In the space of a day passengers flying from Japan to Uganda leave the country with the world s highest life expectancy - almost 79 years - and land in one with the world s lowest - barely 42 years. A day away by plane, but half a lifetime s difference on the ground. A flight between France and C?te d‘Ivoire takes only a few hours, but it spans almost 26 years of life expectancy. A short air trip between Florida in the USA and Haiti represents a life expectancy gap of over 19 years.
The purpose of the report is to highlight such inequities and to tackle the wider question: what are the global health priorities? It also tries to answer other crucially important questions. Which are the major diseases, the major causes of death, handicap, disability and diminution of the quality of life? Which conditions cause most misery, although they may not be fatal? Which countries, or communities within countries, have the greatest health needs? Where should health resources be targeted?
The report, for the first time, has attempted to examine the burden of ill-health not just by disease, but also by age, as the impact of illness differs across the age spectrum. Where possible, the analysis of health status has been carried out for infants and children, adolescents, adults and the elderly. On the basis of the data available and considered to be reasonably reliable, ten leading causes of death, illness and disability have been identified. There is also an explanation of what WHO is doing to bridge the gaps in health, an attempt to assess health trends in the coming years, and an effort to chart a health future for mankind - a future in which a baby lives, not dies, in its mother‘s arms.
Child health
The number of children under 5 years who died in 1993 - more than 12.2 million - equals the entire populations of Norway and Sweden combined. Of such deaths in the developing world, the great majority could have been avoided if those countries enjoyed the same health and social conditions as the world s most developed nations. The gap between the developed and the developing world in terms of infant and child survival is one of the starkest examples of health inequity.
The estimated global figure for mortality among children under 5 years in 1993 was 87 per 1 000 live births, an encouraging fall from rates of 215 during the period 1950-1955 and of 115 in 1980. Yet in parts of the developed world only 6 out of 1 000 liveborns die before reaching age 5, whereas in 16 of the least developed countries the rate is over 200 per 1 000, and in one country it is 320 per 1 000.
Infant mortality - deaths of children under 1 year - varies from 4.8 per 1 000 live births to 161 - a 33-fold difference. The gap in infant mortality between developed and developing world narrowed by 50% during the years 1960-1993, from 113 to 54 per 1 000 live births. But at the same time the gap widened between least developed and developing countries.
Malnutrition contributes substantially to childhood disease and death but often goes unrecognized as such. In 1990 more than 30% of the world s children under 5 years were underweight for their age. As many as 43% of children in the developing world - 230 million - have low height for their age. Micronutrient malnutrition is estimated to affect at least 2 billion people of all ages, but children are particularly vulnerable. As a result of iodine deficiency - a public health problem in 118 countries - at least 30 000 babies are stillborn each year and over 120 000 are born mentally retarded, physically stunted, deaf-mute or paralysed. A quarter of all children under age 5 in developing countries are at risk of vitamin A deficiency.