WHO Library Cataloguing in Publication Data world health report 1999: Making a difference 1. World health- trends 2. Health priorities 3. Cost of illne: 4. Health services accessibility 5. Social justice 6. Fover 7. Forecasting 8. Mortality-trends 9 Malaria- prevention and control 10. Smoking- prevention and control 11. World Health Organization I.Title: Making a difference IsBN 92 4 1561947(NLM Classification: WA 540.1) ISSN1020-331 The World Health Organization welcomes requests for permission to or translate its publications, in part or in full Applications and enquiries should be addressed to of Publications, World Organization, 1211 Geneva 27, Switzerland, which will be glad to the latest information hanges made to the text, plans for new editions, and reprints and translations already available Al orld Health Organization 1999 The designations employed and the presentation of the material in this publication, including tables and Healey do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World ountry, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate bor- der lines for which there may not yet be full agreement The mention of specific companies or of certain manufacturers products does not imply that they endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned Errors and omissions excepted, the names of proprietary products are distinguished by blication can be obtained World Health Report 1211 Geneva 27. Switzer rland Fax(41-22)7914870 Thomson Prentice, with the a core team composed of Emmanuela Gakidou, Mie Inoue, and Michel Beusenberg Other contributors were, in alphabetical order, Howard Engers, Catherine Goodman, Emmanuel Guidon, Prabhat Jha, Kamini Mendis, David Nabarro, Jim Tulloch, Jia Wang, and Derek Yach Comments were appreciated from a number of indi- viduals including Anarfi Asamoah-Baah, David Evans, Tore Godal, Joseph Kutzin, Alan Lopez, Christopher Murray, Richard Feto and Nicholas White; additional help was gratefully received from WHO Regional Direc tors and their B dministrative support was provided by Aquilina John-Mutaboyerwa and Shelagh Probst. The report ade Guyonnet The index was prepared by Liza Weinkove and, for the French edition, by Laurent Gaiddon The report was prepared under the general direction of Jonas Store, Executive Director, Director-Gener- aI's Office, and Senior Policy Adviser; Julio Frenk, Executive Director, Evidence and Information for Pblicy; and Susan Holck, Director of Health Information Management and Dissemination African Art, Kampala, uganda, is reproduced with the kind permission of the arae zi Studio and Gallery of The cover painting"Working Woman", by Mr Nuaa Wamala-Nnyanzi, of the Nnyar by Marilyn Langfeld Layout by WHO Grii The World Health Report 1999 WHO Library Cataloguing in Publication Data The world health report 1999: Making a difference 1. World health – trends 2. Health priorities 3. Cost of illness 4. Health services accessibility 5. Social justice 6. Poverty 7. Forecasting 8. Mortality – trends 9. Malaria – prevention and control 10. Smoking – prevention and control 11. World Health Organization I. Title: Making a difference ISBN 92 4 156194 7 (NLM Classification: WA 540.1) ISSN 1020-3311 The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, 1211 Geneva 27, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © World Health Organization 1999 All rights reserved. The designations employed and the presentation of the material in this publication, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate bor￾der lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Information concerning this publication can be obtained from: World Health Report World Health Organization 1211 Geneva 27, Switzerland Fax: (41-22) 791 4870 This report was prepared by Dean T. Jamison, Andrew Creese and Thomson Prentice, with the assistance of a core team composed of Emmanuela Gakidou, Mie Inoue, and Michel Beusenberg. Other contributors were, in alphabetical order, Howard Engers, Catherine Goodman, Emmanuel Guidon, Prabhat Jha, Kamini Mendis, David Nabarro, Jim Tulloch, Jia Wang, and Derek Yach. Comments were appreciated from a number of indi￾viduals including Anarfi Asamoah-Baah, David Evans, Tore Godal, Joseph Kutzin, Alan Lopez, Christopher Murray, Richard Peto and Nicholas White; additional help was gratefully received from WHO Regional Direc￾tors, Executive Directors and their respective staffs. Administrative support was provided by Aquilina John-Mutaboyerwa and Shelagh Probst. The report was edited by Barbara Campanini and Angela Haden, and translated into French by Barbara Audrin and Jean￾Claude Guyonnet. The index was prepared by Liza Weinkove and, for the French edition, by Laurent Gaiddon. The report was prepared under the general direction of Jonas Støre, Executive Director, Director-Gener￾al’s Office, and Senior Policy Adviser; Julio Frenk, Executive Director, Evidence and Information for Policy; and Susan Holck, Director of Health Information Management and Dissemination. The cover painting “Working Woman”, by Mr Nuwa Wamala-Nnyanzi, of the Nnyanzi Studio and Gallery of African Art, Kampala, Uganda, is reproduced with the kind permission of the artist. Design by Marilyn Langfeld. Layout by WHO Graphics Printed in France 99/12368 – Sadag – 20000