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World Health Report: Addressing main risk factors key to improving global health

October 29, 2002

Authors of a study to be published on THE LANCET's website-www.thelancet.com-which forms the basis of this year's World Health Report 2002 conclude that worldwide health can be substantially improved if individuals and government's address the main risk factors that are responsible for the global health burden.

A clear understanding of the major risk factors to health is crucial for public-health planning and the prevention of disease and disability. Christopher Murray, Majid Ezzati and colleagues from the World Health Organisation (WHO) aimed to estimate the contributions of selected major risk factors to global and regional burden of disease.

For 25 selected risk factors-including malnutrition, access to safe water and sanitation, high blood pressure, high cholesterol concentrations, unsafe sex, tobacco and alcohol consumption-expert WHO working groups undertook a comprehensive review of published work and other sources (such as government reports and international databases) to obtain data on the prevalence of risk-factor exposure and hazard size for 14 regions of the world.

Childhood and maternal underweight (9.5%), unsafe sex (6.3%), high blood pressure (4.4%), tobacco (4.1%), and alcohol (4.0%) were the leading causes of global burden of disease. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation, and hygiene, indoor smoke from solid fuels, and various micronutrient deficiencies (eg. Iron, zinc, and vitamin A deficiency), were major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure, and high cholesterol were major causes of disease burden.

In an accompanying Commentary, John Powles and Nick Day from the Institute of Public Health, Cambridge, UK, assess how realistic it may prove to reduce certain risk factors. They comment: "Increasing fruit and vegetable consumption to a mean of 600 g/day may turn out to be relatively simple compared to the cultural transformations needed to bring mean cholesterols in developed countries down to 3.8 mmol/L".

Commenting overall on the World Health Report they conclude: "Public-health surveillance on this scale is a new, and immature, science. Production of such a report is evidence of ambition, energy, and determination. It will have required orchestrating the activities of many expert groups and marshalling and standardising enormous quantities of data. This exercise is more comprehensive, more informative, and more theoretically coherent than its predecessor (based on estimates for 1990), 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 favour of their continued iteration. It is to the credit of WHO that it hosts this ongoing work."

Lancet