WHO 07/04/08 

Climate change will erode foundations of health

WHO Director-General warns vulnerable populations at greatest risk of projected impacts

7 APRIL 2008 | GENEVA -- Scientists tell us that the evidence the Earth is warming is "unequivocal." Increases in global average air and sea temperature, ice melting and rising global sea levels all help us understand and prepare for the coming challenges. In addition to these observed changes, climate-sensitive impacts on human health are occurring today. They are attacking the pillars of public health. And they are providing a glimpse of the challenges public health will have to confront on a large scale, WHO Director-General Dr Margaret Chan warned today on the occasion of World Health Day.

"The core concern is succinctly stated: climate change endangers human health," said Dr Chan. "The warming of the planet will be gradual, but the effects of extreme weather events -- more storms, floods, droughts and heat waves -- will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter and freedom from disease."

Human beings are already exposed to the effects of climate-sensitive diseases and these diseases today kill millions. They include malnutrition, which causes over 3.5 million deaths per year, diarrhoeal diseases, which kill over 1.8 million, and malaria, which kills almost 1 million.

Examples already provide us with images of the future:

• European heat wave, 2003: Estimates suggest that approximately 70 000 more people died in that summer than would have been expected.
• Rift Valley fever in Africa: Major outbreaks are usually associated with rains, which are expected to become more frequent as the climate changes.
• Hurricane Katrina, 2005: More than 1 800 people died and thousands more were displaced. Additionally, health facilities throughout the region were destroyed critically affecting health infrastructure.
• Malaria in the East African highlands: In the last 30 years, warmer temperatures have also created more favourable conditions for mosquito populations in the region and therefore for transmission of malaria.
• Epidemics of cholera in Bangladesh: They are closely linked to flooding and unsafe water.

These trends and events cannot be attributed solely to climate change but they are the types of challenges we expect to become more frequent and intense with climate changes. They will further strain health resources that, in many regions, are already under severe stress.

"Although climate change is a global phenomenon, its consequences will not be evenly distributed," said Dr Chan. "In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to control."

To address the health effects of climate change, WHO is coordinating and supporting research and assessment on the most effective measures to protect health from climate change, particularly for vulnerable populations such as women and children in developing countries, and is advising Member States on the necessary adaptive changes to their health systems to protect their populations.

WHO and its partners -- including the UN Environment Programme, the Food and Agriculture Organization, and the UN World Meteorological Organization -- are devising a workplan and research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection. WHO will be working closely with its Member States in coming years to develop effective means of adapting to a changing climate and reducing its effects on human health.

"Through its own actions and its support to Member States," said Dr Chan, "WHO is committed to do everything it can to ensure all is done to protect human health from climate change."

WHO 070408

The impact of climate change on human health

Statement by WHO Director-General Dr Margaret Chan

Last year marked a turning point in the debate on climate change. The scientific evidence continues to mount. The climate is changing, the effects are already being felt, and human activities are a principal cause.

In selecting climate change as the theme for this year’s World Health Day, WHO aims to turn the attention of policy-makers to some compelling evidence from the health sector. While the reality of climate change can no longer be doubted, the magnitude of consequences, and -- most especially for health -- can still be reduced. Consideration of the health impact of climate change can help political leaders move with appropriate urgency.

The core concern is succinctly stated: climate change endangers health in fundamental ways.

The warming of the planet will be gradual, but the effects of extreme weather events – more storms, floods, droughts and heatwaves – will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter, and freedom from disease.

Although climate change is a global phenomenon, its consequences will not be evenly distributed. Scientists agree that developing countries and small island nations will be the first and hardest hit.

WHO has identified five major health consequences of climate change.

First, the agricultural sector is extremely sensitive to climate variability. Rising temperatures and more frequent droughts and floods can compromise food security. Increases in malnutrition are expected to be especially severe in countries where large populations depend on rain-fed subsistence farming. Malnutrition, much of it caused by periodic droughts, is already responsible for an estimated 3.5 million deaths each year.

Second, more frequent extreme weather events mean more potential deaths and injuries caused by storms and floods. In addition, flooding can be followed by outbreaks of diseases, such as cholera, especially when water and sanitation services are damaged or destroyed. Storms and floods are already among the most frequent and deadly forms of natural disasters.

Third, both scarcities of water, which is essential for hygiene, and excess water due to more frequent and torrential rainfall will increase the burden of diarrhoeal disease, which is spread through contaminated food and water. Diarrhoeal disease is already the second leading infectious cause of childhood mortality and accounts for a total of approximately 1.8 million deaths each year.

Fourth, heatwaves, especially in urban “heat islands”, can directly increase morbidity and mortality, mainly in elderly people with cardiovascular or respiratory disease. Apart from heatwaves, higher temperatures can increase ground-level ozone and hasten the onset of the pollen season, contributing to asthma attacks.

Finally, changing temperatures and patterns of rainfall are expected to alter the geographical distribution of insect vectors that spread infectious diseases. Of these diseases, malaria and dengue are of greatest public health concern.

In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to combat. On this World Health Day, I am announcing increased WHO efforts to respond to these challenges. WHO and its partners are devising a research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection.

Citizens, too, need to be fully informed of the health issues. In the end, it is their concerns that can spur policy-makers to take the right actions, urgently.

More information from  http://www.who.int/world-health-day/en/

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25/04/2008 

Monitoring AIDS treatment by regular physical examination is nearly as effective as advanced laboratory tests

25 April: GENEVA -- When millions of HIV-infected people in poor countries began receiving advanced drug therapies, critics worried that patient care would suffer because few high tech laboratories were available to guide treatments. But according to a study being published in Lancet Friday, 25 April, these concerns are as yet unfounded. In fact, the study indicates that when clinicians use simple physical signs of deteriorating health -- such as weight loss or fever -- these doctors can provide therapies almost as effective those relying on the most advanced laboratory analysis.

"The results of this study should reassure clinicians in Africa and Asia, who are treating literally millions of people without these laboratory tests, that they are not compromising patient safety," said a coauthor of the paper, Dr Charles Gilks, the Coordinator of Antiretroviral Treatment (ART) and HIV Care at the World Health Organization in Geneva. "In fact, the outcome of their treatment is almost as good as those patients in the USA and Europe where laboratory-guided treatment is the norm."

The aim of the study was to look at the medium and long-term consequences of different approaches to monitoring antiretroviral therapy in a resource limited setting: using clinical signs and symptoms alone as recommended in WHO guidelines; or more sophisticated and costly but far less  accessible immunological and virological load tests. The scientists used a model that had been tried and tested in London, and shown accurately to predict the course of the epidemic in the UK over twenty years, but with various changes to reflect realities on the ground.

According to the study authors, survival rates for individuals assessed for clinical symptoms alone were almost identical to those who underwent laboratory monitoring. The 5-year survival rate was 83% for individuals monitored for viral load, 82% for CD4 (a critical immune component) monitoring, and 82% for clinical monitoring alone. Corresponding values over a 24-year period were 67%, 64% and 64% respectively.

Although the survival rate was slightly higher with viral load monitoring, study authors pointed out it was not the most cost-effective strategy in the poorest countries. The study also examined whether clinical observation alone was effective in determining when to switch patients from WHO-recommended first-line treatments to more costly second-line medicines. Again, diagnosis based on an assessment of clinical symptoms was almost as effective as those relying on expensive laboratory tests. 

Study authors concluded that, for patients on the WHO first-line regimen of stavudine, lamivudine and nevirapine, the benefits of CD4 count or viral load monitoring were only modest at best.

The study, by a prominent group in the United Kingdom working with WHO scientists, employs mathematical models which were designed to identify emerging problems and problems that might appear after long term use of ART. But more work must be done. The study is based on mathematical projections and not on real world patients. While there is little real world data yet available, because these drugs have been used for such a short time in these countries, the little existing information does support the findings. Other studies are ongoing and more results should be available soon.

LINKS: http://www.thelancet.com/  and http://www.who.int/hiv/drugresistance/

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 Statement WHO/5

7 April 2008

The Impact of Climate Change on Human Health

A Statement by the WORLD HEALTH ORGANIZATION Director-General

Last year marked a turning point in the debate on climate change. The scientific evidence continues to mount. The climate is changing, the effects are already being felt, and human activities are a principal cause.

In selecting climate change as the theme for this year’s World Health Day, WHO aims to turn the attention of policy-makers to some compelling evidence from the health sector. While the reality of climate change can no longer be doubted, the magnitude of consequences, and -- most especially for health -- can still be reduced. Consideration of the health impact of climate change can help political leaders move with appropriate urgency.

The core concern is succinctly stated: climate change endangers health in fundamental ways.

The warming of the planet will be gradual, but the effects of extreme weather events – more storms, floods, droughts and heatwaves – will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter, and freedom from disease.

Although climate change is a global phenomenon, its consequences will not be evenly distributed. Scientists agree that developing countries and small island nations will be the first and hardest hit.

WHO has identified five major health consequences of climate change.

First, the agricultural sector is extremely sensitive to climate variability. Rising temperatures and more frequent droughts and floods can compromise food security. Increases in malnutrition are expected to be especially severe in countries where large populations depend on rain-fed subsistence farming. Malnutrition, much of it caused by periodic droughts, is already responsible for an estimated 3.5 million deaths each year.

Second, more frequent extreme weather events mean more potential deaths and injuries caused by storms and floods. In addition, flooding can be followed by outbreaks of diseases, such as cholera, especially when water and sanitation services are damaged or destroyed. Storms and floods are already among the most frequent and deadly forms of natural disasters.

Third, both scarcities of water, which is essential for hygiene, and excess water due to more frequent and torrential rainfall will increase the burden of diarrhoeal disease, which is spread through contaminated food and water. Diarrhoeal disease is already the second leading infectious cause of childhood mortality and accounts for a total of approximately 1.8 million deaths each year.

Fourth, heatwaves, especially in urban “heat islands”, can directly increase morbidity and mortality, mainly in elderly people with cardiovascular or respiratory disease. Apart from heatwaves, higher temperatures can increase ground-level ozone and hasten the onset of the pollen season, contributing to asthma attacks.

Finally, changing temperatures and patterns of rainfall are expected to alter the geographical distribution of insect vectors that spread infectious diseases. Of these diseases, malaria and dengue are of greatest public health concern.

In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to combat.

On this World Health Day, I am announcing increased WHO efforts to respond to these challenges. WHO and its partners are devising a research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection.

Citizens, too, need to be fully informed of the health issues. In the end, it is their concerns that can spur policy-makers to take the right actions, urgently.

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  25 March 2008

10,000 health workers stop polio in one of most dangerous places on earth

Somalia passes polio-free landmark

25 March 2008, Geneva, Switzerland – Somalia is again polio-free, the Global Polio Eradication Initiative (GPEI) announced today, calling it a 'historic achievement' in public health.  Somalia has not reported a case since 25 March 2007, a major landmark in the intensified eradication effort launched last year to wipe out the disease in the remaining few strongholds.

Against a backdrop of widespread conflict, large population movements and a dearth of functioning government infrastructure, transmission of poliovirus in the country has been successfully stopped.  This landmark victory is a result of the efforts of more than 10,000 Somali volunteers and health workers who repeatedly vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times, across a country ranked one of the most dangerous places on earth. 

The use of innovative approaches tailored to conflict areas was pivotal in stopping polio in the country.  These included increased community involvement and the effective use of monovalent vaccines to immunize children in insecure areas with several doses, within a short period of time.

"This truly historic achievement shows that polio can be eradicated everywhere, even in the most challenging and difficult settings," said Dr Hussein A Gezairy, Regional Director for the World Health Organization's Office for the Eastern Mediterranean. 

Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following a 20-year concerted international effort. Only four polio-endemic countries remain – Afghanistan, India, Nigeria and Pakistan – and the eradication of polio globally now depends primarily on stopping the disease in these countries. 

Poliovirus travels easily and, in the world of modern travel, can cover long distances. Until transmission of the virus has been interrupted in the four remaining endemic countries, the risk to the rest of the world remains high.  Somalia, which had already eradicated the disease in 2002, became re-infected in 2005 by poliovirus originating in Nigeria.  This repeated success in Somalia indicates the disease can be stopped even in areas with no functioning central government.

“Somalia beat polio in the midst of more widespread conflict and poverty than that affecting Afghanistan and Pakistan,” according to Dr Maritel Costales, Senior Health Advisor, UNICEF New York, citing insecurity and large population movements in those countries as challenges to reaching all children with vaccine.  “But Somalia shows that when communities are engaged, children everywhere can be reached.” Afghanistan and Pakistan could be the first of the remaining endemic countries to stop polio; between them they account for 5% of all cases of polio in 2007. 

Consistent financial commitment continues to be crucial to completing polio eradication.  The global effort currently faces a shortage of US$525 million for 2008-2009, funding urgently needed to fight the disease in the remaining endemic areas and protect children in high-risk polio-free areas.  Rotary International, the top private sector contributor and volunteer arm of the GPEI, has contributed US$9.2 million for polio eradication in Somalia, and US$700 million worldwide since 1985.  “Somalia clearly shows that the tailored tools and tactics of the intensified eradication effort are working,” commented Mohamed Benmejdoub, Chair of Rotary's Eastern Mediterranean PolioPlus Committee.  “A polio-free world is a feasible public health goal and a global public good.  I urge governments across the world – and in particular the G8 countries – to rapidly make available the necessary resources.  Together, we can ensure that no child need ever again suffer the terrible pain of lifelong polio-paralysis.”   

Notes to editors:

The Global Polio Eradication Initiative is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.  Since 1988, the incidence of polio has been reduced by more than 99 percent.  At the time, more than 350,000 children were paralysed every year, in more than 125 endemic countries.  Today, four countries remain which have never stopped endemic transmission of polio:  Afghanistan, India, Nigeria and Pakistan.  In 2007, 1,308 cases have been reported worldwide (data as at 18 March 2008).

One of the 10,000 Somali volunteers and health workers is Ali Mao Moallim, who – more than 30 years ago on 26 October 1977 – became the last person on earth to contract smallpox.  Over the past few years, working with WHO, he has travelled extensively throughout Somalia to immunize children against polio and foster community engagement during immunization campaigns.  "Somalia was the last country with smallpox.  I wanted to help ensure that we would not be the last place with polio, too," he stated.

Somalia's last case of indigenous polio was in 2002.  On 12 July 2005, the country was re-infected by poliovirus originating in Nigeria, resulting in an outbreak of 228 cases in total.  Systematic and wide-scale outbreak response activities, including intensive community engagement, successfully stopped the epidemic, and the last case was reported on 25 March 2007 in Mudug Province, in central Somalia. 

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WHO 17 March 08 FOR 24 March 08 

WORLD TB DAY 2008

WORLDWIDE EFFORTS TO CONFRONT TUBERCULOSIS ARE MAKING PROGRESS, BUT TOO SLOWLY

17 March 2008 -- Geneva -- The World Health Organization (WHO) report, Global Tuberculosis Control 2008, released today, finds that the pace of the progress to control the tuberculosis (TB) epidemic slowed slightly in 2006, the most recent year for which data were available. The new information documents a slowdown in progress on diagnosing people with TB. Between 2001 to 2005, the average rate at which new TB cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase was cut in half, to 3%.

The reason for this slowing of progress is that some national programmes that were making rapid strides during the last five years have been unable to continue at the same pace in 2006. Moreover, in most African countries there has been no increase in the detection of TB cases through national programmes. Other studies have also shown that many patients are treated by private care providers, and by non-governmental, faith-based and community organizations, thus escaping detection by the public programmes.

"We've entered a new era," said Dr Margaret Chan, WHO Director-General.  "To make progress, firstly public programmes must be further strengthened. Secondly, we need to fully tap the potential of other service providers. Enlisting these other providers, working in partnership with national programmes, will markedly increase diagnosis and treatment for people in need."

This is the twelfth annual WHO report on global TB control, and is based on data given to WHO by 202 countries and territories.  

There were 9.2 million new cases of TB in 2006, including 700 000 cases among people living with HIV, and 500 000 cases of multi-drug resistant TB (MDR-TB). An estimated 1.5 million people died from TB in 2006. In addition, another 200,000 people with HIV died from HIV-associated TB.

The report highlights two aspects of the epidemic that could further slow progress on TB. The first is multidrug-resistant tuberculosis (MDR-TB), reported by WHO last month to have reached the highest levels ever recorded. To date, however, the response to this epidemic has been inadequate. Given limited laboratory and treatment capacity, countries project they will provide treatment only to an estimated 10% of people with MDR-TB worldwide in 2008.

The second threat to continued progress is the lethal combination of TB and HIV, which is fuelling the TB epidemic in many parts of the world, especially Africa. Although TB/HIV remains a massive challenge, some countries are making strides against the co-epidemic. Almost 700 000 TB patients were tested for HIV in 2006, up from 22 000 in 2002--a sign of progress but still far from the 2006 target of 1.6 million set by the Global Plan to Stop TB 2006-2015. The three African countries achieving the highest HIV testing rates in TB care settings in 2006 were Rwanda (76%), Malawi (64%) and Kenya (60%).

"The report tells us that we are far from providing universal access to high-quality prevention, diagnostic, treatment and care services for HIV and TB," said Dr Peter Piot, Executive Director of UNAIDS. "Clear progress has been made but we must all do more to make a joint approach to reducing TB deaths among people with HIV a reality."

The report also documents a shortage in funding. Despite an increase in resources, especially from the Global Fund and some middle-income countries, TB budgets are projected to remain flat in 2008 in almost all of the countries most heavily burdened by the disease. Ninety countries in which 91% of the world's TB cases occur provided complete financial data for the Report.  To meet the 2008 targets of the Global Plan to Stop TB, the funding shortfall for these 90 countries is about US$ 1 billion.

"We look forward to working with all partners to further assist countries to achieve TB targets for 2015 and beyond," said Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "Together we are bringing hope to the individuals and communities suffering from the enormous burden of TB."

In recognition of World TB Day, Dr Jorge Sampaio, former President of Portugal and the UN Secretary-General's Special Envoy to Stop TB, called for enhanced leadership to address TB/HIV. "TB is a leading cause of death among people living with HIV/AIDS," he said. "Several countries have shown that targets relating to TB/HIV are achievable and have put in place measures that will have an impact on the lives of those at most risk.  But this is a restless battle. We still need to do much more and much better." 

Note to Editors
Change in WHO classification of causes of death. This year, under new guidelines, deaths from a combination of HIV and TB are no longer classified as TB deaths.

The Global Plan to Stop TB (2006-2015), launched by the Stop TB Partnership (www.stoptb.org) in January 2006, sets forth a roadmap for treating  50 million people for TB and enrolling 3 million patients who have both TB and HIV on antiretroviral therapy  over the next 10 years, saving about 14 million lives. It aims to halve TB prevalence and deaths compared with 1990 levels by 2015.

World TB Day (24 March each year), is observed around the world to build public awareness about tuberculosis. It commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus.

For further information, please contact:
Judith Mandelbaum-Schmid, Communications Officer, Stop TB Partnership, mobile +41 79 254 6835, email: schmidj@who.int.
Glenn Thomas, Communications Officer, WHO Stop TB Department, mobile +41 79 509 0677,  email: thomasg@who.int.
All press releases, fact sheets and other WHO media material may be found at  www.who.int.

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