| WHO-Lifestyle Major Cause
of Global Health Problems
LONDON (Reuters Health)
- The World Health Organization released
a major report Wednesday fingering alcohol, tobacco, high blood
pressure and high cholesterol as some the biggest causes of illness
and death worldwide--including the developing world.
WHO Director-General Gro Harlem Brundtland
told a news conference in London the report was a major step forward
in public health policy.
"The world is living dangerously,"
she said. "A large part of the world's population does so because
they have little choice, but a large part does so because they
make the wrong choices."
She called the findings a wake-up
call. "With this report the WHO is moving to spur a global reassessment
of the way we think of disease and the role of public health,"
The United Nations' health agency
sought to rank 26 major causes of illness on a global scale based
on deaths caused and years of life lost due to disability. Details
were published in the October 30 issue of the British medical
journal The Lancet.
The report shows that the biggest
contributions came from maternal and childhood underweight, unsafe
sex, high blood pressure, smoking, alcohol, consumption of contaminated
water, poor sanitation, iron deficiency, inhaling smoke from indoor
fires and high cholesterol and obesity.
"While none of these is new, the fact
that tobacco, alcohol and cholesterol rank so high in a global
survey is a big surprise," said Chris Murray, author of WHO's
World Health Report 2002.
"There is no longer a risk or disease
that is the exclusive preserve of the rich countries," he added.
The authors of the report, led by
Dr. Majid Ezzati, said the top 10 contributors to the global burden
of disease accounted for more than one third of the 56 million
deaths globally each year.
Life expectancy could be raised by
up to a decade by actions targeted at these known risks, they
In developing countries, the biggest contributors to the burden
of disease were undernutrition of mothers and children (14.9%),
micronutrient deficiencies (3.1% iron, 3.2% zinc, 3.0% vitamin A),
unsafe sex (10.2%), poor sanitation or hygiene and unsafe water
(5.5%) and indoor smoke from solid fuels (3.6%).
But tobacco, blood pressure and
cholesterol also resulted in "significant loss of health life
years" in poor regions, the authors note.
In both developed and developing
nations more than one billion people were overweight. Of these,
300 million were clinically obese and at least 500,000 died each
In fact, the contributions to disease
burden of underweight and overweight were both around 3% in developing
regions, they note.
In the developed world, tobacco
(12.2%), high blood pressure (10.9%) alcohol (9.2%), high cholesterol
(7.6%) and overweight and obesity (7.4%) were the biggest contributors
to disease burden.
In a commentary on the report,
Drs. John Powles and Nick Day from the Institute of Public Health
in Cambridge, England, said the relative rankings of the different
risk factors should not be given too much weight because the method
for calculating risks has not been perfected.
"Public health surveillance on
this scale is a new, and immature, science," they write. "This
exercise is more comprehensive, more informative, and more theoretically
coherent than its predecessor, but should still be regarded as
a report of work in progress.
"That past conjectures of this
kind have been shown to be open to challenge and to subsequent
refinement argues in favor of their continued iteration. It is
to the credit of WHO that it hosts this ongoing work."
SOURCE: The Lancet online October
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