The World Health Organization (WHO) releasedWorld Health Statistics 2011. Based on a wide-range of global health indicators from 194 Member States – derived from multiple sources and statistical modelling – the report highlights progress and remaining challenges in achieving the health-related Millennium Development Goals (MDGs). It also calls urgent attention to the major health challenge of the 21st century: non-communicable diseases (NCDs).
In terms of the MDGs, the report confirms that substantial progress has been made in reducing child and maternal mortality, improving nutrition, reducing morbidity and mortality due to HIV infection, tuberculosis and malaria, and increasing access to improved drinking water sources. The world has met the MDG target relating to access to safe-drinking water (MDG 7.C), and all six WHO regions are on track to achieve MDG target 6.C – to halt by 2015 and begun to reverse the incidence of malaria and other major diseases. Impressive progress has also been made in reducing the number of child deaths caused by measles, with a 74% decline compared to ten years ago. Nevertheless, only 37 out of 143 low- and middle-income countries are expected to reach MDG 4 (reducing child mortality) by 2015. Many countries will fail to reach MDG 5 (reducing maternal deaths); as well as the target on access to basic sanitation (also MDG 7.C).
However, the report underlines that large variations in health status between and within countries and world regions continue to exist. Especially the WHO African region is lagging behind on many indicators analyzed in the report. For example, although the annual rate of decline in the under-five mortality rate has increased for this region, the region is unlikely to achieve the MDG target to reduce child mortality (base-year: 1990) by two-thirds by 2015. Similarly, despite a significant reduction in the number of maternal deaths, the report finds that the proportion of births attended by skilled personnel – essential for reducing perinatal, neonatal and maternal deaths – remains below 50% in the African region. The region is further characterized by the lowest level (approximately 22%) of any method of contraceptive prevalence, and it accounts for 70% of all those who acquire HIV infection globally, despite a considerable rate of decline in the number of people newly infected with HIV.
Beyond the MDGs, the main message of the report is centred on the growing incidence of NCDs – a phenomenon supported by population growth and increased longevity – and the subsequent challenges for global health. NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, and are often caused by behavioural risk factors (e.g. tobacco use, physical inactivity, unhealthy diets, and harmful alcohol use) that can result in four metabolic and/or physiological changes (raised blood pressure; obesity; hyperglycaemia; and hyperlipidemia) that in turn can have multiple effects and lead to NCDs. The report notes that 36 million or 63% of the global deaths in 2008 were caused by NCDs – a figure that is expected to increase to 55 million by 2030. It explains that especially raised blood pressure is a high-risk condition that causes approximately 51% of deaths from stroke and 45% from coronary hearth disease. Another stunning finding in the report is that 2.8 million people die each year from the consequences of being overweight or obese. In only 28 years, the number of obese people in the world has almost doubled. Figures are particularly worrying for the region of the Americas, where the number of obese adults is twice the global average. But also Europe and the Eastern Mediterranean region are characterized by high levels of obesity.
Although obesity seems to be a disease that is more prevalent in high-income countries, the majority of all NCD deaths (about 80%) occur in low- and middle-income countries, especially in Sub-Saharan Africa, Eastern Europe and parts of Asia. These countries are least able to sufficiently address NCDs, as they have fewer resources available to invest in health. The report demonstrates a situation that, in some way, is turning the world upside down, with richer countries with lower disease burdens using more health resources than poorer countries with higher disease burdens. It illustrates this with examples from Luxembourg and Eritrea, where Eritrea spends US$11 per person per year in terms of health expenditures, while Luxembourg spends US$8,262 per person a year. Another problem found in the report for the treatment of NCDs in low- and middle-income is related to the availability of medicines. According to the report, many low- and middle-income countries are characterized by a poor availability of medicines for the treatment of chronic NCDs, especially in the public sector. This forces patients to purchase medicines from the private sector, where generic medicines cost on average 610% more than their international reference price. “Low public sector availability and high private sector prices drive many families into catastrophic poverty, particularly those with a family member suffering from a chronic NCD,” the report warns.
Finally, the report calls upon countries to improve their civil registration systems and data collection. For example, only 34 countries representing 15% of the world population produce high-quality cause-of-death information. So, although the report is very extensive and includes the best country-reported data available, it cautions that some data in the report should be considered with significant uncertainty, due to weak data available in many countries, among others caused by differences in definitions, data-collection methods, population coverage and estimation methods.
Access the full report or a summary in English, French or Spanishhere.