World faces 'health catastrophe'

Life expectancy in the world's poorest countries is likely to fall by 2000, according to the first global health survey . The report, by the World Health Organisation, points to poverty as the world's biggest killer, especially of children.

WHO says that one fifth of the 5.6 billion people in the world live in extreme poverty; that almost one third of the world's children are under- nourished, and that half the global population does not have access to essential drugs.

In 1993, more than 12 million children under the age of five died in the developing world - a figure which could have been cut to 350,000 if they had access to the same health care and nutrition as in wealthy countries. Chest infections in children, particularly pneumonia, kill at a rate of one child every eight seconds - 4 million annually - and yet it costs less than 20 cents to treat, the report says.

Dr Hiroshi Nakijima, director-general of WHO, warns of a "health catastrophe in which many of the great achievements . . . in recent decades will be thrown into reverse".

Poverty-linked diseases such as cholera, tuberculosis and plague are on the rise in rich and poor countries alike, while rates of immunisation against fatal childhood diseases are dropping.

The report points to the "neglected underclass" appearing in every city in the world: the elderly, the unemployed, the homeless, the street children and millions of women "whose greatest disadvantage is their gender". It also highlights the growing burden of the elderly as "one of the most profound forces affecting health and social services in the next century".

Population growth between 1990 and 2000 is estimated to be 17 per cent; the elderly will increase by 30 per cent. WHO predicts that care of elderly dementia patients and replacement of joints will be two of the most pressing demands on health care systems in the next century.

Globally, life expectancy at birth has increased to about 65 years but the difference between countries is a stark reminder of the growing inequity in health status, which means some countries spend less than $4 (£2.50) per person on healthcare annually, WHO says.

In Japan, Sweden, and Iceland, life expectancy is 78 years or more. In the poorest countries the figure is 43 years and falling. By 2000, life expectancy in Ivory Coast, the Central African Republic, Congo, Uganda and Zambia will have dropped to 42 years.

Infant mortality, one of the key indicators of a country's health, has fallen globally by 25 per cent, from 82 per 1,000 live births in 1980 to about 62. However, up to 320 out of 1,000 babies fail to reach their fifth birthdays in the poorest countries, compared with only 6 in the richest countries.

Maternal well-being varies dramatically - a pregnant woman in Africa is 13.5 times as likely to die in childbirth as her counterpart in Europe. More than 500,000 women die during labour or after delivery each year. Unsafe abortions account for 70,000 deaths.

8The World Health Report 1995, Bridging the Gaps, is published by the World Health Organisation, 1211 Geneva 27, Switzerland: Sfr15.

Comment, page 15

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