Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 58, Num. 2, 2004, pp. 82-86

Indian Journal of Medical Science Vol. 58 No. 2, February 2004 , pp. 82-86

News

WHO releases new report on global problem of oral diseases

24 FEBRUARY 2004 | GENEVA — Oral diseases such as dental caries (tooth decay), periodontitis (gum disease) and oral and pharyngeal cancers are a global health problem in both industrialized and increasingly in developing countries, especially amongst poorer communities, the World Health Organization (WHO) said today. Announcing the findings of the World Oral Health Report, WHO said that an estimated five billion people worldwide had experienced dental caries. "Worldwide, losing teeth is seen as a natural consequence of ageing, but it is in fact preventable," said Dr Catherine Le Gales- Camus, WHO's Assistant-Director General, Noncommunicable Diseases and Mental Health. "There is a perception that dental caries is no longer a problem in the developed world, but it affects 60-90% of schoolchildren and the vast majority of adults. Dental caries is also the most prevalent oral disease in several Asian and Latin American countries."

The impact of oral diseases in pain, suffering, impaired function and reduced quality of life, is both extensive and expensive. Treatment is estimated to account for between 5-10% of health costs in industrialized countries, and is beyond the resources of many developing countries.

While it appears to be less severe in most African countries, the report states that with changing living conditions, dental caries is expected to increase in many developing countries in Africa, particularly as a result of the growing consumption of sugars and inadequate exposure to fluorides.

"In many developing countries, access to oral health care is limited and teeth are often left untreated, or extracted," said Dr Poul Erik Petersen, coordinator of WHO's Global Oral Health Programme. "In Africa, the dentist-to-population ratio is approximately 1:150,000, against about 1:2,000 in most industrialized countries. And while we have made limited progress in reducing tooth decay amongst younger people in the developed world, for many older people it remains a major source of pain and ill-health."

Globally, most children shows signs of gingivitis (bleeding gums) and among adults, the initial stages of periodontal disease are prevalent. Severe periodontitis, which may result in tooth loss, is found in 5-15% of most populations. In industrialized countries, studies show that smoking is a key risk factor for periodontal disease.

The prevalence of oral cancer is the eighth most common cancer of men worldwide. In south central Asia, cancer of the oral cavity ranks amongst the three most common types of cancer. However, sharp increases of oral/pharyngeal cancers have also been reported for several countries and regions such as Denmark, Germany, Scotland, central and eastern Europe, and to a lesser extent, Australia, New Zealand, Japan and the USA. Smoking, smokeless tobacco, chewing betel, and alcohol use, are all risk factors.

The major priorities and components of WHO's Global Oral Health Programme are set out in the new report. In addition to addressing modifiable risks such as oral hygiene practices, sugar consumption, lack of calcium and micronutrients, and tobacco use, key elements include addressing the major sociocultural determinants. These include: poor living conditions, low education level, as well as lack of traditions supporting oral health. Countries should ensure appropriate use of fluorides for prevention of dental caries, while unsafe water and poor hygiene are environmental risk factors for oral as well as general health.

Oral health systems need to be oriented to primary health care and prevention. WHO's Global School Health Initiative, which seeks to mobilize health promotion and education levels at local national, regional and global levels, has recently been strengthened by an oral health technical document. Increasing emphasis has also been placed on targeting the elderly; by 2050, there will be two billion people over the age of 60, 80% of them living in the developing world. The Oral Health Programme will also make an important contribution to the early diagnosis, prevention and treatment of HIV/AIDS, which often shows up first in oral fungal, bacterial or viral infections and lesions.

"Poor oral health can have a profound effect on general health and the quality of life," said Dr Petersen. "The experience of pain, endurance of dental abcesses, problems with eating, chewing, and missing, discoloured or damaged teeth, has a major impact on people's daily lives and wellbeing."

Source: http://www.who.int/mediacentre/releases/2004/pr15/en/

Health professionals to promote a new code of conduct on tobacco control

New code asks health professionals to lead by example, and reduce smoking themselves

30 January 2004 | GENEVA — To stem trends in tobacco use, which currently causes nearly five million deaths per year, healthcare professional associations today agreed to promote a new code of conduct. The associations, meeting this week at the World Health Organization (WHO), represent members in almost all countries. The code looks at tangible ways to stop the use of a product which will eventually kill half of its regular users.

Participants included professional associations representing pharmacists, dentists, nurses, midwifes, chiropractors and physicians. During the discussions, professionals vowed to increase and strengthen tobacco surveillance, cessation programmes, ensure access to tobacco-free healthcare facilities and implement education and community advocacy programmes.

"When it comes to tobacco use, health professionals have the opportunity to help people change their behaviour. Their involvement is key to successfully curbing the tobacco epidemic," said Dr Vera Luiza da Costa e Silva, Director of the Tobacco Free Initiative, WHO. "For example, If dentists warned all their patients that smoking causes excess plaque, yellowing teeth and contributes to tooth decay, as well as a five-fold increased risk of oral cancer, the impact on smoking would be dramatic."

Studies have shown that even brief counselling by health professionals on the dangers of smoking and importance of quitting is one of the most cost-effective methods of reducing smoking. According to the proposed code of conduct, health professionals shall also lead by example. They should act as role-models for their patients, by ceasing to smoke, and by ensuring their workplaces and public facilities are smoke and tobacco-free.

Smoking prevalence among health professionals in many countries is the same if not higher than the average of the population. In Albania in 2000, 44% of medical students smoked, compared with 39% of the population. In Saudi Arabia, 20% of the doctors smoke whereas the average for the population is 13%.

The participants agreed that another important role of health professionals is to introduce tobacco control in the public health agenda at country level, supporting the political process through the signature and ratification of the WHO Framework Convention on Tobacco Control (FCTC) by their governments, and supporting the implementation of the Convention by their own members.

In a display of support for the Convention, the associations have decided to create a list of `mirror signatures', which will be open for signature by all affiliates and members.

Dr Catherine Le Galès-Camus, Assistant Director-General for Noncommunicable Diseases and Mental Health, WHO, said: "With 1.1 billion people addicted to tobacco and five million annual deaths, tobacco should continue to be a priority on the health agenda." She added: "We would like these associations to convey the message that this is the time for government action, as we now have, with the WHO FCTC, the right tool to fight this epidemic".

Notes for the editors:

The WHO FCTC, adopted in May 2003, sets out the standards on tobacco-related issues, such as price and tax increases, illicit trade, labelling, advertising and sponsorship and second-hand smoke. Since its adoption, 87 countries and the European Community have signed it, and six (Fiji, Malta, New Zealand, Norway, Seychelles, Sri Lanka) have ratified it (as at 29 January 2003).

The WHO FCTC will be open for signature in the United Nations Headquarters in New York until 29 June 2004. Member States that sign the Convention indicate that they will strive in good faith to ratify it. Countries wishing to become a party to the Convention after 29 June 2004 may do so by means of accession.

The FCTC will become law 90 days after 40 countries have signed and ratified it, binding the countries that are parties to the Treaty to legislate according to its provisions.

Source: http://www.who.int/mediacentre/releases/2004/pr9/en/

Unprecedented spread of avian influenza requires broad collaboration

FAO/OIE/WHO call for international assistance

27 January 2004 | GENEVA/ROME/PARIS — The spread of highly pathogenic avian influenza in several areas in Asia is a threat to human health and a disaster for agricultural production, the UN Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO) said in a joint statement today.

Although it has not happened yet, the so-called "bird flu" presents a risk of evolving into an efficient and dangerous human pathogen, the three agencies warned.

The possible widespread occurrence of avian flu in animals in developing countries represents a significant control challenge. FAO, OIE and WHO appealed to donors to address the global threat from avian flu and to provide funds and technical assistance to countries to help eliminate this threat.

"With SARS, we learned that only by working together can we control emerging global public health threats," said Dr. LEE Jong-wook, WHO Director-General "Now, we confront another threat to human health and we must reaffirm existing collaboration and form new ones. At the international level, WHO, FAO and OIE stand together in close working relationship to provide the necessary guidance to Member States."

Highly pathogenic avian influenza is a threat to public health because, if it circulates long enough in humans and farm animals, there is an increased risk that it may evolve into a pandemic influenza strain which could cause disease worldwide. In addition, avian influenza is an economic disaster for the poultry industry as well as small poultry farmers.

The focus of FAO, OIE and WHO activities is to avert a human and animal pandemic.

"We have a brief window of opportunity before us to eliminate that threat," said Dr. Jacques Diouf, FAO Director-General.

"Farmers in affected areas urgently need to kill infected and exposed animals and require support to compensate for such losses. This will represent a huge cost, especially to struggling economies and small farmers. The international community has a stake in the success of these efforts and poorer nations will need help," Dr. Diouf said. FAO and OIE also called for a tight and effective control of animal movement in affected areas. Farm workers need to be protected during the culling operations by wearing protective clothing. In addition, vaccines need to be supplied. Farmers, especially backyard farmers, need to be supported for losses that will surely be significant.

The threat from avian influenza is well understood. Unlike SARS, diagnostic tests already exist, as do effective, although costly, antivirals for humans. While it is challenging, research is already well underway on the development of a human vaccine against this strain.

"This is a serious global threat to human health," said Dr. Lee Jong-wook. "But we have faced several emerging infectious diseases in the past. This time, we face something we can possibly control before it reaches global proportions if we work cooperatively and share needed resources. We must begin this hard, costly work now."

Source: http://www.who.int/mediacentre/releases/2004/pr7/en/

Unique opportunity for eradication success now rests with key governments

"We Will Finish Polio Before Year's End," say Ministers of Health

15 January 2004 — Polio should be relegated to the history books within the next twelve months, Ministers of Health and representatives from the six remaining polio-endemic countries declared today at a high-level meeting in Geneva. The Ministers unveiled a bold new plan to immunize 250 million children multiple times during a series of massive polio immunization campaigns in 2004.

Data presented from Afghanistan, Egypt, India, Niger, Nigeria and Pakistan, show poliovirus beaten back to only a few remaining reservoirs. These data, and the introduction of aggressive new programmes, present an unprecedented opportunity to eradicate a disease that once paralyzed hundreds of thousands of children each year.

After an international investment of US$ three billion over 15 years, and the successful engagement of over 200 countries and 20 million volunteers, polio could be the first disease of the 21st century to be eradicated. Health ministers in Geneva noted that the success or failure of the world's largest public health initiative, spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, now rests with the governments of the six endemic countries. Polio transmission levels are now at their lowest ever in the key countries of India, Pakistan and Egypt, providing these governments with a rare opportunity to halting spread of the virus. The first milestone in 2004 toward global polio eradication may well come from Egypt, according to epidemiologists, followed closely by India. Nigeria is currently the greatest risk to global eradication. In late 2003, immunization activities against polio were brought to a halt in the state of Kano, the last major polio reservoir in Africa, because of unfounded rumours which suggested that the polio vaccine was not safe. With immunization activities stalled in Kano and polio campaigns of a sub-optimal quality in other northern states, polio was able to creep back across Nigeria and spread into the previously polio-free countries Cameroon, Chad, and through Niger, into Benin, Burkina Faso, Ghana and Togo, putting 15 million children at risk and necessitating a massive immunization campaign across west and central Africa. The Nigerian Minister of Health, Professor Eyitayo Lambo, outlined the steps his country will take to "dramatically" improve polio campaigns in the first half of 2004, particularly in the northern states where the virus continues to circulate widely. He said: "We will work together as one federal, state and local governments, religious and traditional leaders, Christians and Muslims to reach every child with the polio vaccine. It is the responsibility of every Nigerian to ensure polio is eliminated from every area, north and south, of our great country. Nigeria is determined to break the chains of polio transmission for the sake of our children, our neighbours' children, and the children of the world."

Speaking from Delhi, Ms Sushma Swaraj, India's Minister of Health, said: "Polio eradication is a tremendous challenge in a vast, densely populated country like India. But in 2003, we have shown the world we have the capacity, resources, and most importantly, the will, to vanquish this devastating disease." The Minister referred to preliminary data from 2003, showing a 84 per cent reduction in polio cases there compared with 2002.

She continued: "We have a unique window of opportunity in which to end polio forever. We will seize this opportunity by reaching each and every child with vaccine, particularly in western Uttar Pradesh and any other corner of India where transmission has not been stopped. There is no room in India's future for polio."

The year 2003 also demonstrated the serious risks at play in the world's final push to eradicate polio. In 2003, funding shortfalls required most polio-free countries to stop their polio immunization campaigns, thereby leaving millions of children more vulnerable to poliovirus infections from endemic countries, underscoring the urgency of interrupting poliovirus transmission in the six remaining endemic countries.

The Ministers concurred on an all-out effort to reach every child with the polio vaccine from early in 2004, particularly in Nigeria, India and Pakistan, which together account for more than 95 per cent of all polio cases worldwide. Within these three countries, transmission of poliovirus is further confined to "polio hotspots," especially in five states and provinces (Kano in Nigeria, Uttar Pradesh and Bihar in India and North West Frontier Province and Sindh in Pakistan) that together are linked to more than 75 per cent of all new cases worldwide in 2003.

To fully implement the bold eradication plans outlined by the Ministers of Health requires the continued generous support of public and private donors. An additional US$150 million is urgently needed to fill the remaining funding gap for activities during 2004 and 2005.

Source: http://www.who.int/mediacentre/releases/2004/pr4/en/

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