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WHO report shows life expectancy discrepancies

Of particular note is impact of AIDS

PRETORIA -- At a time when a girl born in Japan can expect to live until 85 and a girl born in Massachusetts can expect to live until 81, a girl in Sierra Leone can only expect to live until 36.

 

The World Health Organization calls that a travesty in a report on global health to be released today.

"It's scandalous that we -- the global health community -- haven't done more," said Robert Beaglehole, editor in chief of "The World Health Report 2003 -- Shaping the Future."

While the causes of short life spans in the poorest nations are complicated -- the problems include poverty, conflict, and weak governments, among other factors -- "much can be influenced by better health care," Beaglehole said. "We can make a difference today for the girl in Sierra Leone if we provide basic health services."

If a girl in Sierra Leone, for instance, falls ill today, she can expect on average medicines worth about $3 a year; there is little chance she will receive immunizations and a great chance she will be underweight throughout childhood. A Japanese girl who falls ill will, on average, receive medications worth $550, and also will have received vaccinations, adequate nutrition, and good schooling, the report said.

The report lays out:

* The vision of WHO's new director general, Dr. Lee Jong Wook, and it builds on the organization's constitution written in 1946.

* The "health for all" declaration at a historic conference in the Soviet Union 25 years ago.

* And the findings by the WHO Commission on Macroeconomics and Health, which two years ago asserted that 8 million lives could be saved every year if rich countries spent more and poor nations used well-known, cheap interventions.

The WHO report said that lessons from fighting SARS and AIDS, as well as efforts to eradicate polio and curb tobacco use, show that "millions of people" could live much longer due to a combination of aid and targeted improvements in health services.

During the past half century, life expectancy has improved by almost 20 years globally -- from 46.5 years in 1950- 1955, to 65.2 in 2002.

But success is not uniform. Exceptions have been sub-Saharan Africa and, to a lesser degree, several countries formerly in the Soviet Union. In those Eastern European nations, male life expectancy fell by 2.9 years in the 1990s, while female life expectancy fell by one year.

In southern Africa, the decline is far greater, largely due to the impact of AIDS: Botswana, Lesotho, Swaziland, and Zimbabwe have seen life expectancies for men and women drop in the past decade by more than 20 years. It soon could get much worse; life expectancy in Mozambique, now at 42, could fall to 27 by 2010, if the AIDS epidemic is not halted and reversed, according to UN estimates.

Advancements in reducing child deaths globally have been felt to a much lesser extent in sub-Saharan Africa.

In 1970, an estimated 17 million children under 5 died around the world; last year, that number was 10.5 million. In Oman, the success of improving health systems has been striking: in 1970, 242 out of 1,000 children died before age 5, but today its rate is just 15 deaths out of 1,000.

But in 14 African countries, child mortality rates are higher than they were in 1990.

Of those 10.5 million child deaths, 98 percent were in the developing world. The leading causes of child deaths remain complications at birth, lower respiratory tract infections, diarrheal diseases, and malaria, with malnutrition contributing to all of them. All such conditions and diseases are easily preventable, the report noted.

The strategies behind Lee's main goals are woven throughout the report: expanding AIDS treatment to 3 million people by the end of 2005; the global eradication of polio; and building primary care health systems around the world, tasks that should be fueled with the sense of urgency behind the SARS fight last year, the report said.

The report also highlights less-noticed causes of deaths in poor countries, including cardiovascular disease, tobacco use, and road accidents. WHO estimates that the world's leading preventable cause of death is from tobacco products and exposure to tobacco smoke, which it says kills about 5 million people annually. In addition, more than 20 million people are severely injured or killed on the world's roads each year.

Beaglehole said that while WHO will focus on a variety of those issues in the coming year, it needs to stress two priorities: building up health systems so that the gap in life expectancy narrows, and expanding AIDS treatment because of the disease's destructive powers.

"What happens when you live in a society and right before your eyes all these parents are dying?" he said. "What does it mean for children growing up? That's why we will be very active on HIV and AIDS, because there hasn't been such a reversal like this of life expectancy, at such a scale, since the Black Death of the 14th century."

John Donnelly can be reached at donnelly@globe.com.

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