Global Health Reform

Out of every ten deaths worldwide, six are due to non-communicable conditions; three to communicable, reproductive or nutritional conditions; and one due to injuries. Many developing countries have mortality patterns that reflect high levels of infectious diseases and the risk of death during pregnancy and childbirth, in addition to the cancers, cardiovascular diseases and chronic respiratory diseases that account for most deaths in the developed world (World Health Statistics, 2009).

The World Health Organization, also known as W.H.O., is the authority for health issues within the United Nations system. The W.H.O. is responsible for providing leadership on global health issues, shaping health research, setting standards, articulating evidence-based policy options, providing technical support to countries and monitoring/assessing health trends.

In the year 2000, the World Health Organization created the Millennium Development Goals, or MDG. The United Nations Millennium Development Goals are eight goals that all 191 UN member states have agreed to try to achieve by the year 2015.

The Millennium Development Goals include eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality, reducing child mortality rates, improving maternal health, combating diseases such as HIV/AIDS and malaria, ensuring environmental sustainability, and developing a global partnership for development.

While reducing mortality rates, improving maternal health and combating disease are essential health issues addressed by the Millennium Development Goals (MDGs), the remaining goals are both necessary and sufficient for achieving those health-related objectives.

W.H.O. reports, at the midpoint between 2000 and 2015, the analysis shows encouraging signs of progress, particularly in child health; it points to areas where current gains need to be sustained, particularly in relation to AIDS, tuberculosis and malaria; and areas where there has been little or no movement, notably maternal and newborn health.

More detailed and updated data for 2008, reported in World Health Statistics 2009, show major differences in progress between and within countries and regions. Looking forward to 2015 and beyond, the challenges presented by weak health systems, the health transition and emerging health threats will become increasingly prominent.

In May 2009, the W.H.O. presented information as to the progress of the Millennium Development Goals. Some of the "Key Facts" include the following:

Globally, the proportion of children under five years of age suffering from under-nutrition, according to WHO Child Growth Standards, declined from 27% in 1990 to 20% in 2005. But, the progress is uneven, and an estimated 112 million children are underweight.

Globally, the number of children who die before their fifth birthday has been reduced by 27% from 12.5 million estimated in 1990 to 9 million in 2007. This reduction is due to a combination of interventions, including the use of insecticide-treated mosquito nets for malaria, oral re-hydration therapy for diarrhea, increased access to vaccines for a number of infectious diseases and improved water and sanitation. But pneumonia and diarrhea continue to kill 3.8 million children aged under five each year, although both conditions are preventable and treatable.

The global maternal mortality ratio of 400 maternal deaths per 100 000 live births in 2005 has barely changed since 1990. Every year an estimated 536 000 women die in pregnancy or childbirth. Most of these deaths occur in sub-Saharan Africa where the maternal mortality ratio is 900 per 100 000 births and where there has been no measurable improvement since 1990. A woman in Africa may face a 1-in-26 lifetime risk of death during pregnancy and childbirth, compared with only 1 in 7300 in the developed regions.

In the war on disease, significant progress was obtained and impressive measures continue to unfold in the treatment for those who suffer from HIV/AIDS, malaria and other diseases.

The percentage of adults living with HIV worldwide has remained stable since 2000 but there were an estimated 2.7 million new infections during 2007. Moreover, deaths are increasing in parts of Africa, particularly eastern and southern Africa. The use of antiretroviral therapy has increased; in 2007, about 1 million more people living with HIV received the treatment. That means one third of the estimated 9.7 million people in developing countries who need the treatment were receiving it.

The MDG target for reducing the incidence of tuberculosis was met globally in 2004. Since then, incidence has continued to fall slowly. Thanks to early detection of new cases and effective treatment using the WHO-recommended DOTS treatment strategy, treatment success rates have been consistently improving, with rates rising from 79% in 1990 to 85% in 2006. Multi-drug resistant tuberculosis is a challenge in countries, such as those of the former Soviet Union, while the lethal combination of HIV and tuberculosis is an issue particularly for sub-Saharan African countries.

Efforts to control malaria are beginning to pay off with significant increases in the proportion of children sleeping under insecticide-treated mosquito nets. Although it is still too early to register the global impact, 27 countries - including five in Africa - have reported a reduction of up to 50% in malaria cases between 1990 and 2006. In 2006, the number of cases was estimated to be 250 million globally.

As far as other diseases, progress has been made in treating neglected tropical diseases that affect some 1.2 billion people. For example, only 9,585 cases of dracunculiasis (guinea-worm disease) were reported in the five countries where the disease is endemic, compared with an estimated 3.5 million reported in 20 such countries in 1985.

Each one of us is a member of the global community. As such, health and related issues are a shared responsibility, involving equitable access to essential care and collective defense against transnational threats. It is imperative that every person, especially those in developed nations, must stride toward achieving the Millennium Development Goals.