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WHO-Lifestyle Major Cause
of Global Health Problems

LONDON (Reuters Health) - The World Health Organization released a major report Wednesday fingering alcohol, tobacco, high blood pressure and high cholesterol as some the biggest causes of illness and death worldwide--including the developing world.

WHO Director-General Gro Harlem Brundtland told a news conference in London the report was a major step forward in public health policy.

"The world is living dangerously," she said. "A large part of the world's population does so because they have little choice, but a large part does so because they make the wrong choices."

She called the findings a wake-up call. "With this report the WHO is moving to spur a global reassessment of the way we think of disease and the role of public health," she added.

The United Nations' health agency sought to rank 26 major causes of illness on a global scale based on deaths caused and years of life lost due to disability. Details were published in the October 30 issue of the British medical journal The Lancet.

The report shows that the biggest contributions came from maternal and childhood underweight, unsafe sex, high blood pressure, smoking, alcohol, consumption of contaminated water, poor sanitation, iron deficiency, inhaling smoke from indoor fires and high cholesterol and obesity.

"While none of these is new, the fact that tobacco, alcohol and cholesterol rank so high in a global survey is a big surprise," said Chris Murray, author of WHO's World Health Report 2002.

"There is no longer a risk or disease that is the exclusive preserve of the rich countries," he added.

The authors of the report, led by Dr. Majid Ezzati, said the top 10 contributors to the global burden of disease accounted for more than one third of the 56 million deaths globally each year.

Life expectancy could be raised by up to a decade by actions targeted at these known risks, they said.

In developing countries, the biggest contributors to the burden of disease were undernutrition of mothers and children (14.9%), micronutrient deficiencies (3.1% iron, 3.2% zinc, 3.0% vitamin A), unsafe sex (10.2%), poor sanitation or hygiene and unsafe water (5.5%) and indoor smoke from solid fuels (3.6%).

But tobacco, blood pressure and cholesterol also resulted in "significant loss of health life years" in poor regions, the authors note.

In both developed and developing nations more than one billion people were overweight. Of these, 300 million were clinically obese and at least 500,000 died each year.

In fact, the contributions to disease burden of underweight and overweight were both around 3% in developing regions, they note.

In the developed world, tobacco (12.2%), high blood pressure (10.9%) alcohol (9.2%), high cholesterol (7.6%) and overweight and obesity (7.4%) were the biggest contributors to disease burden.

In a commentary on the report, Drs. John Powles and Nick Day from the Institute of Public Health in Cambridge, England, said the relative rankings of the different risk factors should not be given too much weight because the method for calculating risks has not been perfected.

"Public health surveillance on this scale is a new, and immature, science," they write. "This exercise is more comprehensive, more informative, and more theoretically coherent than its predecessor, but should still be regarded as a report of work in progress.

"That past conjectures of this kind have been shown to be open to challenge and to subsequent refinement argues in favor of their continued iteration. It is to the credit of WHO that it hosts this ongoing work."

SOURCE: The Lancet online October 30, 2002.


Reference Source 89

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