医学口语世界卫生状况英文报告2.docx

医学口语世界卫生状况英文报告2.docx

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医学口语世界卫生状况英文报告2

【医学口语】世界卫生状况英文报告2

　　Healthoftheelderly

　　Theincreaseinthenumberofoldpeopleintheworldwillbeoneofthemostprofoundforcesaffectinghealthandsocialservicesinthenextcentury.Overall,theworldspopulationhasbeengrowingatanannualrateof1.7%duringtheperiod1990-1995-butthepopulationagedover65isincreasingbysome2.7%annually.Ofaworldtotalof355millionpeopleover65in1993,morethan200millionareinthedevelopingworld,wheretheymakeup4.6%ofthepopulation,withmorethan150millionindevelopedcountries,wheretheproportionis12.6%.AlthoughEurope,JapanandtheUSAcurrentlyhavethe'oldest'populations,themostrapidchangesarebeingseeninthedevelopingworld,withpredictedincreasesinsomecountriesofupto400%inpeopleagedover65duringthenext30years.

　　Alongsidetheincreaseinthenumberofpeopleoverage65,therewillalsobeadramaticriseinthenumbersof'oldold'-peopleover80.In1993theyconstituted22%ofthoseover65indevelopedcountriesand12%inthedevelopingworld.Theworldelderlysupportratio（thenumberofpeopleover65yearscomparedtothoseaged20-64）in1990was12elderlytoevery100peopleofworkingage.Itisestimatedthatthefigurewillbe12.8intheyear2000and13.2in2020.Inotherwords,whilepopulationincreaseduring1990-2000isestimatedtobe17%,theincreaseinthenumberofelderlyislikelytobe30%.

　　Oneofthemostdifficultquestionsforhealthplannersandpoliticianstryingtoallocatefunds,aswellasforthecommunityandindividualsthemselves,iswhetherincreasedlifeexpectancymeansmorehealthorsimplymoreyearsofsickness.Thisisanareathatisgreatlyunderresearched,yetthequestionisassumingevergreaterimportance.

　　Twoofthemostpressingproblemsinthefuturewillbetheprovisionofcareforpeoplewithdementiaandthoseneedingjointreplacementsforarthriticdiseases.WHOestimatesthatthereare165millionpeopleintheworldwithrheumatoidarthritis.Thelong-termcareofthefrailelderlyisbecomingoneofthemostdebatedmedicalandpoliticalissuesinmanydevelopedcountries,andthedevelopingworldtoowillsoonhavetowrestlewithit.Ifpeoplearenottobeleftdestituteanduncaredforattheendoftheirlives,moreattentionmustbegiventosocialmechanismsforthesupportoftheelderlyandthemeanstofundthem.

　　Generalhealthissues

　　Althoughinthepast10yearstherehasbeenaglobaltrendtowardsthedemocratizationofpoliticalsystems,themuchanticipated'peacedividend'hasfailedtomaterialize.Povertyhascontinued,andwillcontinue,tobeamajorobstacletohealthdevelopment.Thenumberofpoorpeoplehasincreasedsubstantially,bothinthedevelopingworldandamongunderprivilegedgroupsandcommunitieswithindevelopedaswellasdevelopingcountries.Duringthesecondhalfofthe1980s,thenumberofpeopleintheworldlivinginextremepovertyincreased,andwasestimatedatover1.1billionin1990-morethanone-fifthofhumanity.

　　Thechangingdemographicpictureacrosstheworld,togetherwiththerapidshifttowardsurbanization,willhaveprofoundimplicationsforthedeliveryofhealthservices.Theunplannedandoftenchaoticgrowthofmegacitiesinthedevelopingworldwillposeparticularchallenges,aspoorsanitationandhousingencouragethespreadofinfectiousdiseases.

　　Againstanyoptimismabouttheglobaleconomythroughouttheremainderofthiscenturyandbeyondshouldbesetanumberofmajoruncertainties.Therehasbeenadisproportionateflowofresourcesfromthedevelopingtothedevelopedworld-poorcountriespayingmoneytorichones-becauseofdebtservicingandrepaymentandasaconsequenceofpricesforrawmaterialsthatfavourthelatterattheexpenseoftheformer.Structuraladjustmentpoliciesaimedatimprovingtheeconomicperformanceofpoorcountrieshaveinmanycasesmadethesituationworse.ThewordsofRobertMcNamara,spokenin1980whenhewasPresidentoftheWorldBank,stillholdtrue：

'Thepursuitofgrowthandfinancialadjustmentwithoutareasonableconcernforequityisultimatelysociallydestabilizing'.

　　Afurtherworryingglobaltrendisgrowingunemployment,especiallyindevelopingcountrieswithoutsocialsecurityarrangementstocushionthoseoutofwork.Long-termunemploymentiscreatinganewclassof'untouchables'-byexcludingalargegroupofpeoplefromthemainstreamofdevelopmentandsociety.Theunemployedareapotentreminderofthedangersofassumingthatthegeneralprosperityofacountrywilltrickledowntoallitsmembers.

　　Thereisalsoconsiderableconcernabouttheadversehealtheffectsofcontinuingenvironmentaldegradation,pollutionandtheuncontrolleddumpingofchemicalwastes,diminishingnaturalresources,depletionoftheozonelayerandpredictedglobalclimatechanges.

　　Socialmoresarealsoundergoingprofoundchanges,withamovetowardsshortermarriagesandmoredivorcesinmanycountries,leadingtofamilybreakdownswhichhaverepercussionsforindividualsandforsocialservicesthatmaybecalledontoprovidehelpforchildrenandsingleparents.

　　Beyondanyconsiderationsforimprovingthehealthoftheworldmustbetherecognitionthatthegrowingworldpopulationwillstraintothelimittheabilityofsocial,political,environmentalandhealthinfrastructurestocope.Healthinfrastructure-buildingsandequipment,thestaff,thedrugs,thevehicles-iscentraltogoodhealthcare.Servicesmustbeintegrated,cost-effectiveandprovidedascloseaspossibletothepeoplewhoneedthem.

　　Withhealthresourcesunlikelytobegreatlyincreasedbutwithevergrowingdemandsforservices,becauseofexpandingpopulationsandtheadvancesofsciencewhichmakemoreconditionstreatable,thedebateabouttherationingofhealthcare,withtheattendantethicalproblems,islikelytobecomeintense.Hardchoiceswillhavetobemade-andgreatlyenhancedmechanismsfoundforlisteningtothevoiceofthehealthconsume

　　WHO'scontributionstoworldhealth

　　Withintheframeworkoftheorganizationsconstitutionandtheguidancegivenintheperiodicgeneralprogrammesofwork,allWHOactivitiesaregearedtorespondtothepriorityproblemsoftheagegroupsreferredtointhissummary.ThefullextentofWHO'sworkatnational,regionalandgloballevelscannotbereflectedhere,butexamplesaregivenofdifferenttypesofaction.

　　Childandadolescenthealth

　　WHOencouragesself-relianceofcountriesinconductingimmunizationthroughbasichealthservices.ItcooperateswithUNICEFinitsinitiativeofsupplyingvaccinestoover100countries.Majorprioritiesaretoatleastsustaintheaccomplishmentsofpreviousyearsandtocontinuetostriveforachievementofthe1992WorldSummitforChildrengoalofimmunizationagainstthesixvaccine-preventablediseases（diphtheria,pertussis,tetanus,measles,poliomyelitis,tuberculosis）.

　　Inanefforttomakethebestuseoflimitedresourcestoeliminateneonataltetanus,WHOhasgivenprioritytocountriesthataccountfor80%oftotalcasesandhaveanestimatedmortalityof5ormoreper1000livebirths.WHOinitiatedaseriesofmeasurestoarrestthespreadofdiphtheriaineasternEurope,includingtheformulationofaplanofactionandtheestablishmentofaEuropeantaskforce.In1993progresstowardsthepoliomyelitiseradicationgoalwasheartening.Effortsarebeingmadetodevelopamoreheat-stablepoliovirusvaccinethatcanbedeliveredwithalessrigorouslymaintainedcoldchain.Largedonationsforpoliomyelitiseradicationwerecoordinatedwithdifferentorganizations.In1994theregionoftheAmericascommitteditselftoeliminatingmeaslesbytheyear2000,andincidenceisnowatthelowestlevelever.IfthemomentumissustainedtheAmericasmaywellleadthewaytowardsglobaleliminationofthismajorkillerofchildren.

　　Bytheendof1994virtuallyalldevelopingcountrieshadimplementedplansofactionagainstdiarrhoealdiseasesinchildren.Nearly42%ofhealthstaffinthecountrieshadbeentrainedinsupervisoryskillsusingmaterialsdevelopedbyWHO,andalmost30%ofdoctorsandotherhealthworkershadbeentrainedindiarrhoeacasemanagement,manyoftheminthemorethan420diarrhoeatrainingunitsestablishedinover90countries.Itisestimatedthatnearly85%ofthepopulationofthecountrieshadaccesstooralrehydrationsaltsattheendof1994.

　　ParticularemphasisisgiventotraininginthemanagementofacuterespiratoryinfectionsWHOsupportscoursesforworkersinfirst-levelhealthfacilitiesandreferralhospitalsonstandardcasemanagement,anddistributestrainingandtechnicalmaterials.Morethan190000healthmanagers,doctors,nursesandcommunityhealthworkersinover60countrieshavebeentrainedsofar.WHOisinvolvedinnumerousstudiesonacuterespiratoryinfectionsinAfrica,AsiaandLatinAmerica.

　　Activitiesforbetternutritionarepromotedin62countries,mostlyincollaborationwithFAOandUNICEF.Aglobaldatabaseonchildgrowthwasestablishedandmorethan90countriesarereceivingtechnicalandfinancialsupporttogiveeffecttotheInternationalCodeofMarketingofBreastmilkSubstitutes.ThenewWHO/UNICEF'baby-friendlyhospitalinitiative'hasprovedhugelysuccessfulinencouragingproperinfantfeedingpractices,startingatbirth.Ithasalreadybeenimplementedintwo-thirdsofAfricancountries.AnumberofcountrieshaveintroducednationalnutritionpolicieswithWHOsupport.

　　AwiderangeofWHOprogrammesfocusontheneedsofadolescentsinsuchfieldsasnutrition,mentalhealth,sexuality,diseaseandinjuryprevention,andsubstanceabuse.