize financial support to combat tuberculosis, which recently has shown a worrying resurgence. Control programmes were reorganized in several countries, and operational and other studies were supported. The research has produced some important results which may have major implications for policy. A study of rifapentine suggests that it is a promising new drug. A large trial is being organized on the efficacy of sparfloxacin, another new drug, against multidrug-resistant tuberculosis. A study in Uganda on the feasibility of tuberculosis chemoprophylaxis for HIV-infected persons suggests that this intervention is not easily applicable on a large scale in a developing country setting. WHO's global task force on cholera control continues to support activities to strengthen national capacity to prepare for and respond to epidemics. Several cholera vaccines are at different stages of development. All 45 countries where malaria is endemic received WHO financial support for control activities. National plans of work, based on a revised regional control strategy, were drawn up in a number of African countries. WHO, together with other agencies and NGOs, responded promptly to requests for assistance in combating malaria epidemics in seven countries, including outbreaks among the 500 000 or so Rwandan refugees. In view of the rapid spread of chloroquine-resistant and multidrug-resistant falciparum malaria, a multicentre research programme has been initiated to study ways of retarding development of drug resistance. The synthetic Colombian malaria vaccine Spf66 has been shown to be safe, to induce antibodies and to reduce the risk of clinical malaria by around 30% among children aged under 5 in the United Republic of Tanzania.

With regard to the other communicable diseases, all countries where leprosy is endemic have implemented national strategies and plans for elimination of the disease as a public problem by the year 2000. The onchocerciasis control programme in West Africa, executed by WHO with support from UNDP, FAO and the World Bank, has succeeded in eliminating the disease as a public health problem in 11 endemic countries. Remarkable progress has been made in eradication of dracunculiasis. National eradication programmes are under way in the 18 endemic countries. A reliable village-based surveillance system has also been implemented, with monthly reporting in operation in all countries. WHO is supporting a campaign to eliminate Chagas disease from the Southern Cone of the Americas. Activities include the development of slow-release insecticidal paints which have shown to be nearly twice as effective as traditional sprays in controlling the triatomine vectors and about half as expensive. Seven-day treatments with eflornithine have been shown to be effective against trypanosomiasis. As the drug is expensive, WHO has arranged to provide it to four countries on a cost-recovery basis, and is participating in the development of a low-cost synthesis and production method. Support is given for research and training in the epidemiology and control of schistosomiasis, and a new candidate vaccine has been identified. Emergency supplies for serological diagnosis and drug treatment of visceral leishmaniasis were provided by WHO and UNICEF during a recent epidemic in Sudan. The outbreak of pneumonic plague in India in 1994 was a stern reminder that the disease often regarded as a scourge of the past still exists. WHO intervened promptly at the request of the Indian authorities. Travel advice was issued based on the International Health Regulations and an international team of experts was set up to conduct a thorough investigation. The results suggested that the outbreak involved far fewer cases than the number reported. No evidence was found of the plague spreading outside the focus; and no imported, confirmed plague was detected in any other country.

Programmes against HIV/AIDS are under way with WHO support in most Member States, including HIV surveillance activities in some 80 developing countries. Similarly, staff from 80 countries were trained in HIV/AIDS programme management. Agreements were concluded for bulk purchase of HIV test kits, ensuring quality and the best possible price for developing countries. A safety trial of a candidate vaccine against HIV, endorsed by WHO, was conducted for the first time in a developing country. Policy guidance is given in such fields as blood safety, restrictions on HIV-positive travellers and HIV testing. Hundreds of NGOs and networks of organizations work with WHO in the fight against HIV/AIDS.

WHO is developing a network of centres and a database in support of a global programme to monitor and prevent cardiovascular diseases, and continues to coordinate the 10-year, 26-country MONICA project which monitors trends and determinants in cardiovascular diseases and measures the effectiveness of interventions. National programmes for the prevention of coronary heart disease were introduced in 41 countries. Sixteen INTER-HEALTH demonstration projects have been set up worldwide (9 of them in developing countries) to assess the effectiveness of integrated community-based intervention. The related CINDI programme now covers 21 countries in Europe. WHO supports the implementation of national cancer pain relief and palliative care policies in 46 countries, and participates in the development of national cancer registers. A model list of 24 essential drugs for cancer chemotherapy was updated. Guidelines were produced on ethical issues in human genetics, and on the provision of genetic services for control of hereditary diseases. National programmes for control of diabetes and rheumatic diseases were established in several countries.

Guidelines on mental retardation, epilepsy and suicide and other aspects of mental health were issued. Studies are promoted on the long-term course and outcome of schizophrenia and obsessive/compulsive disorders. An international review of mental health legislation was undertaken. As part of efforts to prevent substance abuse, recommendations were made on international control of psychoactive substances and support is given to Member States in revising policies and legislation on treatment and rehabilitation of drug and alcohol dependence.

"Africa 2000", a new investment initiative aimed at providing universal coverage of water supply and sanitation services, was launched. A broad programme of hygiene education and promotion of low-cost sanitation is being developed in cooperation with UNICEF and other organizations. Training packages and manuals on the proper operation, maintenance and optimization of systems are being prepared, and one on health in water resources development is being tested. The healthy cities initiative now covers over 650 cities worldwide. The global WHO/UNEP networks for monitoring air and water quality are operational in more than 60 countries. Revised WHO guidelines on drinking-water quality were issued. WHO and FAO support the Codex Alimentarius Commission in promoting the adoption of scientifically-based national food legislation. Together with FAO, WHO has established acceptable daily intakes for well over 700 food additives, contaminants and veterinary drug residues in food.

WHO/UNICEF/UNFPA policy statements were issued on promotion of the health of women. National safe motherhood action plans were formulated in 10 countries. Databases for monitoring patterns and trends in maternal health are being disseminated. A total of 87 research projects are funded, many dealing with the causes of maternal death and disability. A project was launched to promote simple methods for early detection of cancer of the cervix and breast in developing countries.

A key objective for WHO is to enable the elderly to exercise their full potential as a community resource, and to give them a satisfactory quality of life. Many WHO programmes are involved in this effort, including those concerned with nutrition, cardiovascular diseases, cancer and palliative care. A multinational collaborative study on the predictors of osteoarthritis was launched. In pursuance of the United Nations international plan of action on aging, WHO is setting up an integrated programme on aging and health, which will become fully operational in 1996.