Message from the Director-General
The desire for a healthier and better world in which to live our lives and raise our children is common to all people and all generations. Now, as we near the end of one century and enter the next, our past achievements and technological advances make us more optimistic about our future than perhaps at any stage in recent history.
Despite being threatened by two devastating world wars in the first half of this century, and by many other conflicts and catastrophes in the second, humanity has, in general, not merely survived; it has thrived. Today, at least 120 countries (total population above 5 billion) have a life expectancy at birth of more than 60 years; the global average is 66 years compared to only 48 years in 1955; it is projected to reach 73 years in 2025.
However, one of the main messages of The World Health Report 1997 was the need to recognize that increased longevity without quality of life is an empty prize - that health expectancy is more important than life expectancy. It is therefore particularly encouraging to show evidence in this year's report of remarkable declines in disability over periods of time among older people in some populations.
In an era of global population ageing, this is not just good news for the individuals concerned and the societies in which they live. It may be a vital signal for us all. It suggests that we are slowly learning one of life's most important lessons: not just how to live longer, but also how to stay longer in good health with less disability, and therefore, less dependence on others.
Issued as the World Health Organization marks its 50th anniversary, The World Health Report 1998 offers a cautiously optimistic vision of the future up to the year 2025. It gives us hope that longer life can be a prize worth winning.
Based on a review of health trends in the past 50 years, it finds that overall, remarkable improvements in health have been due to socioeconomic development, the wider provision of safe water, sanitation facilities and personal hygiene, and the establishment and expansion of national health services.
Major infectious diseases, such as poliomyelitis, leprosy, guinea-worm disease, Chagas disease and river blindness, are steadily being defeated. There have been spectacular advances in the development of vaccines and medicines, and countless other innovations in the investigation, diagnosis and treatment of illness, in the reduction of disability and in rehabilitation.
Tragically, however, while average life expectancy has been increasing throughout the 20th century, 3 out of 4 people in the least developed countries today are dying before the age of 50 - the global life expectancy figure of half a century ago. This year, 21 million deaths - 2 out of every 5 worldwide - will be among the under-50s, including 10 million small children who will never see their fifth birthday though most children worldwide are now immunized against major childhood killers. Over seven million will be men and women in what should be some of the best and most productive years of their lives. Reducing these premature deaths is one of the greatest challenges facing humanity at the dawn of the 21st century.
There are others challenges. For while health globally has steadily improved over the years, great numbers of people have seen little if any improvement at all. The gaps between the health status of rich and poor are at least as wide as they were half a century ago, and are becoming wider still.
The prime concern of the international community must be the plight of those most likely to be left furthest behind as the rest of the world steps confidently into the future. These are the many hundreds of millions of men, women and children still trapped in the past by the grimmest poverty. They live mainly in the least developed countries, where the burdens of ill-health, disease and inequality are heaviest, the outlook is bleakest, and life is shortest.
Worldwide, the majority of premature deaths are preventable. At least 2 million children a year die from diseases for which there are vaccines. The report gives encouraging evidence that premature deaths among adults, too, can be significantly reduced. Deaths from heart disease have been dramatically reduced in many countries which are experiencing a transition from high incidence of circulatory diseases to low incidence mainly due to the adoption of healthier lifestyles. It is imperative that such a favourable shift, conducive to further reductions in the incidence of these diseases, should be sustained and if possible accelerated.
Infectious diseases, meanwhile, remain leading causes of premature death among adults in much of the developing world. Reducing these tolls depends largely on the political will and commitment of individual governments, and the active support of the international community.
This means putting health high on the agenda of all countries, rich and poor, and keeping it there. It is time to realize that health is a global issue; it should be considered as an essential component of the continuing globalization process that is reshaping our world; it should be included in the growing interaction between countries that currently exists in terms of world trade, services, foreign investment and capital markets.
With the help of instant international communications and information technologies, and global surveillance systems to detect problems, prepare for them and respond to them, a wonderful opportunity now exists to build the new international partnerships for health, based on social justice, equity and solidarity, that the world of the 21st century will so urgently need.
They are partnerships involving all countries, their governments, their civil societies, and their individuals. All can be partners who are willing to share and exchange the life-enhancing information and technology that is already at the fingertips of the rich but as yet beyond the reach of the poor. Such a political vision is fundamental to ensure a participatory approach to peace and development at local, national and international levels and thus enhance the welfare of the individual and society.
The progress and achievements of the past 50 years are solid foundations for a healthier and better world. It is already time to build on them. Life in the 21st century could and should be better for all. We can pass no greater gift to the next generation than a healthier future. That is our vision. Together, the people of the world can make it a reality.