The World Health Report 2002 CHAPTER 7 PREVENTING RISKS AND TAKING ACTION Focusing on prevention means focusing on risks The world faces some common, large and certain risks to health Effective and affordable preventive interventions are available Narrowing the gap between potential and actual benefit: a key research priority 164 Population-wide prevention strategies: key to risk reduction Government responsibility for health 165 Reducing major risks to health will promote sustainable development 165 Reducing major risks to health can reduce inequities in society Governments need to prioritize and focus on the most important risks 165 Exercising stewardship means fulfilling the government's responsibility to protect its citizens 166 Recommended actions Reducing risks, promoting healthy life 167 STATISTICAL ANNEX 169 Explanatory Notes Annex Table 1 Basic indicators for all Member States 178 Annex Table 2 Deaths by cause, sex and mortality stratum in WHO Regi estimates for 2001 Annex Table 3 Burden of disease in DALYs by cause, sex and mortality stratum in WHO Regions, estimates for 2001 Annex Table 4 Healthy life expectancy (HALE) in all Member States, estimates Annex Table 5 Selected National Health Accounts indicators for all Member States, estimates for 1995 to 2000 Annex Table 6 Summary prevalence of selected risk factors by subregion, 2000 Annex Table 7 Selected population attributable fractions by risk factor, sex and level of development(% DALYs for each cause), 2000 Annex Table8 Distribution of attributable mortality and DALYs by risk factor, anney Annex Annex e50 Attributable mortality by risk factor, level of developI ctor au023 Attributable mortality by risk factor, sex and mortality stratum in WHO Regions, 2000 Annex Table 12 Attributable DALYs by risk factor, sex and mortality stratum in WHO Regions, 2000 Annex Table 13 Attributable years of life lost (YLL) by risk factor, mortality stratum in WHO Regions, 2000 Annex Table 14 Major burden of disease-leading 10 selected risk factors and leading 10 diseases and injuries, high mortality developing countries, 2000 Annex Table 15 Major burden of disease-leading 10 selected risk factors and leading 10 diseases and injuries, low mortality developing countries, 2000 Annex Table 16 Major burden of disease-leading 10 selected risk factors d leading 10 diseases and injuries, developed countries, 2000
vi The World Health Report 2002 CHAPTER 7 PREVENTING RISKS AND TAKING ACTION 159 Focusing on prevention means focusing on risks 161 The world faces some common, large and certain risks to health 162 Effective and affordable preventive interventions are available 163 Narrowing the gap between potential and actual benefit: a key research priority 164 Population-wide prevention strategies: key to risk reduction 164 Government responsibility for health 165 Reducing major risks to health will promote sustainable development 165 Reducing major risks to health can reduce inequities in society 165 Governments need to prioritize and focus on the most important risks 165 Exercising stewardship means fulfilling the government’s responsibility to protect its citizens 166 Recommended actions 166 Reducing risks, promoting healthy life 167 STATISTICAL ANNEX 169 Explanatory Notes 170 Annex Table 1 Basic indicators for all Member States 178 Annex Table 2 Deaths by cause, sex and mortality stratum in WHO Regions, estimates for 2001 186 Annex Table 3 Burden of disease in DALYs by cause, sex and mortality stratum in WHO Regions, estimates for 2001 192 Annex Table 4 Healthy life expectancy (HALE) in all Member States, estimates for 2000 and 2001 198 Annex Table 5 Selected National Health Accounts indicators for all Member States, estimates for 1995 to 2000 202 Annex Table 6 Summary prevalence of selected risk factors by subregion, 2000 218 Annex Table 7 Selected population attributable fractions by risk factor, sex and level of development (% DALYs for each cause), 2000 220 Annex Table 8 Distribution of attributable mortality and DALYs by risk factor, age and sex, 2000 223 Annex Table 9 Attributable mortality by risk factor, level of development and sex, 2000 224 Annex Table 10 Attributable DALYs by risk factor, level of development and sex, 2000 225 Annex Table 11 Attributable mortality by risk factor, sex and mortality stratum in WHO Regions, 2000 226 Annex Table 12 Attributable DALYs by risk factor, sex and mortality stratum in WHO Regions, 2000 228 Annex Table 13 Attributable years of life lost (YLL) by risk factor, sex and mortality stratum in WHO Regions, 2000 230 Annex Table 14 Major burden of disease – leading 10 selected risk factors and leading 10 diseases and injuries, high mortality developing countries, 2000 232 Annex Table 15 Major burden of disease – leading 10 selected risk factors and leading 10 diseases and injuries, low mortality developing countries, 2000 232 Annex Table 16 Major burden of disease – leading 10 selected risk factors and leading 10 diseases and injuries, developed countries, 2000 232
Contents LIST OF MEMBER STATES BY WHO REGION AND MORTALITY STRATUM 233 ACKNOWLEdgEmENtS 236 239 TAbLES Table 4.1 Population impact fractions by subregion for counterfactual of population moving from living on US$ 2 per day to USS 2 per day 51 Table 4.2 Selected major risks to health: childhood and maternal undernutrition Table 4.3 Selected major risks to health: other diet-related factors and physical inactivity 57 Table 4.4 Selected major risks to health: sexual and reproductive health Table 4.5 Selected major risks to health: addictive substances Table 4.6 Selected major risks to health: environmental factors Table 4.7 Selected major risks to health: occupational hazards Table 4. 8 Selected other risks to health Table 4.10 Attributable DALYs by risk factor, level of development and sex 20 Table 4.9 Attributable mortality by risk factor, level of development and sex, 200 Table 4.11 Ranking of estimated attributable and avoidable burdens of 10 leading selected risk factors Table 5.1 Leading 10 selected risk factors as percentage causes of disease burden measured in dAlys Table 5.2 Time gains from improved access to water and sanitation in subregions AFR-D and EMR-D Table 5.3 Cost-effective interventions FIGURES Figure 2.1 Example of distributional transitions for blood pressure and for tobacco smoking Figure 2.2 Causal chains of exposure leading to disease Figure 2.3 The importance of population distributions of exposure Figure 2.4 Attributable and avoidable burdens Figure 2.5 Key inputs for assessment of attributable and avoidable burdens Figure 2.6 Determination of attributable burden, taking account of prevalence ure 3.1 Hazards for dread and risk ure 4.1 Prevalence of moderate underweight in children by average daily household income(<USS 1, US$ 1-2 and >USS 2 per day), by subregion igure 4.2 Burden of disease attributable to childhood and maternal undemutrition ( DALYs in each subregion) Figure 4.3 Burden of disease attributable to diet-related risk factors and physical inactivity(% DALYs in each subregion) Figure 4.4 Nine examples of continuous associations between risks and disease Figure 4.5 Burden of disease attributable to sexual and reproductive health risks ( DALYs in each subregion) Figure 4.6 Burden of disease attributable to tobacco, alcohol and illicit drug ( DALYs in each subregi
Overview vii LIST OF MEMBER STATES BY WHO REGION AND MORTALITY STRATUM 233 ACKNOWLEDGEMENTS 236 INDEX 239 TABLES Table 4.1 Population impact fractions by subregion for counterfactual scenario of population moving from living on < US$ 2 per day to > US$ 2 per day 51 Table 4.2 Selected major risks to health: childhood and maternal undernutrition 52 Table 4.3 Selected major risks to health: other diet-related factors and physical inactivity 57 Table 4.4 Selected major risks to health: sexual and reproductive health 62 Table 4.5 Selected major risks to health: addictive substances 64 Table 4.6 Selected major risks to health: environmental factors 67 Table 4.7 Selected major risks to health: occupational hazards 73 Table 4.8 Selected other risks to health 79 Table 4.9 Attributable mortality by risk factor, level of development and sex, 2000 86 Table 4.10 Attributable DALYs by risk factor, level of development and sex, 2000 87 Table 4.11 Ranking of estimated attributable and avoidable burdens of 10 leading selected risk factors 91 Table 5.1 Leading 10 selected risk factors as percentage causes of disease burden measured in DALYs 102 Table 5.2 Time gains from improved access to water and sanitation in subregions AFR-D and EMR-D 128 Table 5.3 Cost-effective interventions 134 FIGURES Figure 2.1 Example of distributional transitions for blood pressure and for tobacco smoking 12 Figure 2.2 Causal chains of exposure leading to disease 14 Figure 2.3 The importance of population distributions of exposure 17 Figure 2.4 Attributable and avoidable burdens 19 Figure 2.5 Key inputs for assessment of attributable and avoidable burdens 20 Figure 2.6 Determination of attributable burden, taking account of prevalence and relative risk 21 Figure 3.1 Hazards for dread and risk 33 Figure 4.1 Prevalence of moderate underweight in children by average daily household income (<US$ 1, US$ 1–2 and >US$ 2 per day), by subregion 50 Figure 4.2 Burden of disease attributable to childhood and maternal undernutrition (% DALYs in each subregion) 53 Figure 4.3 Burden of disease attributable to diet-related risk factors and physical inactivity (% DALYs in each subregion) 58 Figure 4.4 Nine examples of continuous associations between risks and disease 59 Figure 4.5 Burden of disease attributable to sexual and reproductive health risks (% DALYs in each subregion) 62 Figure 4.6 Burden of disease attributable to tobacco, alcohol and illicit drugs (% DALYs in each subregion) 65 Contents