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HEALTH AND SUSTAINABLE DEVELOPMENT - BACKGROUND INTRODUCTORY PAPER

3. Health trends2

  1. Over the past decade, there have been improvements in life expectancy and declines in infant and child mortality rates – all key indicators of health. However, these global trends, while highlighting what has been achieved, hide the fact that the gains of development are being reversed in a number of countries, particularly in sub-Saharan Africa. This is strongly associated with the impact of HIV/AIDS, but is also tied to underdevelopment, people becoming poorer, or being negatively affected by war and conflict.


  2. In 1999, average life expectancy at birth was 49.2 years in the least developed countries, 61.4 for all developing countries and 75.2 for developed countries. These gaps highlight the increased disease burden in the absence of sustainable development. The differences in life expectancy are paralleled by similar differentials in the burden of morbidity and mortality related to pregnancy and childbirth: more than 90% of the over half a million annual maternal deaths occur in Africa and Asia. Chances of a woman dying in childbirth in sub-Saharan Africa range from 1 in 11 in Eastern Africa to 1 in 65 in Southern Africa, compared to 1 in 1100 in Eastern Europe and 1 in 5000 in Southern Europe. The mortality rate for children in the least developed countries is 159 per 1000 births, compared to 6 per 1000 in developed countries.


  3. In communicable diseases, notable successes have been achieved against polio, guinea worm (dracunculiasis) and river blindness (onchocerciasis). However conditions such as AIDS, tuberculosis and malaria (which result in approximately 2 million, 1.5 million and 1 million deaths respectively each year), as well as the major communicable diseases of childhood such as acute respiratory infections, (predominantly pneumonia), diarrhoea and measles (which lead to approximately 4 million, 1.5 million and 800 000 deaths respectively each year). Together they are responsible for more than 90% of deaths from communicable disease. Malnutrition, including micronutrient deficiency is associated with more than half of these deaths. The death burden is greatest in sub-Saharan Africa. Developing countries remain vulnerable to epidemics, such as cholera.


  4. According to UNAIDS, about 40 million people are now living with HIV/AIDS, 95 per cent of them in developing countries. In 2001 2.3 million people died of AIDS in sub-Saharan Africa out of a total of 3 million worldwide. Life expectancy in the most severely affected countries in sub-Saharan Africa has been reduced by almost a third, from about 60 years to 43, reversing gains made over the past half century. Poverty, underdevelopment and illiteracy increase the vulnerability to HIV infection and AIDS exacerbates poverty. Poverty leads to migration, influences sexual behaviour and limits care and education. In turn, AIDS threatens efforts to revitalize economies and has devastating social impacts, not least of which is children orphaned. But, as with many other communicable diseases, there is much that can be done.


  5. Consequent on unsustainable development, non-communicable diseases (NCDs) are a significant and growing burden in developing countries. Most non-communicable disease deaths and high levels of morbidity occur in the developing world. 77% of deaths from NCDs worldwide occur in developing countries. These include diseases of lifestyle (for example due to unhealthy diets, physical inactivity, tobacco and alcohol use), injuries, violence, mental ill-health, disability and occupation. In developing countries each year, there are around 5.5 million deaths from heart attacks, 5.1 million from strokes and 2.9 million from tobacco-related disease.


  6. Concern about the high disease burden is increasing. A number of programmes to address these have been put in place over the past decade, and have significant potential to impact on disease burden.3


  7. A number of targets have also been set for reduction of the disease burden, notably the Millennium Development Targets, and targets set in global and regional fora (see box 1). If current trends continue, it seems that, as was the case with many previous efforts, these targets will not be reached. A major scaling up of effort, not only in regard to disease programmes, but also with respect to improving basic health services (and impacting the sustainable development triad) is required if these targets are not to be seen as empty words.


Box 1: The Millennium Development Goals and Other Targets
  1. Reduce by 2005 HIV prevalence among young men and women aged 15 to 24 in the most affected countries, by 25% and by 25% globally by 20104
  2. By 2005, reduce the proportion of infants infected with HIV by 20%, and by 50% by 20105
  3. Reduce TB deaths and prevalence of the disease by 50% by 20106
  4. Reduce the burden of disease associated with malaria by 50% by 20107
  5. Reduce by two-thirds, between 1990 and 2015, the under-five mortality8
  6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ration9


Inequity in health status within and between countries strongly reflects inequalities in development, and also in health systems.

Footnote
  1. For more detail, see: Health in the Context of Sustainable Development: Background Document for the WHO Meeting “Making Heath Central to Sustainable Development”, Oslo, Norway, 29 November-1 December 2001.
  2. These include various AIDS programmes, Roll Back Malaria, Stop TB, the Integrated Mother and Child Initiative and Safe Motherhood initiative, the Framework Convention on Tobacco Control, Vision 2020 - The Right to Sight and the Global Campaign against Epilepsy.
  3. For more detail see: Declaration of Commitment on HIV/AIDS, “Global crisis – Global action” adopted at the Twenty-sixth Special Session of the General Assembly, 25-27 June 2001.
  4. Declaration of Commitment on HIV/AIDS, “Global crisis – Global action” adopted at the Twenty-sixth Special Session of the General Assembly, 25-27 June 2001.
  5. For more detail see: Final CommuniquР№ of the G8 Kyushu Okinawa Summit, 21-23 July 2000.
  6. Final CommuniquР№ of the G8 Kyushu Okinawa Summit, 21-23 July 2000.
  7. For more detail see: “Millennium Development Goals”, adopted at the United Nations Millennium Summit, 6-8 September 2000.
  8. “Millennium Development Goals”, adopted at the United Nations Millennium Summit, 6-8 September 2000.
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