The objective of this paper is, in a first part, to give an overview of the main health problems in the world today and of their main causes. Then an attempt is made to compare the financial and human resources available today to solve these problems with the resources which would be needed if we are to achieve the Health Millennium Development Goals by 2015. Given the fact that the available resources are limited, the question is then raised as to the selection of the strategies which would contribute the most to an improvement of the health situation in the world. To conclude on a positive note, a few examples are then given of great achievements in the health field over the past 50 years, but attention is drawn to the tremendous challenges remaining if the health MDGs are to be reached by 2015, particularly in Africa.
I. What are the main health problems in the world today?
* The total number of healthy life years lost to morbidity and premature mortality 2 is estimated at 1.49 billion years (3) in 2002. As shown in Table 1, an estimated 41% of this total is due to infectious diseases and perinatal conditions, while non-communicable diseases and injuries explain 47% and 12% of the total respectively.
* Among infectious diseases, perinatal conditions and pneumonia (acute lower respiratory infections) account for an estimated 6.5% and 6.1% respectively of the total number of healthy life years lost to diseases.
* In principle, the share of infectious diseases in the total burden of diseases may decrease in the coming years, on the condition that the ongoing efforts to control these diseases are actively pursued.
* The share of non-communicable diseases (in particular, neuropsychiatric and mental disorders, cardiovascular diseases and cancers) is likely to increase as a result of the demographic and epidemiological transitions.
* These averages hide wide disparities between high-income countries on the one hand, and low and middle income countries on the other. For example, the risk of falling sick to infectious diseases is nine times higher in low and middle-income countries than in high-income countries, while the risk of being injured is twice as high. Contrary to popular belief, the risk of falling sick to non-communicable diseases is just as high in low and middle-income countries as in high-income countries.
* Just as serious, these averages also hide wide disparities in practically all countries between high and low income quintiles of the population, the poorer quintile running on the average a much higher risk of falling sick or injured than the high income quintile.
2. What are the main causes?
* Proximate causes for the estimated total of 1.49 billion years of healthy life lost to diseases are listed in Table 2. As shown in this table, malnutrition is the most important proximate determinant of the health situation in the world, explaining almost 16% of the total number of lost years. Other main causes include infected water, unsafe sex, alcohol, indoor air pollution and tobacco.
* Beyond the proximate causes mentioned above, more fundamental and underlying factors are contributing in an important way to the poor health situation of particular countries. Among these factors are a low level of education, poorly functioning health services, environmental risks, bad governance (including the poor functioning of government institutions, internal and external conflicts, corruption and violations of human rights) and poverty. In many ways, these factors are at the root of the proximate causes mentioned above and can be considered as the ultimate causes of poor health.
3. What are the financial and human resources available to solve these problems?
(a) Health expenses per country and out-of-pocket expenses
* As shown in Table 3, the poorer the country, the less it spends on health as a proportion of its GDP. …