Health of adults
Globally about 51 million people of all ages died in 1993, about three-quarters of them adults. Some 39 million deaths took place in the developing world and about 12 million in the developed. Poor countries had three times more deaths than rich ones.
Communicable diseases such as tuberculosis and respiratory infections as well as maternal, perinatal and neonatal conditions account for about 20 million, or about 40%, of the 51 million global deaths; and 99% of these occur in the developing world.
Noncommunicable diseases such as cancer and heart disease account for about 19 million deaths, or 36% of the global total, divided more or less equally between the developing and the developed world. The great majority of such deaths are among adults.
External causes such as accidents and violence account for about 4 million deaths, or some 8% of the total, again mostly among adults. Developing countries have nearly four times the number of deaths from these causes as the developed world. Other and unknown causes account for the remaining 16% of deaths worldwide.
Maternal complications claim another 508 000 lives a year.
Of the 20 million deaths due to communicable diseases more than 16 million, or about 80%, are due to infectious and parasitic diseases. Tuberculosis kills about 3 million people, malaria around 2 million and hepatitis B possibly 1 million.
Among the major communicable diseases, tuberculosis was responsible for more than 5% of the global total of deaths - over 7 000 a day - and it is estimated that there will be 8.8 million new cases in 1995 - equal to more than 1 000 new cases every hour of every day. Drug treatment, in most cases costing as little as US $13-30 per person for a six-month course, can cure people; but providing the drugs to those who need them, and ensuring that patients take them for the required period, is a major public health challenge.
Meanwhile the lethal relationship of tuberculosis with HIV is making the death toll many times worse. During the next 10 years in Asia alone it is estimated that tuberculosis and AIDS together will kill more people than the entire populations of the cities of Singapore, Beijing, Yokohama and Tokyo combined.
Malaria, directly or in association with acute respiratory infections and anaemia, causes around 2 million deaths a year, the vast majority among young children, and some 400 million cases annually. Globally more than 2 billion people are threatened. The estimated direct and indirect cost of the disease in Africa alone is expected to reach US $1.8 billion by 1995.
Cholera has become endemic in many countries in Africa, Asia and Latin America. In 1993 there were 377 000 new cases reported and only 6 800 deaths. Nevertheless, the number of cases and deaths remain at far higher levels than those reported earlier.
Among the other communicable diseases, dengue and dengue haemorrhagic fever are now the most important and rapidly rising arbovirus infections in the world. There are millions of cases annually, with approximately 500 000 people needing hospital treatment, and thousands of deaths. The ancient scourge of leprosy still causes 600 000 new cases a year. Between 2 and 3 million people are disabled by the disease, including those who have been cured but crippled in some way prior to treatment. Onchocerciasis (river blindness) infects 18 million people in 34 countries, while dracunculiasis (guinea- worm disease) causes terrible suffering and disability among 3 million of the world s most deprived people who have no access to safe water. Chagas disease affects 17 million people in 21 countries in Latin America and causes 45 000 deaths and 400 000 cases of heart and stomach disease annually. African trypanosomiasis (sleeping sickness), kills an estimated 55 000 people a year. Schistosomiasis (bilharziasis or snailfever) affects 200 million people in 74 countries in the Americas, Africa and Asia and kills perhaps 200 000 people. Leishmaniasis infects about 13million people. Visceral leishmaniasis, also known as kala-azar, is the most severe form. Almost always fatal if untreated, it causes some 500 000 cases and more than 80 000 deaths a year. Lymphatic filariasis (elephantiasis)affects around 100 million people, while Ascaris causes clinical symptoms in as many as 214 million people, Trichuris in 133 million and hookworm in 96 million.