Associated Press - October 30, 2002
Emma Ross, AP Medical Writer

The recommendation is part of a package of suggestions contained in this year's annual World Health Report, which for the first time tries to rank the major threats to health worldwide and examine ways to reduce them.

The report describes the amount of disease, disability and death in the world that can be attributed to 20 of the most important risks to human health.

It estimates that, if the threats are tackled properly, at least an extra decade of healthy life could be achieved in even the poorest countries and that people in the rich nations could gain another five years of healthy life.

Food and drink play a central role in many of the health risks examined, from the top-ranked problem of underweight to the scourge of overweight, ranked 10th.

"Bold policies are required," the report says. "A mixture of public and private sector agreements and legislation are required to create the social milieu for health gains resulting from tobacco taxation or gradual changes to food manufacturing."

"Salt has been done (in England), and there's no reason why it couldn't be done more," said WHO Director General Dr. Gro Brundtland. "And I'm sure with sugar it could be the same. You could obviously get a code of conduct where certain products should not have a sugar level over X."

Detailed, accurate and easily understandable labels about fat content also are needed so that people know what they are eating and have a choice, she said. "We can use a guideline approach, where we recommend what governments could be thinking about regulating."

The report, one of largest research projects ever undertaken by the U.N. health agency, also concluded that alcohol is responsible for much more death and disease than previously thought.

Malnutrition is still the worst health problem in the world - it accounts for one in 14 deaths globally.

A summary of the findings were also published Wednesday in the online version of The Lancet medical journal.

In a critique in the journal, two Cambridge University experts cautioned that too much emphasis must not be put on the relative rankings of the different health hazards.

They said the estimates depend on the quality of the studies underlying them and that some hazards, such as blood pressure, have been extensively studied and are well understood, while others, such as exercise and diet, are less understood and that their importance has likely been underestimated.

"Public health surveillance on this scale is a new, and immature, science," said the scientists, Dr. John Poles and Nicholas Day from the Institute of Public Health at Cambridge. "This exercise ... should still be regarded as a report of work in progress."

The top 10 health hazards worldwide - in terms of how much disease and death they cause - are, in order of danger: underweight, unsafe sex, high blood pressure, tobacco, alcohol, contaminated water, sanitation and hygiene, iron deficiency, indoor pollution, high cholesterol and obesity.

"This report brings out for the first time that 40 percent of the global deaths are due to just the 10 biggest risk factors, while the next 10 risk factors add less than 10 percent," said Alan Lope, a WHO senior science adviser.

The report also ranks the hazards separately for three groups; the poorest regions such as sub-Saharan Africa and parts of South Asia, other developing countries and the developed world. No individual country listings are given.

In the poorest group, malnutrition was by far the worst health hazard, followed by unsafe sex - which reflects the massive HIV /AIDS burden in those areas.

Researchers were surprised to find that indoor pollution, from the burning of manure and charcoal for cooking, causes much illness and death. It was the fourth leading health hazard in that region, after unsafe water, sanitation and hygiene, but had never been noticed before, said the report's lead author, Dr. Christopher Murray, executive director of WHO's global program on evidence for health policy.

In the other developing countries, alcohol turned out to be the biggest menace to health, followed by blood pressure and tobacco. Strangely, underweight and overweight jostled for position in fourth and fifth places respectively. Cholesterol came next, then low fruit and vegetable intake.

In rich nations, the biggest peril was tobacco, closely followed by the entangled bevy of blood pressure, alcohol, cholesterol, overweight, low fruit and vegetable intake and inadequate exercise.

--- On the Net:

World Health Report 2002

http://www.who.int/whr/2002/en/

http://www.thelancet.com

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AP021030

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