The world health report

Chapter 1: Global Health: today's challenges

Global Health: today's challenges

Reviewing the latest global health trends, this chapter finds disturbing evidence of widening gaps in health worldwide. In 2002, while life expectancy at birth reached 78 years for women in developed countries, it fell back to less than 46 years for men in sub-Saharan Africa, largely because of the HIV/AIDS epidemic. For millions of children today, particularly in Africa, the biggest health challenge is to survive until their fifth birthday, and their chances of doing so are less than they were a decade ago. This is a result of the continuing impact of communicable diseases. However, a global increase in noncommunicable diseases is simultaneously occurring, adding to the daunting challenges already facing many developing countries.

Although this report is global in scope, the findings irresistibly draw the main focus to the increasingly fragile health of sub-Saharan Africa. It is here, where scores of millions of people scrape a living from the dust of poverty, that the price of being poor can be most starkly seen. Almost an entire continent is being left behind.

Overall, 35% of Africa's children are at higher risk of death than they were 10 years ago. Every hour, more than 500 African mothers lose a small child. In 2002, more than four million African children died. Those who do make it past childhood are confronted with adult death rates that exceed those of 30 years ago. Life expectancy, always shorter here than almost anywhere else, is shrinking. In some African countries, it has been cut by 20 years and life expectancy for men is less than 46 years.

Mostly, death comes in familiar garb. The main causes among children are depressingly recognizable: the perinatal conditions closely associated with poverty; diarrhoeal diseases; pneumonia and other lower respiratory tract conditions; and malaria. Becoming more familiar by the day, HIV/AIDS, now the world's leading cause of death in adults aged 15--59 years, is killing almost 5000 men and women in this age group, and almost 1000 of their children, every 24 hours in sub-Saharan Africa.

The main components of Africa's tragedy are shared by many of the poorest people everywhere and include the agonizingly slow progress towards the Millennium Development Goals of reduced maternal and child mortality; the HIV/AIDS pandemic; and the double burden of communicable diseases plus noncommunicable diseases, including the tobacco epidemic and the avoidable deaths from road traffic crashes. Subsequent chapters of this report will examine each of these components and show how they can and must be reshaped for a better future.

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