Executive summary
Chronic conditions
Since chronic conditions have a number of common risk factors, WHO adopts an integrated approach to their prevention through the INTERHEALTH project. Genetic factors, for example, play an important role in determining individual susceptibility to various types of cancer and to diabetes mellitus, cardiovascular diseases and hereditary disorders. WHO has set up such integrated programmes in all regions of the world. In Europe, the countrywide integrated noncommunicable diseases intervention (CINDI) programme now covers 24 countries; based on the experience in the CINDI network, a special action plan has been developed with the aim of building capacity for preventing chronic diseases in eastern Europe. In the Americas, there is a similar project known as CARMEN, which focuses mainly on cardiovascular diseases but is also concerned with diabetes, cervical cancer and injury prevention.
The International Agency for Research on Cancer (IARC) coordinates and conducts epidemiological and laboratory research and risk evaluations that form the basis of scientific strategies for preventing cancer. In 1996 the Agency published monographs on the carcinogenic risks posed by printing inks and printing processes; by some pharmaceutical drugs, including tamoxifen; and by retroviruses, including HIV. Other publications dealt with cancer chemoprevention, cancer incidence and mortality, and fibre carcinogenesis.
The 10-year-old, 26-country MONICA project continues to monitor trends and determinants of circulatory diseases and measures the effectiveness of interventions. During 1996, WHO disseminated the first five-year trend data on risk factors and incidence of heart attacks and strokes, and made available protocols and a training manual for monitoring cardiovascular risk factors in developing countries, as well as guidelines for promoting physical activity as part of a prevention strategy. The Organization also published a regional plan for control of cardiovascular diseases and specific guidelines for countries in the Eastern Mediterranean.
During 1996, WHO conducted a study to determine the worldwide prevalence of diabetes mellitus. It concluded that approximately 120 million people are currently affected, and that this figure will more than double in the next 25 years. The theme of World Diabetes Day, "Insulin for life", highlighted the continuing unavailability and unaffordability of this essential medication in many of the world's poorest countries. WHO set up a computerized information system (DIABCARE), and issued (with the International Diabetes Federation) guidelines for the management of non-insulin-dependent diabetes mellitus in Africa, and developed a plan for diabetes control in the Eastern Mediterranean.
The Organization continued to support studies of primary prevention approaches for a variety of hereditary disorders including familial hypercholesterolaemia, haemophilia and cystic fibrosis. A landmark technical report, Control of hereditary diseases, was published in 1996.
WHO's work in 1996 on the epidemiology of mental and neurological disorders included a study of the prevalence, severity and cost of neurological disorders such as dementia, stroke, epilepsy and headache. An internationally accepted nomenclature has been translated into 25 languages. A WHO collaborative project in 14 countries showed that one in four adults visiting a general doctor had a current and diagnosable mental disorder, and only 1% of people with such disorders receive specialized care. The Organization has prepared simple, user-friendly versions of diagnostic and treatment guidelines for the common mental disorders. WHO and the International League against Epilepsy announced a worldwide campaign against epilepsy in 1996.
The Organization studied global patterns of substance dependence and analysed its health and social consequences. Action to fight smoking is a central priority for the CINDI programme in Europe, which organized a smoking cessation campaign in 1996 in which 24 countries participated and some 70 000 smokers registered. A conference on alcohol dependence with participants from 46 countries adopted a European Charter setting out basic ethical principles and action strategies. WHO has a global epidemiological surveillance system to assess and describe patterns and trends of psychoactive substance abuse together with the health consequences and national policy responses.
WHO promotes community-based rehabilitation as a component of primary health care, and in 1996 the Organization continued its close cooperation in this area with ILO, UNESCO, organizations for the disabled and other international nongovernmental organizations. Over 80 countries have programmes, which are now tending to broaden their focus to cover "persons with social disadvantages" or "persons more in need" and to include vulnerable and special population groups such as displaced persons and war victims. WHO trained senior personnel from 26 countries in managing community-based rehabilitation, issued training materials, and continued with a major revision of the International Classification of Impairments, Disabilities and Handicaps.