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Journal Article


Lancet Infect. Dis. 1997; 349(9061): 1263.


(Copyright © 1997, Elsevier Publishing)






It is commonplace for national exchequers and international financial institutions to fund studies aimed at projecting industrial output, inflation, and investment yields. By contrast, comparatively little attention is paid to predicting the future health of nations: the burdens of the present are, perhaps, too pressing, and there is seen to be little profit in such speculation. The World Bank, however, in collaboration with WHO, initiated such a study in 1992. When the results were published by WHO in 1994, they attracted little attention. In this issue, The Lancet publishes the first of four articles by Christopher Murray and Alan Lopez on the Global Burden of Disease Study (pp 1269--76). The findings of the first article on mortality by cause throughout the world may surprise some readers and certainly suggest that current strategies to improve the world's health may need to be reassessed. Four of this ten--ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and lung cancer--may be partly prevented by political determination to discourage tobacco smoking, by correcting industrial pollution and unbalanced diets, and by discouraging sloth. One, measles, may be conquered by immunisation, and another, diarrhoeal diseases, by improved sanitation and provision of oral rehydration solutions. Road-traffic accidents and perinatal disorders have proved refractory to attempts at prevention, and there is no realistic prospect of overcoming tuberculosis, unless pharmaceutical companies can be persuaded substantially to increase their investment in antituberculosis treatments. Further down the list come the real surprises. In 1990, suicides (786 000, no 12) far outnumbered deaths from HIV infection (312 000, no 30); death by drowning (504 000, no 20) was more common than death through war (502 000, no 21). Malaria is only just out of the top ten with 856 000 deaths. This list does not reflect the emphasis placed on public-health preventative measures worldwide, nor the projects which attract the largest funding. It is worth pondering on how much more money is spent on research into HIV infection than into the causes of suicide or prevention of road-traffic accidents and why should this be. Murray and Lopez predict, in a coming article, that by the year 2000, the first two most common causes of death worldwide will be unchanged but that chronic obstructive pulmonary disease will move up to no 3, lung cancer to no 5, road traffic accidents to no 6, and suicide to no 10. Considering the questions these results raise, has WHO suggested a change in their current policy of making it a priority to eradicate infectious diseases, and encouraging both nations and charities to fund such endeavours? Far from it. Indeed, WHO insisted at the last minute on the addition of a disclaimer to these articles, noting that: "the views expressed… do not reflect the opinions, policies, or standards of the World Health Organization". This timid response is unacceptable. Far from seeking to distance itself from Murray and Lopez's findings, a more productive attitude would be to endorse their value as a catalyst for initiating a new and far-reaching debate about the priorities of international health, both inside and outside WHO.


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