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Women’s Health Facts

Posted by Эрнандo (Ernando) comments (5)

Key facts

  • On average, women live six to eight years longer than men globally.
  • In 2007, women's life expectancy at birth was more than 80 years in 35 countries, but only 54 years in the WHO African Region.
  • Girls are far more likely than boys to suffer sexual abuse.
  • Road traffic injuries are the leading cause of death among adolescent girls in high- and middle-income countries.
  • Essentially all (99%) of the half a million maternal deaths every year occur in developing countries.
  • Breast cancer is the leading cancer killer among women aged 20–59 years in high-income countries.
  • Globally, cardiovascular disease, often thought to be a "male" problem, is the leading killer of women.

Infancy and childhood (0-9 years)

Both death rates and the causes of death are similar for boys and girls during infancy and childhood. Pre-term births, birth asphyxia and infections are the main causes of death during the first month of life, which is also the time of life when mortality is the highest.
Pneumonia, diarrhoea and malaria are the main causes of death during the first five years of life, with malnutrition being a major factor.
Globally, girls under five years are more likely to be overweight than boys, which – together with obesity – may lead to cardiovascular disease, diabetes, muculoskeletal disorders and some cancers later in life.
Girls are far more likely than boys to suffer sexual violence (any sexual abuse: 8.7% boys; 25.3% girls globally).

Adolescent girls (10-19 years)

Unintentional injuries
Injuries from road traffic accidents are the leading cause of death among adolescent girls (10–19 years) in high- and middle-income countries.
Mental health
Suicide and mental health disorders contribute significantly to the burden of ill-health and death in all regions.
HIV/AIDS
HIV infection is high in virtually all countries that have generalized HIV epidemics. Adolescent girls are at risk of unsafe and often unwanted and forced sexual activity that can lead to HIV/AIDS, other sexually transmitted infections, unwanted pregnancy and unsafe abortion.
Adolescent pregnancy
Pregnancy-related complications are a leading cause of death among girls aged 15–19 years in developing countries; unsafe abortion – provided by unskilled persons in unhygienic conditions – contributes substantially to these deaths.
Substance use
Adolescent girls are increasingly using tobacco and alcohol, which risks compromising their health, including in later life, as do poor diet and physical inactivity. For instance, there is evidence that tobacco advertising is increasingly targeting young girls and women.

Reproductive age (15-44 years) and adult women (20-59 years)

HIV/AIDS
For women in their reproductive years (15–44), HIV/AIDS is the leading cause of death and disease worldwide, while unsafe sex is the main risk factor in developing countries. Biological factors, lack of access to information and health services, economic vulnerability and unequal power in sexual relations expose young women particularly to HIV infection.
Maternal health
Every year, 99% of some half a million maternal deaths occur in developing countries. Despite the increase in contraceptive use over the past 30 years, significant unmet needs remain in all regions. For example, in sub-Saharan Africa, one in four women who wish to delay or stop childbearing does not use any family planning method.
Tuberculosis
Tuberculosis is often linked to HIV infection and the third leading cause of death among women of reproductive age (15–44 years) in low-income countries and worldwide. It ranks fifth worldwide among women aged 20–59 years.
Injuries
Injuries from road traffic accidents figure among the top 10 causes of death among adult women (20-59 years) globally. Furthermore, in the WHO South-East Asia Region, burns are a leading cause of death among women aged 15–44. Women suffer significantly more fire-related injuries and deaths than men. Many fire-related deaths are related to cooking accidents and many are a result of intimate partner and family violence.
Cervical cancer
Cervical cancer is the second most common type of cancer among women, with virtually all cases linked to genital infection with the human papillomavirus (HPV). Almost 80% of cases today and an even higher proportion of deaths from cervical cancer occur in low-income countries, where access to cervical cancer screening and treatment virtually does not exist.
Violence
Violence against women is widespread around the world. Women who have been physically or sexually abused have higher rates of mental ill-health, unintended pregnancies, abortions and miscarriages than non-abused women. Most violence against women is perpetrated by an intimate male partner. Increasingly in many conflicts sexual violence is also used as a tactic of war.
Depression and suicide
Women are more susceptible to depression and anxiety than men. An estimated 73 million adult women worldwide suffer a major depressive episode each year. Mental disorders following childbirth, including depression, are estimated to affect about 13% of women within a year of delivery. Suicide is the seventh top cause of death globally for women aged 20-59 years.
Chronic obstructive pulmonary disease (COPD)
Tobacco use and the burning of solid fuels for indoor heating and cooking are the primary risk factors for chronic obstructive pulmonary disease (COPD) – a lung ailment – in women. Women prepare most of the family food, hence, the burden of COPD caused by exposure to indoor smoke is over 50% higher among women than among men.

Older women (60 years and over)

Because they tend to live longer than men, women represent a growing proportion of all older people. Worldwide, in 2007, 55% of adults aged 60 years and over were women, a proportion that rises to 58% at age 70 and above. Chronic conditions – mainly cardiovascular disease and COPD – account for 45% of deaths in women over 60 years of age worldwide. A further 15% of deaths are caused by cancers, mainly of the breast, lung and colon. Many of the health problems faced by women in older age are the result of risk factors that arise in their adolescence and adulthood, such as smoking, sedentary lifestyles and unhealthy diets. Other debilitating health problems faced by older women are poor vision (including cataracts), hearing loss, arthritis, depression and dementia.
Cardiovascular disease: heart attacks and strokes
Globally, cardiovascular disease (mainly heart attacks/ischaemic heart disease and stroke), often thought to be a "male" problem, is the main killer of older women. Women often show different symptoms from men, which contributes to under diagnosis of heart disease in women. Women also tend to develop heart disease later in life than men. Tobacco is implicated in nearly 10% of cardiovascular disease in women.
Breast, lung and colon cancer
Cancers of the breast, lung and colon are among the top ten causes of death of older women globally. The incidence (new cases) of breast cancer is much higher in high-income countries compared to low- and middle-income countries, but mortality is similar. This is due to the availability of better treatment in the high-income countries. For lung and colon cancer, both incidence and mortality are currently higher in high-income countries. Globally, 71% of lung cancer deaths are caused by tobacco use.

Table: 10 leading causes of death in females by country income group, 2004

Table 3: Ten leading causes of death in females by country incomes group, 2004
Source: World Health Organization
*Chronic obstructive pulmonary disease.
**Includes severe neonatal infections and other non-infectious causes arising in the perinatal period.

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Poliomyelitis Facts

Posted by Эрнандo (Ernando) comments (3)

Key facts

  • Polio (poliomyelitis) mainly affects children under five years of age.
  • One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
  • Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 1 352 reported cases in 2010. The reduction is the result of the global effort to eradicate the disease.
  • In 2012, only three countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988.
  • Persistent pockets of polio transmission in northern Nigeria and the border between Afghanistan and Pakistan are the current focus of the polio eradication initiative.
  • As long as a single child remains infected, children in all countries are at risk of contracting polio. In 2009-2010, 23 previously polio-free countries were re-infected due to imports of the virus.
  • In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.
  • Success hinges on financing the next steps of the global eradication initiative.

Polio and its symptoms

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

People most at risk

Polio mainly affects children under five years of age.

Prevention

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Global caseload

Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 1352 reported cases in 2010. In 2012, only parts of three countries in the world remain endemic for the disease - the smallest geographic area in history - and case numbers of wild poliovirus type 3 are down to lowest-ever levels.

The Global Polio Eradication Initiative

Launch

In 1988, the forty-first World Health Assembly, consisting then of delegates from 166 Member States, adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative, spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF). This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Progress

Overall, since the Global Polio Eradication Initiative was launched, the number of cases has fallen by over 99%. In 2012, only three countries in the world remain polio-endemic. Persistent pockets of polio transmission in northern Nigeria and along the border between Afghanistan and Pakistan are key epidemiological challenges.
In 1994, the WHO Region of the Americas (36 countries) was certified polio-free, followed by the WHO Western Pacific Region (37 countries and areas including China) in 2000 and the WHO European Region (51 countries) in June 2002. In 2010, the European Region suffered its first importation of polio after certification. In 2011, the WHO Western Pacific Region also suffered an importation of poliovirus.
In 2009, more than 361 million children were immunized in 40 countries during 273 supplementary immunization activities (SIAs). Globally, polio surveillance is at historical highs, as represented by the timely detection of cases of acute flaccid paralysis.

Objectives

The objectives of the Global Polio Eradication Initiative are:
  • to interrupt transmission of wild poliovirus as soon as possible;
  • to achieve certification of global polio eradication;
  • to contribute to health systems development and strengthen routine immunization and surveillance for communicable diseases in a systematic way.

Strategies

There are four core strategies to stop transmission of the wild poliovirus in areas that are affected by the disease or considered at high risk of re-infection:
  • high infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life;
  • supplementary doses of OPV to all children under five years of age during SIAs;
  • surveillance for wild poliovirus through reporting and laboratory testing of all acute flaccid paralysis (AFP) cases among children under fifteen years of age;
  • targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
Before a WHO region can be certified polio-free, three conditions must be satisfied:
  • there are at least three years of zero polio cases due to wild poliovirus;
  • disease surveillance efforts in countries meet international standards; and
  • each country must illustrate the capacity to detect, report and respond to “imported” polio cases.
Laboratory stocks must be contained and safe management of the wild virus in inactivated polio vaccine (IPV) manufacturing sites must be assured before the world can be certified polio-free.
The Independent Monitoring Board (IMB) evaluates on a quarterly basis the progress towards each of the major milestones of the Global Polio Eradication Initiative Strategic Plan 2010-2012, determine the impact of any 'mid-course corrections' that are deemed necessary, and advise on additional measures when appropriate.

Coalition

The Global Polio Eradication Initiative (GPEI) is spearheaded by WHO, Rotary International, CDC and UNICEF. The eradication of polio is about equity in health and the moral imperative of reaching every child with an available health intervention.
The polio eradication coalition includes governments of countries affected by polio; private sector foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, Malaysia, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Republic of Korea, the Russian Federation, Saudi Arabia, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies and the Global Poverty Project) and corporate partners (e.g. Sanofi Pasteur and Wyeth). Volunteers in developing countries also play a key role: 20 million people have participated in mass immunization campaigns.

Priorities for polio eradication

As long as a single child remains infected with polio, children in all countries are at risk of contracting the disease.
To stop transmission of the wild poliovirus and optimize the benefits of polio eradication, the global priorities are:
Stopping wild poliovirus transmission in endemic countries
Polio today is more geographically restricted than ever before. The highest priority is reaching all children during SIAs in the four countries which have never stopped transmission of polio. To succeed, high levels of political commitment must be maintained at national, state/provincial and district levels. In 2010, a new strategic plan was launched, based on lessons learned in the past years and an independent evaluation of the major barriers to stopping polio transmission. This strategic plan is based on district-specific planning to address the unique challenges of each of the infected areas, fully exploiting new tools such as bivalent oral polio vaccine and strengthening health systems.
Putting an end to re-established transmission
Three countries - Angola, Chad and the Democratic Republic of the Congo - are classified as having 're-established transmission' because they have had ongoing transmission for over 12 months. These countries are treated with the same level of priority as the endemic countries. In early 2011, all three countries initiated emergency action plans to address the situation and fill operational gaps.
Preventing new outbreaks
Poliovirus has a habit of finding pockets of inadequately vaccinated children. As China, Congo, the Russian Federation and Tajikistan have learned, the poliovirus does not respect national borders. To minimize the risk of outbreaks from importation, countries must maintain high population immunity levels.
Closing the funding gap
Substantial financial resources are required to support polio eradication. However, in addition to the obvious humanitarian benefits, economic modelling has demonstrated the financial benefits of polio eradication to be at least US$ 40-50 billion. Success in carrying out the necessary vaccination campaigns and surveillance hinges on sufficient funds from financial stakeholders.

Impact of the initiative

More than eight million people who would otherwise have been paralysed are walking today because they have been immunized against polio since the initiative began in 1988.
By preventing a debilitating disease, the Global Polio Eradication Initiative is helping reduce poverty, and is giving children and their families a greater chance of leading healthy and productive lives.
By establishing the capacity to access children everywhere, more than two billion children worldwide have been immunized during SIAs, demonstrating that well-planned health interventions can reach even the most remote, conflict-affected or poorest areas.
Planning for SIAs provides key demographic data – “finding” children in remote villages and households for the first time, and "mapping" their location for future health services.
In most countries, the Global Polio Eradication Initiative has expanded the capacity to tackle other infectious diseases, such as avian influenza or Ebola, by building effective disease-reporting and surveillance systems, training local epidemiologists and establishing a global laboratory network. This capacity has also been deployed in health emergencies such as the 2010 floods in Pakistan and the 2011 drought in the Horn of Africa.
Routine immunization services have been strengthened by bolstering the cold chain, transport and communications systems for immunization. Improving these services helped to lay the groundwork for highly successful measles vaccination campaigns that have saved millions of young lives.
Vitamin A is often administered during polio SIAs. Since 1988, more than 1.2 million childhood deaths have been prevented through provision of vitamin A during polio SIAs.
On average, one in every 250 people in a country has been involved in polio immunization campaigns. More than 20 million health workers and volunteers have been trained to deliver OPV and vitamin A, fostering a culture of disease prevention.
Through the synchronization of SIAs, many countries have established a new mechanism for coordinating major cross-border health initiatives aimed at reaching all people – a model for regional and international cooperation for health.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio in the next five years would save at least US$ 40-50 billion, mostly in low-income countries

For more information contact

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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Obesity and Overweight

Posted by Эрнандo (Ernando) comments (2)

Key facts

  • Worldwide obesity has more than doubled since 1980.
  • In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.
  • 65% of the world's population live in countries where overweight and obesity kills more people than underweight.
  • More than 40 million children under the age of five were overweight in 2010.
  • Obesity is preventable.

What are overweight and obesity?

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2).
The WHO definition is:
  • a BMI greater than or equal to 25 is overweight
  • a BMI greater than or equal to 30 is obesity.
BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

Facts about overweight and obesity

Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.
Some WHO global estimates from 2008 follow.
  • More than 1.4 billion adults, 20 and older, were overweight.
  • Of these overweight adults, over 200 million men and nearly 300 million women were obese.
  • Overall, more than one in ten of the world’s adult population was obese.
In 2010, more than 40 million children under five were overweight. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. Close to 35 million overweight children are living in developing countries and 8 million in developed countries.
Overweight and obesity are linked to more deaths worldwide than underweight. For example, 65% of the world's population live in countries where overweight and obesity kill more people than underweight (this includes all high-income and most middle-income countries).

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:
  • an increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients; and
  • a decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.
Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.

What are common health consequences of overweight and obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:
  • cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2008;
  • diabetes;
  • musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints);
  • some cancers (endometrial, breast, and colon).
The risk for these noncommunicable diseases increases, with the increase in BMI.
Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Facing a double burden of disease

Many low- and middle-income countries are now facing a "double burden" of disease.
  • While they continue to deal with the problems of infectious disease and under-nutrition, they are experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings.
  • It is not uncommon to find under-nutrition and obesity existing side-by-side within the same country, the same community and the same household.
Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant and young child nutrition At the same time, they are exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor foods, which tend to be lower in cost. These dietary patterns in conjunction with low levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, making the healthier choice of foods and regular physical activity the easiest choice, and therefore preventing obesity.
At the individual level, people can:
  • limit energy intake from total fats;
  • increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts;
  • limit the intake of sugars;
  • engage in regular physical activity;
  • achieve energy balance and a healthy weight.
Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to:
  • support individuals in following the recommendations above, through sustained political commitment and the collaboration of many public and private stakeholders;
  • make regular physical activity and healthier dietary patterns affordable and easily accessible too all - especially the poorest individuals.
The food industry can play a significant role in promoting healthy diets by:
  • reducing the fat, sugar and salt content of processed foods;
  • ensuring that healthy and nutritious choices are available and affordable to all consumers;
  • practicing responsible marketing;
  • ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.

WHO response

Adopted by the World Health Assembly in 2004, the WHO Global Strategy on Diet, Physical Activity and Health describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.

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