Executive summary
Looking forward to health
The 21st century offers a bright vision of better health for all. It holds the prospect not merely of longer life, but superior quality of life, with less disability and disease. As the new millennium approaches, the global population has never had a healthier outlook.
Weighing the evidence of the past and the present, The World Health Report 1998 shows that humanity has many good reasons for hope in the future. Such an optimistic view must be tempered by recognition of some harsh realities. Nevertheless, unprecedented advances in health during the 20th century have laid the foundations for further dramatic progress in the years ahead.
This report provides the latest expert assessment of the global health situation, and uses that as a basis for projecting health trends to the year 2025. Examining the entire human life span, and sifting data gathered in the past 50 years, it studies the well-being of infants and children, adolescents and adults, older people and the "older old", and identifies priority areas for action in each age group. Women's health is given special emphasis. The future of human health in the 21st century depends a great deal on a commitment to investing in the health of women in the world today. Their health largely determines the health of their children, who are the adults of tomorrow.
The report's most disturbing finding is that, despite increasing life expectancy, two-fifths of all deaths in the world this year can be considered premature, in that more than 20 million people a year are dying before the age of 50, while average life expectancy has risen to 68 years. Ten million of these deaths are among children under 5 years; 7.4 million others are among adults aged 20-49.
Even so, the most important pattern of progress now emerging is an unmistakable trend towards healthier, longer life. Supported by solid scientific evidence of declines in disability among older people in some populations, this has considerable implications for individuals and for societies.
The explanation for this trend lies in the social and economic advances that the world has witnessed during the late 20th century - advances that have brought better living standards to many, but not all, people. The world saw a golden age of unparalleled prosperity between 1950 and 1973, followed by an economic slump that lasted 20 years. A global economic recovery has been under way since 1994. The long-term benefits are now becoming apparent. While they are most evident in the industrialized world, they are slowly but surely materializing in many poorer countries, too.
For example, food supply has more than doubled in the past 40 years, much faster than population growth. Per capita GDP in real terms has risen by at least 2.5 times in the past 50 years. Adult literacy rates have increased by more than 50% since 1970. The proportion of children at school has risen while the proportion of people chronically undernourished has fallen.
These trends are changing the world. Without question, the world of 2025 will be significantly different from today's, and almost unrecognizable from that of 1950. The stunning technological advances of recent years, particularly in global telecommunications, have made the planet seem smaller than ever before. By the year 2025, it is likely to seem smaller still - and, with continuing population growth, it will certainly be much more crowded. In many ways, the face of humanity is being rapidly reshaped.
Two main trends - increasing life expectancy and falling fertility rates - mean that by 2025:
- Worldwide life expectancy, currently 68 years, will reach 73 years - a 50% improvement on the 1955 average of only 48 years.
- The global population, about 5.8 billion now, will increase to about 8 billion. Every day in 1997, about 365 000 babies were born, and about 140 000 people died, giving a natural increase of about 220 000 people a day.
- There will never have been so many older people and so relatively few young ones.
- The number of people aged over 65 will have risen from 390 million in 1997 to 800 million - from 6.6% of the total population to 10%.
- The proportion of young people under 20 years will have fallen from 40% in 1997 to 32% of the total population, despite reaching 2.6 billion - an actual increase of 252 million.
These demographic trends, which have profound implications for human health in all age groups, follow on the many positive changes that have occurred in the past 50 years. More people than ever before now have access to at least minimum health care, safe water supplies and sanitation facilities. Most of the world's children are now immunized against the six major diseases of childhood - measles, poliomyelitis, tuberculosis, diphtheria, pertussis and neonatal tetanus.
During the same period there have been steady and sometimes spectacular advances in the control and prevention of other diseases, the development of vaccines and medicines, and countless other medical and scientific innovations. The past decades have seen the final defeat of smallpox, one of the oldest diseases of humanity, and the gradual reduction in several others, including leprosy and poliomyelitis.