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. 5, 2004, pp. 217-230

Indian Journal of Medical Science Vol. 58 No. 5, May, 2004, pp. 217-230

News

Code Number: ms04041

Launch of "Diabetes Action Now"

3.2 million deaths can be attributed to diabetes each year according to a new publication released by the World Health Organization (WHO) and the International Diabetes Federation (IDF) to mark the launch of their joint programme "Diabetes Action Now". Updated estimates suggest that six deaths can be attributed to diabetes or related conditions somewhere in the world every minute, a figure three times higher than previous calculations.¹

"Diabetes is a major threat to global public health that is rapidly getting worse and the biggest impact is on adults of working age in developing countries," said Dr Catherine Le Galès-Camus, WHO Assistant-Director General, Noncommunicable Diseases and Mental Health. "In most developing countries at least one in ten deaths in adults aged 35 to 64 is attributable to diabetes, and in some the figure is as high as one in five." Diabetes has become one of the major causes of premature illness and death in most countries, mainly through the increased risk of cardiovascular disease (CVD). Diabetes Action Now is supported by a World Diabetes Foundation grant to the International Diabetes Federation and WHO funds. The purpose of "Diabetes Action Now" is to raise awareness about diabetes and stimulate and support the adoption of effective measures for the management and prevention of the condition in low- and middle-income countries and communities.

"Diabetes can be effectively managed and the risk of developing complications reduced substantially", said Professor Pierre Lefèbvre, President of the International Diabetes Federation.

"Simple lifestyle adjustments such as a healthy diet and physical activity, often combined with medication, have been shown to be effective in promoting a full and healthy life with diabetes. In many cases, type 2 diabetes accounting for over 90% of all cases of diabetes can be prevented through lifestyle interventions alone."

Diabetes is a common condition and its frequency is dramatically rising all over the world. In 2000, there were 171 million people with diabetes worldwide, and by 2030 this figure is expected to more than double, to reach a total of 366 million. Most of this increase will occur as a result of a 150% rise in developing countries. For example, in India there were approximately 32 million people with diabetes in 2000, but by 2030 this number is expected to increase to almost 80 million. These figures appear in the booklet "Diabetes Action Now", which contains details about the WHO-IDF programme, key facts and figures about diabetes, and profiles and statements from people with diabetes around the world. The booklet is available in print or via the Diabetes Programme web site.

These estimates are based on relative differences in risk of death between people with diabetes and those without. They include deaths where diabetes would have been the underlying cause of death or would have been mentioned as a contributory condition on the medical certificate of cause of death.

Source: http://www.who.int/mediacentre/releases/2004/pr31/en/

Unprecedented opportunity to fight HIV/AIDS

This is a critical moment in the history of HIV/AIDS. There is more money, more political will and more attention being paid to this killer disease than ever before. And yet, more people than ever are dying of AIDS and becoming infected with HIV. By using HIV treatment programs to strengthen existing prevention programs and improve health systems, the international community has a unique opportunity to change the course of history, says The World Health Report 2004 - Changing History.

WHO, UNAIDS and partners are implementing a comprehensive HIV/AIDS strategy which links prevention, treatment, care and support for people living with the virus. Until now, treatment has been the most neglected element in most developing countries. Yet among all possible HIV- related interventions, the report says it is treatment that can most effectively boost prevention efforts and in turn drive the strengthening of health systems and enable poor countries to protect people from a wide range of health threats.

"At long last, global investment in health - and particularly in the fight against HIV/AIDS - is on the rise. It brings a welcome and long overdue improvement in the prospects for controlling the worst global epidemic in several centuries. The challenge now is to coordinate all our efforts and to ensure that this money benefits the people who need it most," said LEE Jong-wook, Director-General of the World Health Organization (WHO).

Vital resources have now been pledged, including more than US$ 20 billion from donor countries and through multilateral funding agencies, including the Global Fund to fight AIDS, Tuberculosis and Malaria, the United States President's Emergency Plan for HIV/AIDS Relief and the World Bank¹. These funds must now be used swiftly and in a coordinated way to prolong the lives of millions of children, women and men who will otherwise soon die. Adequate technical support for HIV/AIDS programmes must be mobilized to ensure that the new investments have the greatest possible long-term impact on the health of people in poor countries.

"We must invest these additional resources in strengthening comprehensive prevention and care strategies that build on twenty years experience of what we know works," said Dr Peter Piot, UNAIDS Executive Director. "Scaling up effective HIV treatment and prevention programmes is the best strategy to save lives and keep future generations HIV-free."

The report says the delivery of AIDS treatment and prevention also offers the chance to build up health systems in the poorest countries, providing health benefits for all. "Future generations will judge our era in large part by our response to the AIDS pandemic," said Dr Lee. "By tackling it decisively we will also be building health systems that can meet the health needs of today and tomorrow. This is an historic opportunity we cannot afford to miss."

Already, AIDS has killed more than 20 million people and is now the leading cause of death and lost years of productive life for adults aged 15-59 years worldwide. Today, an estimated 34-46 million people are living with HIV/AIDS. Without treatment, all of them will die a premature and in most cases painful death. In 2003, three million people died and five million became infected. Almost six million people in developing countries will die in the near future if they do not receive treatment - but only about 400 000 of them were receiving it by the end of 2003.

The long-term economic and social costs of HIV/AIDS have been seriously underestimated in many countries, the report says. Projections now suggest that some countries in sub-Saharan Africa will face economic collapse unless they bring their epidemics under control, mainly because HIV/ AIDS weakens and kills adults in their prime - depriving communities of doctors, teachers and lawyers, as well as farmers, miners and police officers, and depriving children of their parents.

Hope through treatment

In September 2003, WHO, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria declared lack of access to treatment with antiretroviral medicines a global health emergency. In response, these organizations and their partners launched an effort to provide three million people in developing countries with antiretroviral therapy by the end of 2005 - the "3 by 5" initiative.

By March 2004, 48 of the countries with the highest burden of HIV/AIDS had expressed their commitment to rapid treatment expansion and requested technical cooperation in designing and implementing scale-up programmes.

"As money is finally beginning to flow through the Global Fund and others towards treatment programmes in developing countries, we see that countries need advice, information about best practices and technical assistance in order to execute the rapid scale-up," says Professor Richard Feachem, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. "WHO will play a crucial role in the years to come to ensure that increased resources are turned into lives saved."

WHO is working closely with all partners, including national health officials, treatment providers, community organizations, people living with HIV/AIDS and other stakeholders to design national treatment scale-up plans and begin their implementation. Political commitment and national ownership of programmes are essential. The streamlined funding mechanisms developed by the Global Fund are enabling many countries to access funding and expand AIDS treatment and prevention programmes faster than ever before.

Prevention and treatment go together

Scaling up treatment can support and strengthen prevention programmes. Where treatment has been made available, this has led to overwhelming demands for testing and counselling. Good counselling and HIV education lead to more effective prevention in those who are uninfected, and significantly reduces the potential for infection transmission in those who have HIV.

Scaling up testing and counselling in health services for people with TB, for pregnant women and for vulnerable populations including youth, sex workers and injecting drug users, leads to greater engagement of those who may be vulnerable - again strengthening opportunities for prevention. Motivating communities to learn their HIV status in a context of access to antiretroviral treatment is altering community responses to HIV, encouraging greater openness and helping to reduce the stigma and denial that has enabled the virus to spread so disastrously.

Action in Countries

As new funding flows in, technical resources and trained staff must be ready to ensure its effective use. Countries often need technical assistance in implementing programmes on the ground, and have requested clear guidance on treatment delivery and programme management. WHO makes a fundamental contribution by providing such guidance.

To help accelerate the treatment initiative, WHO has developed a simplified set of antiretroviral drug regimens, testing and treatment guidelines that are consistent with the highest standards of quality of care. The guidelines are intended to be used at all levels of the health system, as well as in the community to monitor and promote adherence to treatment. Because these regimens make it possible for even the poorest areas to start treating those who need it, they ensure that rollout of treatment programs can be done equitably.

WHO has also designed streamlined guidelines for training health workers in a wide range of skills, from HIV counselling and testing and recruitment of patients to treatment delivery, clinical management of patients and the monitoring of drug resistance.

In partnership with UNICEF and the World Bank, WHO has established the AIDS Medicines and Diagnostics Service to ensure that developing countries have access to quality antiretrovirals and diagnostic tools at the best prices. The service aims to help countries to buy, forecast and manage the supply and delivery of products necessary for treatment and monitoring. It will also provide information to manufacturers to enable them to forecast demand, thus ensuring that quantities produced reflect real needs at affordable prices.

As policy and technical support work at country level intensifies, WHO, UNAIDS and partners will continue advocating globally for adequate resources to support countries. New resources available through the Global Fund and other partners will be critical to success. On request, WHO is providing countries with technical assistance in the preparation of applications to the Global Fund and other potential donors.

Towards Health for All

The report says that the global HIV/AIDS treatment gap reflects wider patterns of inequality in health and is a test of the international community's commitment to tackle these inequalities. Beyond working to save millions of lives under immediate threat, WHO and its partners are confronting a broad range of health problems that afflict poor communities and keep them poor, viewing HIV/AIDS treatment expansion and the Millennium Development Goals as steps on the road to Health for All.

The report makes it clear that the treatment initiative will not end in 2005. Ahead lie the challenges of extending treatment to many more millions of people and maintaining it for the rest of their lives, while simultaneously building and sustaining the health infrastructures to make that huge task possible. "The ultimate aim is nothing less than to reduce health inequalities by building up effective, equitable health systems for all," the report says.

The World Health Report 2004 - Changing History is published on May 11, price Swiss francs 30.00. The price for developing countries is Swiss francs 10.00. The report is available on the WHO web site, at www.who.int/whr.

Source: http://www.who.int/mediacentre/releases/2004/pr33/en/

ASIAN AND NORTH AFRICAN COUNTRIES CLOSE TO ENDING POLIO

Asian and North African countries could be polio-free within months, while west and central African countries must change track to stop the virus, according to data presented in Geneva today by Health Ministers from the world's six remaining polio-endemic countries. The ministers announced a two-pronged strategy to further accelerate eradication activities in both areas.

With latest figures showing the Asian and North African regions at record low levels of polio (together reporting only 21 cases in 2004, compared to 94 this time last year), ministers of health of Afghanistan, Egypt, India, and Pakistan announced an accelerated strategy to "mop-up" each new virus. Under this ambitious initiative, each new poliovirus found will trigger two massive, tailored immunization campaigns in response, targeting between one and five million children, before the virus has the opportunity to spread.

Mr. M. N. Khan, Federal Minister of Health, Pakistan, said: "President Musharraf himself has endorsed the accelerated mop-up strategy. We will finish the job this year."

With the all-time low levels of polio in Afghanistan, Egypt, India and Pakistan, four of the six remaining endemic countries are on track to meet the end-2004 target for stopping polio a date set by endemic country governments on 15 January at the signing of the "Geneva Declaration for the Eradication of Poliomyelitis."

However, countries in west and central Africa, particularly Nigeria and Niger, will need different strategies to bring the regional eradication initiative into line with the progress in the Asian region this year. After making the most rapid progress of any region in the world, west and central Africa suffered a significant setback, due to the outbreak which originated in areas of northern Nigeria where immunization campaigns have been suspended since August 2003.

The new strategy for the African region includes the reintroduction of a mass, synchronized immunization campaign across 21 countries by early 2005 at the latest. This strategy will be supplemented, where appropriate, with mop-up campaigns around any importations.

Recognizing that the northern Nigerian state of Kano has yet to resume immunization activities, Professor Eyitayo Lambo, Minister of Health, Nigeria, informed the meeting: "This month, an understanding was reached and signed between Kano state government and federal authorities on the required conditions for re-starting the polio immunization activities in Kano. As these conditions are now being met, we have made preparations to support full catch-up immunization campaigns in Kano, ahead of the nation-wide activities in September, October and November."

The spearheading partners of the Global Polio Eradication Initiative warned that the spread of virus from Kano across west and central Africa already cost US$ 25 million for emergency campaigns in 2003 alone, in response to these re-infections. The further intensification of activities will result in significant additional costs.

The Global Polio Eradication Initiative is spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. The poliovirus is now endemic in only six countries, down from over 125 when the Global Polio Eradication Initiative was launched in 1988. The six countries with indigenous wild poliovirus are: Nigeria, India, Pakistan, Niger, Afghanistan and Egypt.

The polio eradication coalition includes governments of countries affected by polio; private 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, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, the Russian Federation, 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 corporate partners (e.g. Aventis Pasteur, De Beers, Wyeth). Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.

Source: http://www.who.int/mediacentre/releases/2004/wha1/en/

GLOBAL STRATEGY ON REPRODUCTIVE HEALTH AND RESOLUTION ON THE FAMILY AND HEALTH

The World Health Organization's first strategy on reproductive health was adopted today by the 57th World Health Assembly (WHA). Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men.

The strategy targets five priority aspects of reproductive and sexual health: improving antenatal, delivery, postpartum and newborn care; providing high-quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities; and promoting sexual health.

"Unsafe sex is one of the biggest risks to our health today, largely as a result of acquiring sexually-transmitted infections, such as HIV/AIDS. Reproductive and sexual health touches the lives of everyone, everywhere," says Joy Phumaphi, Assistant Director-General of Family and Community Health at WHO. "It is fundamental to the social and economic development of communities, economies and nations."

Each year, some eight million of the estimated 210 million women who become pregnant, suffer life-threatening complications related to pregnancy, many experiencing long-term morbidities and disabilities. In 2000, an estimated 529 000 women died during pregnancy and childbirth from largely preventable causes.

The strategy comes in response to a 55th WHA resolution requesting WHO to develop a strategy for accelerating progress towards the attainment of the Millennium Development Goals (MDGs) and other international goals and targets relating to improving reproductive health, notably those from the International Conference on Population and Development (ICPD) in 1994, and its five-year follow-up (ICPD+5).

Three of the eight MDGs are directly related to reproductive and sexual health, namely, improving maternal health, reducing child mortality and combating HIV/AIDS, malaria and other diseases.

"The strong endorsement of this strategy by the WHA represents an unequivocal message that countries are committed to do all they can to achieve the goals and targets of the ICPD Program of Action adopted in 1994," says Dr Paul Van Look, Director of WHO's Department of Reproductive Health and Research. "The Strategy gives our Member States and the Organization itself a clear roadmap on how we can work together in the coming years to achieve the ICPD goals."

The Assembly also adopted a resolution on the Family and Health in the context of the 10th anniversary of the International Year of the Family. The resolution acknowledges that active participation of families and communities in promoting and protecting their own health has proved to be effective and that families and communities who are thus empowered show an increased awareness and a higher demand for good quality health services.

The Family and Health resolution also calls for a re-evaluation of the traditional approaches guiding models of care and its content because health institutions and professionals have adopted the individual as the focus for health service delivery and that as a consequence, the needs of the family as a whole may not be addressed properly.

Source: http://www.who.int/mediacentre/releases/2004/wha2/en/

GLOBAL STRATEGY ON DIET, PHYSICAL ACTIVITY AND HEALTH

The World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health was endorsed by Member States at their annual Health Assembly in Geneva. The strategy addresses two of the major risk factors responsible for the heavy and growing burden of noncommunicable diseases (NCDs), which now account for some 60% of global deaths and almost half (47%) of the global burden of disease. NCDs include cardiovascular disease, type 2 diabetes, cancers and obesity-related conditions.

"This is a landmark achievement in global public health policy and provides our Member States with a powerful instrument, which will enable them to develop effective and integrated national strategies to reduce the human and socioeconomic costs of non-communicable diseases," said Dr LEE Jong-wook, Director-General, WHO. "The burden of death, illness and disability caused by noncommunicable diseases is now greatest in developing countries, where those affected are on average younger than in the developed world."

WHO has developed the strategy over the past two years through a wide-ranging series of consultations with all concerned stakeholders, including Member States, other UN agencies, civil society and nongovernmental organisations, and the private sector. The strategy specifies roles for these stakeholders in reducing NCDs. The strategy emphasizes the need to limit the consumption of saturated fats and trans fatty acids, salt and sugars, and to increase consumption of fruit and vegetables and levels of physical activity. It also addresses the role of prevention in health services; food and agriculture policies; fiscal policies; surveillance systems; regulatory policies; consumer education and communication including marketing, health claims and nutrition labelling; and school policies as they affect food and physical activity choices.

There was extensive debate on the strategy during the Health Assembly, and a drafting group met for two days to agree upon amendments to the resolution adopting the strategy. These included the addition of paragraphs to address concerns expressed by some Member States that nothing in the strategy should be construed as justification for the adoption of trade-restrictive or trade distorting practices; to reaffirm that the strategy complements WHO's strong commitment to addressing malnutrition, and to reaffirm that appropriate levels of intakes for energy, nutrients and foods should be determined in accordance with national guidelines and dietary habits and practices.

"Noncommunicable diseases are imposing a growing burden upon low and middle-income countries, which have limited resources and are still struggling to meet the challenges of existing problems with infectious diseases," said Dr Catherine Le Galès-Camus, WHO Assistant-Director General, Noncommunicable Diseases and Mental Health. "The strategy recommends a prevention-oriented approach that emphasizes the need for countries to develop coherent, multi-sectoral national strategies with a long-term, sustainable perspective, to make the healthy choices the preferred alternatives at both the individual and community level. We welcome the commitment shown by Member States to the strategy and will be working closely with them to help them implement its recommendations."

Source: http://www.who.int/mediacentre/releases/2004/wha3/en/

WORLD HEALTH ASSEMBLY RAISES GLOBAL PUBLIC HEALTH TO NEW LEVEL

The World Health Assembly, the supreme decision-making body of the World Health Organization, has raised global public health to a new level, by resolving to take more action to prevent death and illness resulting from heart disease, diabetes, cancers, road safety, and lack of access to health services as well as from diseases spread by viruses, bacteria and other dangerous microbes.

"This World Health Assembly clearly raised the bar for improving public health of all people. The Assembly agreed to tackle diseases which can spread from the environment, or from person to person, and also those linked to the foods we eat, the amount we exercise and the safety of our roads." said Dr LEE Jong-wook, Director-General of the World Health Organization. "I also welcome the resolve to take action to improve the reproductive health of women and men."

The 57th World Health Assembly, which met from 17-22 May 2004, attracted more than 2,000 delegates from WHO's 192 Member States as well as those from official observers and non-governmental organizations. Invited speakers included former Presidents and Nobel Peace Prize winners Kim Dae-jung of the Republic of Korea, and Jimmy Carter of the United States of America, who both spoke about the challenges presented by the growing gap between the world's rich and poor. Ms Anastasia Karmylk, of Belarus, also spoke passionately about the need to do more to prevent and treat HIV/AIDS, including overcoming the stigma and discrimination faced by people living with the HIV/AIDS. This press release summarizes decisions taken at the 57th World Health Assembly, including several resolutions as well as recognition for progress made in several important health areas. Please note that full texts of all documents and decisions taken are available at www.who.int/gb. *All World Health Assembly resolutions can be found at the bottom of this page.

The WHO Global Strategy on Diet, Physical Activity and Health was unanimously endorsed by Member States. The strategy addresses two of the major risk factors responsible for the heavy and growing burden of noncommunicable diseases (NCDs), which now account for some 60% of global deaths and almost half (47%) of the global burden of disease. NCDs include cardiovascular disease, type 2 diabetes, cancers and obesity-related conditions.

The strategy emphasizes the need to limit the consumption of saturated fats and trans fatty acids, salt and sugars, and to increase consumption of fruit and vegetables and levels of physical activity. It also addresses the role of prevention in health services; food and agriculture policies; fiscal policies; surveillance systems; regulatory policies; consumer education and communication including marketing, health claims and nutrition labelling; and school policies as they affect food and physical activity choices.

Recognizing that health promotion is important for attaining the health-related United Nations Millennium Development Goals, the World Health Assembly adopted a resolution encouraging all Member States to strengthen existing policies and programmes related to health promotion and healthy lifestyles. The resolution calls for countries to give high priority to promoting healthy lifestyles for children and young people, to focus on poor and marginalized groups, and to give attention to the prevention of alcohol-related harm.

The Assembly adopted the WHO's first strategy on reproductive health, intended to help countries stem the serious repercussions of reproductive and sexual ill-health, which accounts for 20% of the global burden of ill-health for women, and 14% for men. The strategy targets five priority aspects of reproductive and sexual health: improving antenatal, delivery, postpartum and newborn care; providing high-quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological illness and disease; and promoting sexual health. The Assembly also adopted a resolution on the family and health in the context of the 10th anniversary of the International Year of the Family.

The Assembly welcomed the Director-General's "3 by 5 strategy" to support developing countries in their response to HIV/AIDS by increasing access to prevention, care and treatment and securing access to antiretroviral treatment for three million people living with HIV/AIDS by the end of 2005. The Assembly confirmed WHO's leading role in supporting countries in delivering prevention, care, support and treatment for HIV/AIDS within strengthened national health systems. Member States urged the Director-General to improve the access of developing countries to antiretroviral medicines and other products used in the diagnosis, treatment and care of HIV/AIDS, including by strengthening the WHO prequalification project. WHO should also help countries strengthen their supply chain management and procurement of good quality products. The resolution also encouraged countries entering into bilateral trade agreements to take into account the flexibilities relating to public health as laid down in TRIPS agreement of the World Trade Organization and the Doha Ministerial Declaration on the TRIPS Agreement and Public Health. The 57th World Health Assembly also unanimously approved a resolution on road safety and health. The resolution seeks to address the lack of safety on the world's roads, responsible for 1.2 million deaths and as many as 50 million injuries annually. The resolution follows the widely celebrated World Health Day 2004, dedicated to road safety. As invited by the United Nations General Assembly through its resolution on improving global road safety, issued during a historic plenary session on the topic on 14 April 2004, the World Health Assembly resolution also accepts the invitation for WHO to serve as coordinator on road safety issues within the United Nations system.

The WHA learned that the global effort to eradicate polio is on track in Asia and north Africa, with India, Pakistan, Egypt and Afghanistan reporting only 22 polio cases to date this year. At the same time, African Union Ministers reported their alarm that in 2004 the number of cases in west and central Africa was already five times that for the same period in 2003, due to the continuing outbreak originating from Kano, Nigeria. WHO announced that it would launch an emergency appeal for resources for a massive immunization campaign across west and central Africa. Dracunculiasis, or guinea-worm disease, remains endemic in 12 countries, all in sub-Saharan Africa. In a bid to complete eradication, the World Health Assembly passed a resolution urging endemic countries to intensify eradication efforts and for the global community to continue its commitment, collaboration and cooperation to assure resources are mobilized for these efforts.

The World Health Assembly adopted a resolution on increasing surveillance and control of Buruli ulcer, a poorly understood disease that can severely affect the skin and cause serious disabilities. The resolution urges all Member States to intensify research to develop tools to diagnose, treat and prevent the disease and encourages active participation in WHO's Global Buruli Ulcer Initiative.

Human African trypanosomiasis, also known as "sleeping sickness", remains a major public health problem, due to its epidemic potential and its 100% fatality rate if untreated. Delegates unanimously adopted a resolution to make the control of this disease a priority, and to direct more resources to endemic areas.

Outstanding progress in reducing measles deaths was reported to Assembly delegates. Global measles mortality decreased by an estimated 30% between 1999 and 2002, with an even greater reduction (35%) in Africa. Continued implementation of a WHO/UNICEF comprehensive strategy can keep Member States on track to achieve the 2005 target of reducing measles deaths by half from 1999 levels.

Genomics and world health

There have been remarkable advances in the science of genomics, or the study of genes, their functions and related techniques. The World Health Assembly adopted a resolution to address concerns about the safety as well as ethical, legal and economic implications of this relatively new science.

The Assembly adopted a resolution on human organ and tissue transplantation to encourage the development of recommendations and guidelines to harmonize global practices and ensure the ethical practice of organ and tissue transplant. The delegates agreed to take measures to protect the poorest and vulnerable groups from "transplant tourism" and the sale or trafficking of tissues and organs. The resolution also addressed the practice of transplanting animal tissue or organs to humans and the need for clear national regulations on the practice and for surveillance of potential infections caused by these transplants.

Health conditions of, and assistance to, the Arab population in the occupied territories, including Palestine

The Assembly adopted a resolution addressing concerns about the deterioration of health conditions and the humanitarian crises resulting from military activities in the occupied Arab territories, including Palestine. The resolution calls for Israel to immediately halt activities that affect the health conditions of civilians under occupation and also urges the WHO Director-General to dispatch a fact-finding team to the occupied territories and to continue providing technical assistance for improving health.

Mental Health - A call for action

In his address to the Assembly, Mr Jimmy Carter, former President of the United States of America, stressed that despite the availability of treatment, too many people simply have no access. The message was reinforced during a technical briefing on Mental Health and Substance Abuse by a number of countries, and by former First Lady Rosalynn Carter, who is a leader for mental health issues and founder and chairperson of the Carter Centrers Mental Health Task Force.

The Assembly adopted a resolution meant to address countries' concerns about the international migration of health personnel. This resolution urges Member States to develop strategies to mitigate the adverse effects of migration of health workers; to develop policies that could provide incentive for health workers to remain in their countries; and, among other issues, requests WHO to help Member States set up information systems to monitor the movement of health resources for health, and to include human resources for health development as a top-priority programme at WHO from 2006-2015.

A detailed progress report was presented on the Framework Convention on Tobacco Control. So far, 114 countries and the European Community have signed, and 16 countries have ratified the Convention. The Assembly also received and debated reports from WHO on progress made on a number of health issues, including: research on the variola virus that causes smallpox; the recently established Commission on Intellectual Property Rights, Innovation and Public Health, which will now present its report to the Executive Board in January 2006 ; the quality and safety of medicines and blood products, on the follow-up to the SARS outbreaks in 2003 and 2004; on measures to protect the safety of patients; and on the importance of strengthening health systems, including primary health care.

Source: http://www.who.int/mediacentre/releases/2004/wha4/en/

FOOD SAFETY AT RISK IN ASIA AND THE PACIFIC

Foodborne diseases pose a serious threat to densely populated areas of Asia and the Pacific, two UN agencies said today. So far, food contamination incidents and foodborne disease outbreaks in the region have been relatively isolated, but there is a real potential for danger. Already an estimated one in three people worldwide suffer annually from a foodborne disease and 1.8 million die from severe food and waterborne diarrhoea.

Seeking to head off future threats to public health and international trade posed by potentially unsafe food in Asia and the Pacific, food safety officials and experts from some 40 countries in the region are meeting this week in Seremban, Malaysia at a four-day Regional Conference on Food Safety, under the auspices of the UN Food and Agriculture Organization (FAO) and the World Health Organization (WHO).

"The danger of food-related outbreaks is particularly acute in Asia and the Pacific, because of the instances in which animals and people live in proximity and the way in which some food is produced and distributed," says Dr Kerstin Leitner, WHO Assistant Director-General responsible for Food Safety. The avian influenza epidemic, as the most recent example of a disease linking food, animals and human health, has been historically unprecedented and of great concern for human health as well as for agriculture, with 23 fatal human cases and about 100 million birds died or culled.

However, in the region, more than 700 000 people die and many more are debilitated every year from single cases of food- and waterborne disease - single cases that most often do not hit media headlines.

On the trade side, disruptions due to shortcomings in food quality have also been on the increase. "Since 2001, unacceptable pesticide residue levels in fruits and vegetables, Chloramphenicol and other antibiotic residues in seafood and poultry, pathogens in seafood and mycotoxins in crops and peanuts have been the cause of rejection of food export from the Asian region," according to Hartwig de Haen, FAO Assistant Director-General, Economic and Social Department. A ban on fish imports into the EU cost one Asian country US$ 335 million of lost export opportunities. The export of peanut meal by one Asian country to the European Union dropped by more than US$ 30 million per year since the EU introduced new mycotoxin regulation in the early 1980s.

Recent scandals with life threatening sub-standard or chemical contaminated food are just the tip of the iceberg of a widespread and growing public health problem. They are symptomatic of food safety systems not properly working and of the lack of integrated mechanisms in the region - and often within individual countries - to predict potential outbreaks and organize rapid responses to prevent them. The Food Safety Regional Conference is the response to the urgent need for countries in the region to work together to develop harmonized and coordinated food safety systems resulting in uniform emergency responses to such threats, the UN agencies say.

The Conference is part of a series of regional meetings that FAO and WHO are jointly organizing to meet the needs of member countries for policy guidance and capacity building in food safety. A practical action plan is expected to emerge from this meeting to help the region overcome the difficulties and problems they face in improving food safety, including their surveillance and response systems. Particular attention is devoted to covering the full food production chain with a special focus on the segments that are best suited for interventions to lower significantly the foodborne disease risk. The meeting will also encourage improved communication among scientists, regulators, industry and consumer representatives in an effort to promote such risk reduction, that has been possible in other regions.

Participants in the Asia Pacific Regional Food Safety Conference come largely from regulatory bodies for food safety in the Ministries of Agriculture and Health of FAO and WHO member countries. Representatives of independent food safety agencies and other ministries with responsibilities for food safety, and international Non-governmental Organizations (NGOs) representing industry, producers, trade and retail associations, and consumer groups will also attend.

Source: http://www.who.int/mediacentre/releases/2004/pr34/en/

DESPITE IMPROVEMENTS, MANY HIGH SCHOOL STUDENTS STILL ENGAGING IN RISKY HEALTH BEHAVIORS

Although significant improvements have occurred over the past decade in various health-related behaviors among high school students, many high school students continue to engage in a variety of behaviors that put them at risk for injury and disease, according to the 2003 Youth Risk Behavior Surveillance System (YRBSS) released by the Centers for Disease Control and Prevention (CDC).

"Too many young people still engage in activities that place them at risk for serious injury, sexually-transmitted diseases, including HIV infection, and chronic disease such as heart disease and cancer. We need to continue to provide them with the information and skills that can help them make the right choices today so that they can live a long and healthy life," said CDC Director Dr. Julie Gerberding.

However, during the past 12 years, the YRBSS has detected improvements in risk behaviors related to sexual activity, injuries and violence, and tobacco and alcohol use.

For example, the percentage of high school students who reported ever having sexual intercourse was 47 percent in 2003 compared to 54 percent in 1991. There was also a decrease in the number of high school students who reported having had four or more sex partners - 14 percent in 2003 compared to 19 percent in 1991. And the percentage of sexually active students who used a condom during last sexual intercourse increased from 46 percent in 1991 to 63 percent in 2003.

Behaviors related to injuries and violence that have improved since 1991 include:

The percentage of high school students who had been in a physical fight dropped to 33 percent in 2003 from 43 percent in 1991;

The percentage of high school students who rode with a driver who had been drinking alcohol decreased to 30 percent in 2003 from 40 percent in 1991.

Behaviors associated with tobacco and alcohol use that have improved include:

The percentage of high school students who reported current cigarette smoking - which had increased from 28 percent in 1991 to 36 percent in 1997 - fell to 22 percent in 2003;

The percentage of high school students who had ever drunk alcohol dropped to 75 percent in 2003 compared to 82 percent in 1991.

"These trends show we are making progress in reaching our youth about positive health choices. A coordinated school health program combined with supportive community policies and programs are essential tools for addressing many of the health issues that affect teenagers today," said Dr. George Mensah, acting director of CDC's National Center for Chronic Disease Prevention and Health Promotion.

The YRBSS is conducted every two years to scientifically-selected samples of high school students throughout the United States. It monitors health-risk behaviors that lead to unintentional injuries; violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to HIV infection, other sexually-transmitted diseases and unintended pregnancy; and dietary behaviors and physical inactivity that contribute to overweight. The report includes national data as well as data for 32 states and 18 large cities.

For the 2003 national survey, 15,214 questionnaires were completed by students in the 9th - 12th grades. Parental permission was obtained, student participation was voluntary and responses were anonymous. States and cities could modify the questionnaire to meet their needs.

The YRBSS is one of three HHS-sponsored surveys that provide data on tobacco and other substance use among youth. The others are the National Survey on Drug Use and Health (NSDUH), sponsored by the Substance Abuse and Mental Health Services Administration and a primary source of statistics on illicit drug use among Americans age 12 and over (www.oas.samhsa.gov/nhsda.htm) and the Monitoring the Future (MTF) Study funded by the National Institute on Drug Abuse and conducted by the University of Michigan's Institute for Social Research (http://monitoringthefuture.org). MTF tracks tobacco, alcohol and illicit drug use and attitudes toward drugs among students in the 8th, 10th and 12th grades.

The 2003 YRBSS is available at www.cdc.gov/yrbss or www.cdc.gov/healthyyouth.

Source: http://www.cdc.gov/od/oc/media/pressrel/r040520b.htm

CDC IMPLEMENTS NEW TIERED TRAVEL HEALTH

Guidance System

The Centers for Disease Control and Prevention (CDC) implemented a new system for providing travelers with guidance about potential health hazards and the steps they can take to protect themselves when traveling abroad. The new system makes it easier for the public to understand what their risks may be during an emerging public health crisis and what they can do to protect themselves.

"As we learned during last year's SARS outbreak, infectious diseases can spread quickly as people travel around the globe," said CDC Director Dr. Julie Gerberding. "This new system allows us to provide travelers with very important, real-time information that will be easy for them to apply to protect their health."

The new system is effective immediately and will replace the previous travel alerts and advisories. Guidance will be posted on the CDC Travelers' Health web site as cases of disease occur and will include four levels:

In The News: is the lowest level of notice and will provide information about sporadic cases of disease or an occurrence of a disease of public health significance affecting a traveler or travel destination. The risk for an individual traveler does not differ from the usual risk in that area.

Outbreak Notice: provides information about a disease outbreak in a limited geographic area or setting. The risk to travelers is defined and limited, and the notice will remind travelers about standard or enhanced travel recommendations, such as vaccination.

Travel Health Precaution: provides specific information to travelers about a disease outbreak of greater scope and over a larger geographic area to reduce the risk of infection. The precaution also provides guidance to travelers about what to do if they become ill while in the area. CDC does not recommend against travel to a specific area, but may recommend limiting exposure to a defined setting, for example, poultry farms or health-care settings.

Travel Health Warning: recommends against nonessential travel to an area because a disease of public health concern is expanding outside of areas or populations that were initially affected. The purpose of a travel warning is to reduce the volume of traffic to affected areas, limiting the risk of spreading the disease to unaffected areas.

CDC has broad authority under section 301 of the Public Health Service Act (42 USC 241) to make information available to the public regarding the causes, diagnosis, treatment, control, and prevention of physical and mental diseases and other impairments of man. CDC endeavors to provide accurate and credible health information and promote health through strong partnerships both at home and abroad.

A complete description of the definitions and criteria for issuing and removing travel notices can be found at www.cdc.gov/travel.

Source: http://www.cdc.gov/od/oc/media/pressrel/r040520.htm

Copyright by The Indian Journal of Medical Sciences