Longer Lives Create New Challenges
Health agencies around the world have made remarkable progress in improving life span and quality of life, but partially as a result of those very successes, they will soon be facing new types of problems, according to a major report issued this week.
The world’s population is living longer than ever before and, as a result, noncommunicable diseases such as cancer, heart disease and diabetes will soon become bigger killers than such traditional scourges as malaria and tuberculosis, according to the World Health Organization’s latest snapshot of global well-being.
Disturbingly, however, 40% of all deaths in the world this year will be considered premature--occurring before the age of 50. Of those 21 million deaths, 10 million will be among children under the age of 5 and 7.4 million among adults in their most productive years, between the ages of 20 and 49.
“Three out of four people in the least-developed countries today are dying before the age of 50--the global life expectancy figure of half a century ago,” said Dr. Hiroshi Nakajima, director-general of WHO. “Reducing these premature deaths is one of the greatest challenges facing humanity at the dawn of the 21st century.”
Even so, the most important pattern of progress now emerging is an unmistakable trend toward healthier, longer life, according to the report, released Monday. Worldwide life expectancy, currently 66 years, will reach 73 years by 2025--a 50% increase over the 1955 average of 48 years.
Many people born at the end of the 20th century will live throughout the 21st and see the advent of the 22nd century. France, for example, is projected to have 150,000 centenarians by 2050, compared to only 200 in 1950.
The number of people over the age of 65 worldwide will rise from 390 million this year to 800 million in 2025--from 6.6% of the total population to 10%.
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One of the reasons for the increased longevity is that the food supply has more than doubled in the past 40 years, increasing much faster than population growth. Per capita gross domestic product has risen, in real terms, by at least 150% in the past 50 years. Adult literacy rates have increased by more than 50% since 1970. The proportion of children in school has risen, while the proportion of people chronically undernourished has fallen.
But the continued increases in life span will occur “primarily as a result of control of infectious diseases in childhood,” according to Dr. David Brandling-Bennett, deputy director of the Pan American Health Organization.
Over the past 40 years, the proportion of the world’s children vaccinated for the six major diseases of childhood--measles, polio, tuberculosis, diphtheria, pertussis and neonatal tetanus--has surged from 5% to 90%. As a result, the number of deaths among children under the age of 5 dropped from 21 million in 1955 to 11 million in 1995--97% of them in developing countries.
The primary causes of death in that age group now are infectious diseases, such as pneumonia and diarrhea, combined with malnutrition. Dr. Paul Kleihues, director of WHO’s International Agency for Research on Cancer, noted that 2 million of those deaths could be prevented by expanded use of vaccines. The report predicts that yearly deaths in the age group will drop to 5 million by 2025.
One of the biggest potential hazards to children in the next century will be the continuing spread of HIV/AIDS, the report warns. Last year, 590,000 children under the age of 15 became infected with HIV. Continued spread of the disease could reverse some of the major gains achieved in child health over the past 50 years, according to Muthu Subramanian, director of the Office of World Health Reports and the report’s author.
Turning to the health care needs of women, the report notes that more than 50% of pregnant women in the developing world are anemic, and about 585,000 women die of pregnancy-related problems. Although the risk of such deaths in Europe is only one in 1,400, the risk in Africa is one in 16.
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An estimated 50 million adult women in developing countries are classified as severely underweight, and about 450 million suffer from goiter caused by iodine deficiency.
As the world population ages, health authorities will face new challenges. Even in wealthy countries, most old and frail people cannot meet more than a fraction of the costs of the health care they need. Some European countries already acknowledge that there are insufficient funds to meet with dignity the needs of all those over the age of 75, who consume many times more medical and social services than the younger population, according to Subramanian.
The key to meeting many of these needs in developing countries is prevention, Brandling-Bennett said. Many of the diseases of the elderly can be prevented--or at least greatly delayed--by such techniques as discouraging smoking and encouraging a healthier diet.
Public health campaigns encouraging such behaviors can be readily carried out by the public health infrastructure that has been built up over the past decades, he said. “These are not expensive technologies.”
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Life and Death in the 21st Century
In its snapshot of health in the next century, the World Health Organization envisions fewer deaths from communicable diseases, leading to a longer life spans. As a consequence, however, more people will die of diseases such as cancer and heart disease.
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Global births per hour, 1955-2025
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Global Population
Global deaths per hour, 1955-2025
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Natural Increase of the world population per hour, 1955-2025
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Prevalence of Cancer Worldwide in 1997
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Global Causes of Death in 1997
Infectious and parasitic diseases: 33%
Other and unknown causes: 12%
Diseases of the respiratory system: 6%
Perinata and neonatal causes: 7%
Childbirth related: 15
Cancers: 12%
Diseases of the circulatory system: 29%
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Life Expectancy at Birth
1955
Above 60 years: 68%
60 years or less: 32%
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1975
Above 60 years: 40%
60 years or less: 60%
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1995
Above 60 years: 86%
60 years or less: 14%
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2025
Above 60 years: 96%
60 years or less: 4%
Source: The World Heath Organization
