The World Health Report 2002 Increasing numbers of people forego or defer essential care or suffer huge financial burdens resulting from an unexpected need for expensive services. Altogether, the continu ing challenges to reduce risks to health thus remain enormous. However, there is growing national and international recognition of the risks them selves. During the World Health Assembly in Geneva in May 2002, WHO,s Member States took part in organized round table discussions on risks to health(1, 2). One after another, health ministers or their representatives spelt out the main risks confronting their country. bacco, alcohol, unhealthy diet and obesity featured prominently alongside chronic diseases and traffic injuries in many low income and middle income countries. Ministers clearly demonstrated their knowledge of the trends in major risks in their countries, and their willingness to take action to reduce them(see Box 1.1). This report is intended to help them choose the best risk reduction policies that will in turn promote healthy life in their populations. Box 1.1 Countries endorse the focus on risks to health Ministers of health attending the Fifty-fifth environments and cessation programmes. Alcohol ized countries In middle income countries these World Health Assembly in Geneva, Switzerland, is another commonly cited and increasing risk to risk factors already contribute to the double bur- in May 2002 participated in round table discus- health in many countries and conditions with im- den of risks to health, and they are also of grow- sions on the major risks to health Faced by the portant dietary components, such as diabetes, ing importance in low income countries. With challenge of balancing preventive and treatment obesity and hypertension, are increasingly glo- ageing populations and trends in disease rates, ervices,and the need to target prevention pro- balized, even in countries with coexistent under- these exposure levels are likely to assume grammes where most health gain can be nutrition creasing importance. Unless prevention begins hieved, they supported the development of a The chain of causes-from socioeconomic fac- early, with initiatives such as those envisaged in scientific framework with consistent definitions tors through environmental and community con- the Framework Convention on Tobacco Control, and methods on which to build reliable, compa- ditions to individual behaviour -offers many then the low and middle income countries will rable assessments. There was support for an different entry points for prevention Approaches suffer a vast increase in the number of prema- intersectoral approach to prevention strategies can be combined so that interventions focus on ture deaths from noncommunicable diseases involving partnerships with communities, background environmental (e. g. indoor air pollu- Every country has major risks to health that nongovernmental organizations, local govern- tion) and distal (e.g. sanitation)risks, as well as are known, definite and increasing, sometimes ment, and private sector organizations. hore proximal risks such as physical inactivity and largely unchecked, for which cost-effective in The number of potential risks to health is al- alcohol abuse. terventions are insufficiently applied Once ma- most infinite, and the rapidly changing age struc- Risk communication is an integral part of the jor risks to health have been identified, the ke tures of many populations will lead to changing risk management process. An open approach be- challenge is to increase the uptake of known risk profiles in the coming decades. Poverty is an tween governments and their scientific advisers cost-effective interventions Where cost-effec underlying determinant of many risks to health and the public is recommended, even when there tive options to reduce major risks are not yet and affects disease patterns between and within may be unpalatable messages or scientific uncer- available, an intemational research investment countries; other aspects of socioeconomic devel- tainty. How risks are described, who are the scien- is needed. Some countries have had consider opment, particularly education for women, also tific spokespersons, how dialogue and able success with risk factor interventions that have a key role. Globalization has been hailed as negotiations take place, and whether uncertain- have led, for example, to large reductions in the a strategy to reduce poverty, but the liberaliza- ties are adequately communicated all have sub- prevalence of HI/AIDS and moderate but popu- n of trade can lead to both benefits and harms stantial influence on maintaining trust. tion-wide shifts in major cardiovascular risk for health Tobacco is either an established or International as well as national efforts are factors, such as blood pressure and high choles- rapidly emerging risk to health in all developing needed to combat the very widely distributed risks terol levels. Sharing other countries' successes countries: the need for more stringent tobacco to health -high blood pressure, tobacco, alcohol, and leaning from their predicaments will im- control is uniformly recognized -including in- inactivity, obesity and cholesterol-that are now prove prevention in many different settings, es- reased taxation, bans on advertising and the in- major threats throughout the world, and cause a pecially in rapidly developing countries. troduction or expansion of smoke-free large proportion of disease burden in industrial REFERENCES 1. Fifty-fifth Wordd Health Assembly. Ministerial round tables: risks to health. Geneva: World Health Organi tion; 2002. WHO document A55/DIV/5. 2. Fifty-fifth World Health Assembly. Ministerial round tables: risks to health. Report by the Secretariat Geneva: World Health Organization; 2002. WHO document A55/DIV/66 The World Health Report 2002 Increasing numbers of people forego or defer essential care or suffer huge financial burdens resulting from an unexpected need for expensive services. Altogether, the continu￾ing challenges to reduce risks to health thus remain enormous. However, there is growing national and international recognition of the risks them￾selves. During the World Health Assembly in Geneva in May 2002, WHO’s Member States took part in organized round table discussions on risks to health (1, 2). One after another, health ministers or their representatives spelt out the main risks confronting their country. Tobacco, alcohol, unhealthy diet and obesity featured prominently alongside chronic diseases and traffic injuries in many low income and middle income countries. Ministers clearly demonstrated their knowledge of the trends in major risks in their countries, and their willingness to take action to reduce them (see Box 1.1). This report is intended to help them choose the best risk reduction policies that will in turn promote healthy life in their populations. REFERENCES 1. Fifty-fifth World Health Assembly. Ministerial round tables: risks to health. Geneva: World Health Organi￾zation; 2002. WHO document A55/DIV/5. 2. Fifty-fifth World Health Assembly. Ministerial round tables: risks to health. Report by the Secretariat. Geneva: World Health Organization; 2002. WHO document A55/DIV/6. Box 1.1 Countries endorse the focus on risks to health Ministers of health attending the Fifty-fifth World Health Assembly in Geneva, Switzerland, in May 2002 participated in round table discus￾sions on the major risks to health. Faced by the challenge of balancing preventive and treatment services, and the need to target prevention pro￾grammes where most health gain can be achieved, they supported the development of a scientific framework with consistent definitions and methods on which to build reliable, compa￾rable assessments. There was support for an intersectoral approach to prevention strategies involving partnerships with communities, nongovernmental organizations, local govern￾ment, and private sector organizations. The number of potential risks to health is al￾most infinite, and the rapidly changing age struc￾tures of many populations will lead to changing risk profiles in the coming decades. Poverty is an underlying determinant of many risks to health and affects disease patterns between and within countries; other aspects of socioeconomic devel￾opment, particularly education for women, also have a key role. Globalization has been hailed as a strategy to reduce poverty, but the liberaliza￾tion of trade can lead to both benefits and harms for health. Tobacco is either an established or a rapidly emerging risk to health in all developing countries: the need for more stringent tobacco control is uniformly recognized – including in￾creased taxation, bans on advertising, and the in￾troduction or expansion of smoke-free environments and cessation programmes. Alcohol is another commonly cited and increasing risk to health in many countries; and conditions with im￾portant dietary components, such as diabetes, obesity and hypertension, are increasingly glo￾balized, even in countries with coexistent under￾nutrition. The chain of causes – from socioeconomic fac￾tors through environmental and community con￾ditions to individual behaviour – offers many different entry points for prevention. Approaches can be combined so that interventions focus on background environmental (e.g. indoor air pollu￾tion) and distal (e.g. sanitation) risks, as well as more proximal risks such as physical inactivity and alcohol abuse. Risk communication is an integral part of the risk management process. An open approach be￾tween governments and their scientific advisers and the public is recommended, even when there may be unpalatable messages or scientific uncer￾tainty. How risks are described, who are the scien￾tific spokespersons, how dialogue and negotiations take place, and whether uncertain￾ties are adequately communicated all have sub￾stantial influence on maintaining trust. International as well as national efforts are needed to combat the very widely distributed risks to health – high blood pressure, tobacco, alcohol, inactivity, obesity and cholesterol – that are now major threats throughout the world, and cause a large proportion of disease burden in industrial￾ized countries. In middle income countries these risk factors already contribute to the double bur￾den of risks to health, and they are also of grow￾ing importance in low income countries. With ageing populations and trends in disease rates, these exposure levels are likely to assume in￾creasing importance. Unless prevention begins early, with initiatives such as those envisaged in the Framework Convention on Tobacco Control, then the low and middle income countries will suffer a vast increase in the number of prema￾ture deaths from noncommunicable diseases. Every country has major risks to health that are known, definite and increasing, sometimes largely unchecked, for which cost-effective in￾terventions are insufficiently applied. Once ma￾jor risks to health have been identified, the key challenge is to increase the uptake of known cost-effective interventions. Where cost-effec￾tive options to reduce major risks are not yet available, an international research investment is needed. Some countries have had consider￾able success with risk factor interventions that have led, for example, to large reductions in the prevalence of HIV/AIDS and moderate but popu￾lation-wide shifts in major cardiovascular risk factors, such as blood pressure and high choles￾terol levels. Sharing other countries’ successes and learning from their predicaments will im￾prove prevention in many different settings, es￾pecially in rapidly developing countries