Message from the Director-General
These are dangerous times for the well-being of the world. In many regions, some of the most formidable enemies of health are joining forces with the allies of poverty to impose a double burden of disease, disability and premature death on many millions of people. It is time for us to close ranks against this growing threat.
Reducing risks to health, the subject of this year's World health report, has been a preoccupation of people and their physicians and politicians throughout history. It can be traced back at least 5000 years to some of the world's earliest civilizations. But it has never been more relevant than it is today.
Virtually every major advance in public health has involved the reduction or the elimination of risk. Improvements in drinking-water supplies and sanitation during the 19th and 20th centuries were directly related to the control of the organisms that cause cholera and other diarrhoeal diseases.
Mass immunization programmes eradicated the scourge of smallpox from the planet and have reduced the risk to individuals and whole populations of infectious diseases such as poliomyelitis, yellow fever, measles and diphtheria by providing protection against the causative agents. Countless millions of premature deaths have been avoided as a result.
Legislation enables risks to health to be reduced in the workplace and on the roads, whether through the wearing of a safety helmet in a factory or a seat belt in a car. Sometimes laws, education and persuasion combine to diminish risks, as with health warnings on cigarette packets, bans on tobacco advertising, and restrictions on the sale of alcohol.
The result is that, in many ways, the world is a safer place today. Safer from what were once deadly or incurable diseases. Safer from daily hazards of waterborne and food-related illnesses. Safer from dangerous consumer goods, from accidents at home, at work or in hospital.
But in many other ways the world is becoming more dangerous. Too many of us are living dangerously -- whether we are aware of that or not. I believe that this World health report is a wake-up call to the global community. In one of the largest research projects WHO has ever undertaken, it tries to quantify some of the most important risks to health and to assess the cost-effectiveness of some of the measures to reduce them. The ultimate goal is to help governments of all countries lower these risks and raise the healthy life expectancy of their populations.
The picture that is taking shape from our research gives an intriguing -- and alarming -- insight into current causes of disease and death and the factors underlying them. It shows how the lifestyles of whole populations are changing around the world, and the impact of these changes on the health of individuals, families, communities and whole populations.
These are issues that deeply concern us all. This was reflected in the in-depth discussions involving ministers of health from almost all of WHO's Member States during the World Health Assembly in Geneva in May of this year. These discussions helped shape this report, and are summarized in the opening chapter. They provided invaluable assessments of the risks to health that countries around the world today regard as most important.
These risks, and some additional ones, are systematically investigated in this report. They include some familiar enemies of health and allies of poverty, such as underweight, unsafe water, poor sanitation and hygiene, unsafe sex (particularly related to HIV/AIDS), iron deficiency, and indoor smoke from solid fuels.
The list also includes risks that are more commonly associated with wealthy societies, such as high blood pressure and high blood cholesterol, tobacco and excessive alcohol consumption, obesity and physical inactivity. These risks, and the diseases linked to them, are now dominant in all middle and high income countries. The real drama now being played out is that they are becoming more prevalent in the developing world, where they create a double burden on top of the infectious diseases that still afflict poorer countries.
In my address to the World Health Assembly in May of this year, I warned that the world is living dangerously, either because it has little choice or because it is making the wrong choices about consumption and activity.
I repeat that warning now. Unhealthy choices are not the exclusive preserve of industrialized nations. We all need to confront them.
Many of the risks discussed in this report concern consumption -- either too little, in the case of the poor, or too much, in the case of the better-off.
Two of the most striking findings in this report are to be found almost side by side. One is that in poor countries today there are 170 million underweight children, over three million of whom will die this year as a result. The other is that there are more than one billion adults worldwide who are overweight and at least 300 million who are clinically obese. Among these, about half a million people in North America and Western Europe combined will have died this year from obesity-related diseases.
Could the contrast between the haves and the have-nots ever be more starkly illustrated?
WHO is determined to tackle specific nutrient deficiencies in vulnerable populations and to promote good health through optimal diets, particularly in countries undergoing rapid nutritional transition.
At the same time, we are developing new guidelines for healthy eating. When these are complete, key players in the food industry will be invited to work with us in combating the rising incidence of obesity, diabetes and vascular diseases in developing countries.
Our actions will be vital. The rapidly growing epidemic of noncommunicable diseases, already responsible for some 60% of world deaths, is clearly related to changes in global dietary patterns and increased consumption of industrially processed fatty, salty and sugary foods. In the slums of today's megacities, we are seeing noncommunicable diseases caused by unhealthy diets and habits, side by side with undernutrition.
As I said at the World Food Summit in Rome in June of this year, economic development and globalization need not be associated with negative health consequences. On the contrary, we can harness the forces of globalization to reduce inequity, to diminish hunger and to improve health in a more just and inclusive global society.
Whatever the particular risks to health, whether they are related to consumption or not, every country needs to be able to adapt risk reduction policies to its own needs.
The best health policies are those based on scientific evidence. The World Health Organization's mandate is to get the evidence right and ensure that it is properly used to make the world a healthier place.
This report contains that evidence. It shows the way forward. It helps every country in the world to see what are the most appropriate, most cost-effective measures it can take to reduce at least some risks and promote healthy life for its own population. I urge each and every one of these countries to consider urgently what actions are necessary and to commit themselves to carrying them out.
This report also explains the importance of communicating risks clearly and openly to the public, and of creating an atmosphere of trust and shared responsibility between the government, the public at large and the media.
This is essential. We know that most people will choose to adopt healthier behaviours -- especially when they receive accurate information from authorities they trust, and when they are supported through sensible laws, good health promotion programmes and vigorous public debate.
Reducing risks to health is the responsibility of governments -- but not only of governments. It rightly remains a vital preoccupation of all people, in all populations, and of all those who serve them. In this World health report there is a message for everybody.