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Humans living longer by six years, report shows

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Margaret Chan

Margaret Chan

LATEST statistics from the World Health Organisation (WHO) show that men and women are living longer by six years even as child deaths have almost halved – falling from an estimated 90 deaths per 1000 live births in 1990 – to 46 deaths per 1000 live births in 2013.

According to the “World Health Statistics 2015”, published yesterday by the global health institution, recent great advances notwithstanding, there is still much to be done in achieving the Millennium Development Goal (MDG) of reducing the death rate by two-thirds.

Less than one third of all countries have achieved or are on track to meet this target by the end of this year.

The top killers of children aged less than five years are now: Preterm birth complications, pneumonia, birth asphyxia and diarrhoea.

Indeed, 2015 is the final year for the United Nations’ MDGs – goals set by governments in 2000 to guide global efforts to end poverty.

However, in September, countries will decide on new and ambitious global goals for 2030 at the United Nations General Assembly in New York. In addition to finishing the MDG agenda, the post-2015 agenda needs to tackle emerging challenges, including the growing impact of non-communicable diseases like diabetes and heart disease, and the changing social and environmental determinants that affect health.

The draft post-2015 agenda proposes 17 goals, including an overarching health goal to “ensure healthy lives and promote well-being for all at all ages”.

This year’s “World Health Statistics” on global health goals for 194 countries– assessed progress towards the health-related goals in each of the 194 countries for which data are available. The results are mixed.

Highlights from the “World Health Statistics 2015 include:
*Life expectancy at birth has increased six years for both men and women since 1990.
*Two-thirds of deaths worldwide are due to non-communicable diseases.
*In some countries, more than one-third of births are delivered by caesarean section.
*In low- and middle-income countries, only two-thirds of pregnant women with Human Immuno-deficiency Virus (HIV) receive anti-retrovirals to prevent transmission to their baby.
*Over one-third of adult men smoke tobacco.
*Only one in three African children with suspected pneumonia receives antibiotics.
*15 per cent of women worldwide are obese.
*The median age of people living in low-income countries is 20 years, while it is 40 years in high-income countries.
*One quarter of men have raised blood pressure.
*In some countries, less than five per cent of total government expenditure is on health.

According to a statement released yesterday by WHO, by the end of this year if current trends continue, the world will have met global targets for turning around the epidemics of HIV, malaria and tuberculosis and increasing access to safe drinking water. It will also have made substantial progress in reducing child under-nutrition, maternal and child deaths, and increasing access to basic sanitation.

WHO’s Director-General, Dr. Margaret Chan, said: “The MDGs have been good for public health. They have focused political attention and generated badly needed funds for many important public health challenges.

“While progress has been very encouraging, there are still wide gaps between and within countries. Today’s report underscores the need to sustain efforts to ensure the world’s most vulnerable people have access to health services.”

Infectious-disease specialist Barry Bloom of the Harvard T. H. Chan School of Public Health in Boston, Massachusetts, United States, said: “The worry would be that some other group will take contingency planning and emergency response away from WHO. That has been the trend and leads back to the fundamental question of what is the role of WHO.”

Chan has acknowledged that the agency made big mistakes in the Ebola epidemic. The outbreak revealed “inadequacies and shortcomings in this organization’s administrative, managerial and technical infrastructure,” she said in a January speech, which asked for reforms to WHO and for an external review of the agency’s performance. A draft of the review released on May 8 concluded that “WHO does not have the operational capacity or culture to deliver a full emergency public health response.”

The main reforms up for discussion in Geneva include creating a US$100-million fund for response to fast-moving events such as the Ebola epidemic; setting up an international cadre of first responders to outbreaks; and setting guidelines for how aid groups, foundations, academic institutions and corporations can take part in WHO meetings.

Such guidelines have been in the works for years as global public health spending has increasingly shifted to non-governmental organizations.

But the importance of private entities was brought to the fore by the Ebola outbreak, with groups such as Médecins Sans Frontières (also known as Doctors Without Borders), proving to be more effective than WHO or governments.

The agency is also asking member states to boost its budget by eight per cent for 2016/17, after having received flat funding since 2012. And Chan wants to strengthen the International Health Regulations — rules agreed by member states in 2005 that require countries to set up basic outbreak-response mechanisms — but there are no specific proposals for how this would occur.

Many reformers attending the meeting are worried that even the enormity of the Ebola epidemic will not motivate the WHO membership to adopt reform, and are pessimistic about the effectiveness of such changes if they are approved. Some of the same ideas were proposed — but never adopted — after outbreaks of the respiratory syndrome SARS, H5N1 ‘bird flu’ and H1N1 ‘swine flu’ in the 2000s.

According to the report, the number of women who died due to complications during pregnancy and childbirth almost halved between 1990 and 2013. This rate of decrease won’t be enough to achieve the targeted reduction of 75 per cent by the end of this year.

The report reads: “The maternal mortality ratio has fallen in every region. However, 13 countries with some of the world’s highest rates have made little progress in reducing these largely preventable deaths.

“In the WHO African Region, one in four women who wants to prevent or delay childbearing does not have access to contraceptives, and only one in two women gives birth with the support of a skilled birth attendant. Less than two-thirds (64 per cent) of women worldwide receive the recommended minimum of four antenatal care visits during pregnancy.

Reversing the spread of HIV
“The world has begun to reverse the spread of HIV, with new infections reported in 2013 of 2.1 million people, down from 3.4 million in 2001.

“The revised target of achieving universal access to treatment for HIV will be more challenging as WHO’s recommendations have resulted in much higher numbers of people needing treatment. At current trends, the world will exceed the target of placing 15 million people in low- and middle-income countries on antiretroviral therapy (ARTs) in 2015.

By the end of 2013, almost 13 million people received ARTs globally. Of these, 11.7 million lived in low- and middle-income countries, representing 37 per cent of people living with HIV in those countries.

“While the global target for increasing access to safe drinking water was met in 2010, the WHO African and Eastern Mediterranean Regions fall far short, particularly for poor people and those living in rural areas.

“The world is unlikely to meet the MDG target on access to basic sanitation. Around 1 billion people have no access to basic sanitation and are forced to defecate in open spaces such as fields and near water sources. Lack of sanitation facilities puts these people at high risk of diarrhoeal diseases (including cholera), trachoma and hepatitis.”


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