Preventing Risks and Taking Action based shows how these countries already face many of the same risks as industrial ized countries-tobacco and high blood pressure, for example- while also having to contend with major remaining problems of undernutrition and communicable diseases At the same time in the developed countries of North America, Europe and the Asian Pacific, at least one-third of all disease burden is attributable to these five risk factors. bacco, alcohol, blood pressure, cholesterol and obesity. The tobacco epidemic alone kills about 2.4 million people every year in industrialized countries. In addition, suboptimal levels of blood pressure and cholesterol each cause millions of deaths annually, and increasing levels of overweight are leading to epidemics of obesity and diabetes The world is living dangerously either because it has little choice, or because it is making the wrong choices. Today there are more than six billion people coexisting on this fragile planet. On one side are the many millions who are dangerously short of the food, water and security they need to live. Developing countries still face a high and highly con centrated burden from poverty, undernutrition, unsafe sex, unsafe water, poor sanitation unhealthy consumption, particularly of tobacco and alcohol. The risks from blood pressure and cholesterol, strongly linked to heart attacks and strokes, are also closely related to excessive consumption of fatty, sugary and salty foods. They become even more dangerous when combined with the deadly forces of tobacco and excessive alcohol consumption Obesity, a result of unhealthy consumption coupled with lack of physical activity, is itself a All of these risk factors-blood pressure, cholesterol, tobacco, alcohol and obesity-and the diseases linked to them are well known to wealthy societies. The real drama is that they now also increasingly dominate in low mortality developing countries where they create a double burden on top of the infectious diseases that always have afflicted poorer countries They are even becoming more prevalent in high mortality developing countries EFFECTIVE AND AFFORDABLE PREVENTIVE INTERVENTIONS ARE AVAILABLE Every country has major risks to health that are known, definite and times largely unchecked; cost-effective interventions exist but are underutilized Very substantial health gains can be made for relatively modest expenditures. Chapter 4 examined in detail the cost-effectiveness of many interventions. Some of the most impor- tant findings are briefly described belor A strategy to protect the child's environment is cost-effective in all settings, with very cost-effective components including some form of micronutrient supplementation, such as vitamin A, iron, and zinc; disinfection of water at point of use to reduce the incidence of diarrhoeal diseases; and treatment of diarrhoea and pneumonia Improved water supply based on disinfection at point of use is cost-effective in re- gions of high child mortality. While acknowledging that regulated piped water sup plies will be the long-term aim of most countries, a policy shift towards household water management appears to be the most attractive short-term water-related health intervention in developing countries reventive interventions to reduce the incidence of HIV infections, including meas- ures to encourage safer injection practices, are very cost-effective. The use of somePreventing Risks and Taking Action 163 based shows how these countries already face many of the same risks as industrial￾ized countries – tobacco and high blood pressure, for example – while also having to contend with major remaining problems of undernutrition and communicable diseases. • At the same time in the developed countries of North America, Europe and the Asian Pacific, at least one-third of all disease burden is attributable to these five risk factors: tobacco, alcohol, blood pressure, cholesterol and obesity. The tobacco epidemic alone kills about 2.4 million people every year in industrialized countries. In addition, suboptimal levels of blood pressure and cholesterol each cause millions of deaths annually, and increasing levels of overweight are leading to epidemics of obesity and diabetes. The world is living dangerously – either because it has little choice, or because it is making the wrong choices. Today there are more than six billion people coexisting on this fragile planet. On one side are the many millions who are dangerously short of the food, water and security they need to live. Developing countries still face a high and highly con￾centrated burden from poverty, undernutrition, unsafe sex, unsafe water, poor sanitation and hygiene, iron deficiency and indoor smoke from solid fuels. On the other side lies unhealthy consumption, particularly of tobacco and alcohol. The risks from blood pressure and cholesterol, strongly linked to heart attacks and strokes, are also closely related to excessive consumption of fatty, sugary and salty foods. They become even more dangerous when combined with the deadly forces of tobacco and excessive alcohol consumption. Obesity, a result of unhealthy consumption coupled with lack of physical activity, is itself a serious health risk. All of these risk factors – blood pressure, cholesterol, tobacco, alcohol and obesity – and the diseases linked to them are well known to wealthy societies. The real drama is that they now also increasingly dominate in low mortality developing countries where they create a double burden on top of the infectious diseases that always have afflicted poorer countries. They are even becoming more prevalent in high mortality developing countries. EFFECTIVE AND AFFORDABLE PREVENTIVE INTERVENTIONS ARE AVAILABLE Every country has major risks to health that are known, definite and increasing, some￾times largely unchecked; cost-effective interventions exist but are underutilized. Very substantial health gains can be made for relatively modest expenditures. Chapter 4 examined in detail the cost-effectiveness of many interventions. Some of the most impor￾tant findings are briefly described below. • A strategy to protect the child’s environment is cost-effective in all settings, with very cost-effective components including some form of micronutrient supplementation, such as vitamin A, iron, and zinc; disinfection of water at point of use to reduce the incidence of diarrhoeal diseases; and treatment of diarrhoea and pneumonia. • Improved water supply based on disinfection at point of use is cost-effective in re￾gions of high child mortality. While acknowledging that regulated piped water sup￾plies will be the long-term aim of most countries, a policy shift towards household water management appears to be the most attractive short-term water-related health intervention in developing countries. • Preventive interventions to reduce the incidence of HIV infections, including meas￾ures to encourage safer injection practices, are very cost-effective. The use of some