Message from the Director-General
We stand on the threshold of a new era in which hundreds of millions of people will at last be safe from some of the world's most terrible diseases. Sooner rather than later poliomyelitis, leprosy, guinea-worm disease, river blindness, Chagas disease and neonatal tetanus will join smallpox as diseases of the past. Already, about 8 out of 10 of all the world's children are protected by immunization against six major childhood diseases.
These achievements would have been impossible without a dedicated international effort in creating awareness and stimulating action focused on the control of these diseases.
However, The World Health Report 1996 shows that we also stand on the brink of a global crisis in infectious diseases. No country is safe from them. No country can any longer afford to ignore their threat.
The optimism of a relatively few years ago that many of these diseases could easily be brought under control has led to a fatal complacency among the international community. This complacency is now costing millions of lives - lives that we have the knowledge and the means to save, yet we are allowing to trickle through our fingers. Furthermore, most of the lives lost are in the vital age groups that societies rely on to alleviate poverty - school-age children and working-age adults - the potential workforces of tomorrow, and the actual workforces of today.
Infectious diseases are attacking us on multiple fronts. Together they represent the world's leading cause of premature death. At least 17 million people were killed by them last year, including about 9 million young children who died from such preventable causes as diarrhoea and pneumonia. Millions more were disabled even though effective measures to prevent them are available.
Many countries and the international community have reduced their investment in the control of diseases that cause heavy economic and human tolls. The socioeconomic development of many nations - their prospect of a better future - is being crippled by the burden of these diseases. Other countries are paying a huge price in lost foreign currency income from food trade and tourism as a result of epidemics of cholera, plague and other diseases.
Major diseases such as malaria and tuberculosis are making a deadly comeback in many parts of the world. In addition to HIV/AIDS, other new and highly infectious diseases such as Ebola haemorrhagic fever are emerging at an unprecedented rate - at least 30 have been recorded in the last 20 years - and many of them are incurable. Until recently, antibiotics were regarded as the solution to many infectious diseases. Today they are becoming less and less effective as resistance to them spreads. Meanwhile, evidence gathers on the role of viruses, bacteria and parasites in the genesis of deadly cancers of the stomach, cervix and liver. Fears are also growing of a possible food chain link between bovine spongiform encephalopathy (BSE or "mad cow disease") and a form of the incurable Creutzfeldt-Jakob disease in humans, due to an infectious agent that affects the brain.
Today's crisis is likely to get worse before it gets better. Internal and international movement of populations including refugees and migrants, haphazard and uncontrolled urbanization, economic development and changes in patterns of land use as well as in ecology and climate are creating new opportunities for the spread of infections. Because of rapidly increasing international air travel, there is also a growing risk that diseases will spread within days or even hours from one continent to another. The expanding world trade and marketing of foods carries with it the threat of foodborne diseases.
Changes in lifestyle and behaviour are an additional factor in the emergence of some infectious diseases, particularly those that are sexually transmitted.
As well as identifying these problems, this report recommends workable solutions. It suggests priorities, spelling out what must be done by the global community at national, regional and international levels. The only answer to a global threat is a global response - a response of the kind that saw smallpox vanquished for ever, and saw the protection of the world's children as a priority. What is needed now is global solidarity that goes beyond selfish interests and national boundaries; it must provide a truly unprecedented response to make this world a safer and healthier one for all - rich or poor, male or female, young or old.
The focus now must be to renew the attack on those major diseases that are already targets for elimination or eradication. Extra resources must be mobilized against them, because to slacken the pace now would be to compromise progress already made. The surveillance and control of infectious diseases must be improved, and laboratory facilities for rapid recognition of outbreaks and monitoring antibiotic susceptibility have to be strengthened; they should be in the mainstream of health systems development. Intensive research on new and emerging diseases and on ways of controlling them has to be promoted and supported. If catastrophe is to be avoided, education of people in simple personal hygiene practices and basic food safety measures should be intensified. The report also shows what the World Health Organization is undertaking in a wide range of activities against infectious diseases. The experience of dealing with recent outbreaks of cholera, plague and Ebola haemorrhagic fever has shown the need to strengthen global preparedness and readiness for epidemics. As it supports development of national expertise and capability, the Organization is strengthening its own capacity to respond rapidly and more efficiently to calls for help in such emergencies. It aims to have a team of experts at the location of an outbreak anywhere in the world within 24 hours of being officially notified of it. Extra resources are being sought to fund these operations.
The world has lost sight of its priority to reduce poverty through better health and foster development by fighting disease. Today, infectious diseases are not only a health issue; they have become a social problem with tremendous consequences for the well-being of the individual and the world we live in. We need to recognize them as a common threat that has been ignored, at great cost, for too long, and to build the global solidarity to confront them. What is required is the commitment of the international community to helping countries most at risk to help themselves. By helping each other, nations united protect the world and protect themselves.
The World Health Report 1996 shows what can be done. It provides an expert and unique assessment of the crisis in infectious diseases and issues today a call for action that the world must not ignore. Hiroshi Nakajima, M.D., Ph. D. Director-General World Health Organization