[JriSS^s \^59 Return this book on or before the Latest Date stamped below. Theft, mutilation, and underlining of books are reasons for disciplinary action and may result in dismissal from the University. University of Illinois Library ' 1 S? •f- L161—0-1096 r 7 ''it •iftT •,i : 2 /' ■ ^ . •Tf::' / ' ,' T'S ■' \ ' ■'. »> i ; ' . I ' V, • * I ' ‘ t ',' paej-Aiti.u POR TviK V;:f v?(^’EKA^NT OPKIiA'f’lONS rE' ' :iEKATK : ;:.J'i'-*’ !/,s '. } ■ -'J", f. '.I ’ ;• f! Hll ' 1 ' *•' « . k' ‘ » I • * jA ' * - « ^' .1 r I i< ■ '^ ^ 'i k ' • - mMi^i \ » '*'• • ■' ‘' a* » ' '^ rt V' ' '■^/, ' ’•,'*' k ’ (.' "TcWaAN't to £i. 'Kea. AS!, «■»!)'« CviJsai’Ji. ;?)■''■■.l;,• i t •'. ■ '' ' 3 TITl .'■' ril ■u./ •V v' '. I' ft, ’' I . V '..^ ft ^-' ■ ' - |.U '.i^- .f 10 , v.:^ ■ ^ i,'*' n "L^ ■ ■' fy' ■■ • ■ y X y ' < i ifwAi^ ** ' t »r, Mftk.i .’ 'i: a':';. ' ■■ ■• m ^—/r ' • , r. 1 . . ' ► ' ' ' ,•" '<* mwvR^iiiany 'u ivy^r , tiWii', JP liw'O thing c /■' _ . f' Vi, V'l'i';' f ..- —|> ^W w ii w o u' ^ h» ,}ij rrr-'j )ifj - O '■* ^ '■' "''m i* ■ f f j ;i I ^ ';.] r.i; :uMjo-i * ^*^i;: luu; f! *. i -' T; Digitized by the Internet Archive in 2020 with funding from University of Illinois Urbana-Champaign Alternates https://archive.org/details/statusofworldheaOOunit FOREWORD By Hon. Hubert H. Humphrey, Chairman, Subcommittee on Reorganization and International Organizations “What would a brief, overall view of world health problems show?’’ This question is answered in part in the pages which follow. The answer—in chart and text—is designed to offer insight on a subject of interest to all mankind. This presentation was prepared by the U.S. Public Health Service at the request of the subcommittee. The compilation is, by intention, relatively brief. It is aimed solely for initial background purposes of the subcommittee, of other interested legislators, and the public. It fills a particular need in the early phases of the world health study, as authorized by the 85th and 86th Congresses. NEED FOR “the BIG PICTURE” However, the publication will, it is believed, make rapidly possible for the reader a larger, more inclusive, type picture than piecemeal views of world health, such as may have been seen in times past. This “big picture” is our goal. Only with the “big picture” in mind can the Congress, it is believed, effectively evaluate existing and pro¬ posed world health programs. BROAD RESPONSIBILITY OF THIS COMMITTEE Under the Rules of the Senate, the Committee on Government Operations bears the continuing responsibility of rendering an ac¬ counting of existing programs. In order to do so, full perspective as to these programs is essential. Such perspective requires a total, not a segmented view. This is especially important because the U.S. responsibilities under world health programs continue to mount. Hardly a year has elapsed since World War II in which these programs have not been elaborated by the legislative and executive branches in response to felt need. U.S. POLICY STATEMENT IN 1958 The committee notes that the Mutual Security Act of 1958, Public Law 85-477, enacted June 30, 1948, provided a policy declaration as follows: (m) The Act of June 14, 1948, as amended (22 U.S.C. 290) authorizing par¬ ticipation in the World Health Organization, is amended by adding the following new section 6: “Sec. 6. The Congress of the United States, recognizing that the diseases of mankind, because of their widespread prevalence, debilitating effects, and heavy toll in human life, constitute a major deterrent to the efforts of many peoples to Y VI FOREWORD develop their economic resources and productive capacities, and to improve their living conditions, declares it to be the policy of the United States to continue and strengthen mutual efforts among the nations for research against diseases such as heart disease and cancer. In furtherance of this policy, the Congress invites the World Health Organization to initiate studies looking toward the strength¬ ening of research and related programs against these and other diseases common to mankind or unique to individual regions of the globe.” The wide dimensions of this policy declaration may now perhaps be better seen by means of the charts in this committee print. LIMITATIONS IMPOSED BY UNAVAILABILITY OF DATA Yet the publication itself does not contain all that the Public Health Service and this subcommittee would have desired if various necessary facts had been actually available. Regrettably, an analysis of the world health situation is difficult due to the lack of accurate, current statistical data, particularly from the less developed countries. The attached material represents a collection of such data as are available and are documented. Primary information is presented on population distribution and growth which is basic to a study of world health problems. Special attention has been given to “indicators of health,” selected disease problems, and health resources. HEALTH INDICATORS In June 1953 a U.N. Committee of Experts met to discuss an international definition and measurement of standards and levels of living. This Committee agreed that it was impossible to establish any single index to measure standards and levels of living but singled out some 12 components, including a wide variety of social and economic factors. The first on the list of these components was health, including demographic conditions. This item was referred to the World Health Organization for further refinement by experts who emphasized several items of value for such measurements. These “health indicators for measurement of levels of living” include life expectancy, infant mortality, and crude annual death rates. Narrative and graphic material have been prepared on these indices to illustrate the general levels of health in the world. LIFE EXPECTANCY DATA Life expectancy data reflect, to a considerable extent, the general health conditions that make possible a longer life for the average indi¬ vidual and sometimes offer a means of making a broad comparison of levels of health in different countries. However, in many under¬ developed areas, life expectancy figures are whoUy lacking; and even in some of the other countries, calculations are made at only 10-year or longer intervals and do not always reflect current progress. More comprehensive data on life expectancy at various ages instead of just at birth would give this indicator much greater usefulness. But except for a few countries, these figures do not exist. FOREWORD vn INFANT MORTALITY The infant mortality charts present the proportion of deaths occurring within the first year of life. Since it is during this period that poor health conditions take their greatest toll, the data are of high significance. These statistics must, however, be taken with some reservations, since in many countries registration of births and infant deaths are far from complete or accurate, and the official rate will often prove unreliable. It may be pointed out that, if available, figures on infant mortality for ages 2 to 12 months would be much more sensitive to actual social, economic, and general health conditions than the first year rate, and that, therefore, deaths within the first month should ideally be placed in a separate category. But there is no immediate likelihood that these figures can be obtained. ANNUAL DEATH RATE The crude annual death rate is of somewhat less importance than the two preceding indicators, since it is influenced greatly by the sex-age structure of the population. For purposes of international comparison, its use is limited to those countries where sex-age structure is roughly the same. Here again, in some underdeveloped countries, these figures are not wholly accurate or complete. However, in those countries where life expectancy and infant mortality figures are nonexistent they constitute the indicator most commonly used for demographic information, DIARRHEAL DISEASES In this report an attempt has been made to present the data by graphs, charts, maps, and tables, with a minimum of narrative com¬ ment, on the most widespread diseases with the exception of diarrheal diseases and upper respiratory infections. Both of these disease entities are universal in prevalence. Morbidity and mortality from these diseases are probably greatest in those areas which are least able to give accurate statistics. The meager data which do exist show that diarrheal diseases are the first cause of death in a number of countries and affect particularly children under 5 years of age. Even where mortality is relatively low, the diseases are important causes of illness not only in children, but in adults as well; and hence it is a source of economic loss. Factors considered pertinent to the control of diarrheal diseases include the provision of a safe, adequate water supply and sanitary facilities for excreta disposal; the prevention of fecal pollution of ground and surface water supplies and of its spread by insect and animal vectors; the provision of adequate housing and the freedom of housing from rodents, insects, and domestic animals; and the sani¬ tary control of the production', processing, and storage of milk and food for family and public consumption. Programs to correct existing conditions which are conducive to the spread of diarrheal diseases require vast capital outlays and the per¬ suasion of people in many areas to think in terms of sanitation and family hygiene, concepts previously unknown to them. VIII FO RE W O RD HEALTH RESOURCES With respect to health resources, the report deals with health per¬ sonnel only. It is the reservoir of trained personnel which defines to a large extent the limits of the services possible. Unfortunately, it was not possible to obtain reliable data on the number of health centers and dispensaries in existence. Latest information on hospitals published in 1954, using data extending back to 1949, was considered outdated in view of the increasing interest over the past decade of national and international health agencies in increasing the quantity and quality of hospital services. A CONCLUSION—MORE STATISTICS NEEDED This publication attempts to offer no conclusion but the one which is most apparent, based on the gaps, which have been mentioned earlier. The conclusion is that more information must become avail¬ able if the health of the world’s people is to be improved through strengthening both preventive and curative medicine. The widespread lack of adequate, accurate, up-to-date vital and health statistics, espe¬ cially in the developing areas of the globe, is serious. These regions, and all authorities are aware that this insufficiency of data represents one of the most severe shortcomings in world health today. This is of course not a new problem; it has its roots in broad socioeconomic needs throughout entire societies. Yet reliable statistics are indispensable now for three main purposes—strengthened research, organization, and planning. Efficient use of medical money, materiel and manpower requires therefore the early improvement of statistical reporting services. This point has been wisely and repeatedly stressed by authorities of the World Health Organization in their impressive work of assistance. The will is present. The way toward better statistics must be per¬ fected. Only then will it be possible for all of the elements in the ‘‘big picture” of world health to be both accurate and complete. At that time, the many major gaps in the present partial picture will have been filled in. Thus, there will have been remedied present unavoid¬ able omissions of such significant but largely undocumented areas as the incidence of mental ill health and neurological disorders, as well as a host of other maladies, throughout the world. SOURCES OF DATA The primary sources from which the data herein were collected in¬ cluded publications and records of the United Nations, the World Health Organization, and the Pan American Sanitary Bureau, maps from the “Atlas of Diseases” by the American Geographical Society, “World Population and Production” by W. S. and E. S. Woytinsky, technical papers, various scientific journals, and the records of the Public Health Service. The reader interested in further data is re¬ ferred to these original sources. We are particularly grateful to J. B. Lippincott & Co. for permission to publish the trypanosomiasis distribution map from Global Epidem¬ iology, volume II, by Simmons and others, to the 20th Century Fund for permission to reproduce several maps appearing in World Popula¬ tion and Production by W. S. and E. S. Woytinsky, to Dr. Jacque FOREWORD JX May and the American Geographical Society for the use of data obtained from the maps in the Atlas of Disease series and to the Statistical Office of the United Nations which provided us with pre¬ viously unpublished mortality data. AGENCY AND STAFF RESPONSIBLE FOR STUDY Lastly, the subcommittee acknowledges with thanks the continued cooperation of Secretary of Health, Education, and Welfare Arthur Flemming in this and related publications. Dr, Aims C. McGuinness, Special Assistant to the Secretary for Health and Medical Affairs has coordinated this and other responses to the subcommittee’s needs in liaison with the chairman and the project director of this study. Valuable comments and suggestions were received from the Deputy Assistant Secretary of Defense (Health and Medical), Dr. Edward H. Cushing and Dr. D. M. Alderson of his staff, and Drs. Eugene P. Campbell and Charles L. Williams, Jr., of the Public Health Division of the International Cooperation Administration. Dr. Leroy E. Burney, Surgeon General of the U.S. Public Health Service has made available all possible assistance. The data and charts herein were developed by the Public Health Services’ Bureau of State Services. The staff for the project con¬ sisted of Dr. Frederick J. Brady, of the Office of the Bureau Chief, Mr. John C. Eason, Jr., of the Division of International Health, and Dr. Alan Donaldson, of the Communicable Disease Center, Atlanta, Ga. Special credit is due to Dr. Donaldson who spent several weeks in Washington in developing and assembling this data. 35048—59 2 or y.. ' ■ ■:' r 1^ '-fifATR'^ai^^- 7oka:&‘A^‘Ir bnl/iTf tVio'i 'oii"g‘>Iffatb illiw aosb^vl-V/CHijCfitf o jDfxatrt^jidWd diliMIv&l^. *’* ri bol/.jTftVio'i 'od-# g^riadt iiliw aa^b^vlir/cmjCfi/tf oj}.)fxatrt6ddx|d ^aaimftitj 06 I: 4^;3 .iCJ. agfiofj^ildiKj'botWot h«A^eidx m utiiallA lfir»tly>M hn w li iTfioU lol xiflJonoob odi oJ Jna jaiRe/v^ [fi eboou.aSotJiraniQodijjr edJ oS aoafioqaoT lodlO briB aidJ botCj .vhCJa ahii hy-ioli^rrtfj odp hiiBdJ^cmhfds^^iid^ dji /r s Yijyq'iff o^ltt ()rtm> bovij99jiTj>7ov# anohao^^sus dH« .irbla'wf>^-.,tff Ji+riti ilHabfh^o^b^iCL Ip > ?*> ■ .feiH bf(h .ibria ,(I iiCF^bjia ' noiHviU dtolTi-oHdA fd !U'Ho!%^0fih^l ’ Vi /» rtTl ♦'j?rrT/Vf I * A^rt/Sf I It f'l .. i j^PilkSlIlHlI dMa) rcA’j Mi t( l| . 1 ,noiJ«itafni/dl>A'^flb(Jifteci6dO fi r0Iii'>if^PxMuT 16 riiibri^f^ddow ' A V" 'Clip da dfda^^b7i '^‘hjair^ ipF^>S ' H7f/io3i oiiidd^’.ddj- vd - ’f^haifix foni^’fiMAoffT . ^ ' -nop, JPo[o'id ort-fCidt flMg pifF' l^poi*no^b/a^lB lo’uiBPiuS VooiT^ ^,|li'JJl^51J XV j. l>J'|jLlU ptW#y'?'*lVl ^l.y 13 Jill IMIlIllM;-/ Jl.iv’ ,JU •'»i ^JiJ>lIVv3i IXJULI^ • JLVl ^ydoo^ ijai^io^ ihoqfe^ifv/ noehbth’o^ f\Tff oi piib ar ilb'baP ySsoB^^ V/ - ".g^abljidVpinJdmoaaB baa afFtqolo^ob fii p M^xniuaaWni^ -j ’-^c j*4iijiav:. i',..-; a ->‘^jv«v*(.?. Jit qitiriv- -i-n J i \ 4 LJlC 3 War«jr^ •p'” -i : ^tk^rf <3:*% y tx'lr -iMiVc'* oA ;.i » Viv'ttI iv-jj^uy-* fV, 'v'-^:id bv? ;yC o. e:^t^ ^K. ■^. vt', fclf^ ^ ' ' ‘ 'I . .♦ ^■' V ' '^ ' *^V• * ., p' 1 .” ^ CONTENTS Page Letter of transmittal_ ni Foreword_ v Part 1. Population A. Definition of regions_ 1 B. World population_ 2 C. Distribution of world population_ 4 D. Rate of growth of world population by region, 1952-56_ 6 E. Percent age distribution of enumerated population_ 8 Part 2. Health Indices A. Annual crude birth and death rates by regions, 1952-56_ 10 B. Range of infant mortality by region_ 12 C. Child mortality under 5 years of age by region_ 14 D. Life expectancy of world population_ 16 E. Life expectancy at birth by geographical areas_ 18 Part 3. Specific Disease Problems A. Predominant diseases in the four major temperature belts of the globe. 20 B. Spread of infectious diseases_ 22 C. Insects carry disease_ 24 D. Extent of the malaria problem_ 26 E. Distribution of malaria_ 28 F. Status of malaria eradication_ 30 G. Insect resistance_ 32 H. Filariasis_ 34 I. Onchocerciasis_ 36 J. African sleeping sickness_ 38 K. Yellow fever_ 40 L. Distribution of yellow fever_ 42 M. Hookworm_ 44 N. Schistosomiasis_ 46 O. Leprosy_ 48 P. Yaws_ 50 Q. Trachoma_ 52 R. Smallpox_ 54 S. Tuberculosis_ 56 T. The control of infectious diseases_ 58 U. Heart disease_ 60 V. Cancer mortality_ 62 W. Food production_ 64 X. Calorie intake_ 66 Y. Protein consumption_ 68 Part 4. Health Resources A. Distribution of physicians_ 70 B. Distribution of medical personnel_. 72 C. Character of medical personnel_ 74 D. Distribution of medical schools_ 76 E. Nursing schools_ 78 F. Scarcity of nurses_ 80 XI WORLD REGIONS AS DELINEATED BY THE UNITED NATIONS Source; 1956 UN Demographic Yearbook PART 1. POPULATION A.IDEFINITION OF REGIONS To meet the needs of demographic statistics, the United Nations has defined 14 regions which are constituted essentially as follows: AFRICA Northern Africa: Algeria, Egypt, Ethiopia, and Eritrea, Libya, Mo¬ rocco, the Somalilands, Spanish possessions in north and west Africa, the Sudan, Tunisia. Tropical and southern Africa: The remainder of Africa. AMERICA Northern America: Alaska, Bermuda, Canada, Greenland, and the United States. Middle America: America south of the United States and north of Colombia, Caribbean republics and islands. South America: Colombia and the nations to the south. ASIA Southwest Asia: The Arabian Peninsula (i.e., Aden, Bahrein, Gaza Strip, Kuwait, Muscat and Oman, Qatar, Saudi Arabia, Trucial Oman, Yemen), Cyprus, Iran, Iraq, Israel, Jordan, Lebanon, Syria, Turkey. Southcentral Asia: Afghanistan, Bhutan, Ceylon, India, Nepal, Pak¬ istan, Portuguese India. Southeast Asia: Brunei, Burma, Cambodia, Malaya, Indonesia, Laos, north Borneo, the Philippines, Portuguese Timor, Sarawak, Singapore, Thailand, Vietnam, west New Guinea. East Asia: The remainder of Asia, except the Asian part of the U.S.S.R., i.e., China, Hong Kong, Japan, Korea, Macau, Mongolian People’s Republic, the Ryukyu Islands. EUROPE » Northern and Western Europe: Belgium, Channel Islands, Denmark, Finland, France, Iceland, Ireland, Luxembourg, Monaco, the Netherlands, Norway, Sweden, United Kingdom. Central Europe: Austria, Czechoslovakia, Germany, Hungary, Liech¬ tenstein, Poland, Switzerland. Southern Europe: The remainder of Europe, except the European parts of the U.S.S.R. and Turkey, i.e., Albania, Andorra, Bulgaria, Gibraltar, Greece, Italy, Malta, Portugal, Romania, San Marino, Spain, Yugoslavia. U.S.S.R.: The Union of Soviet Socialist Republics including Asian Republics. OCEANIA Australia, New Zealand, New Guinea, Hawaii, American Samoa, Fiji Islands, Tonga, Pacific Islands. 1 2 THE STATUS OF WORLD HEALTH B. WORLD POPULATION In 1957, the world population was estimated to be about 2,790 million persons. Over one-half of this number (55.8 percent) live in Asia, 15 percent in Europe, 9 percent in North and Middle America, 8 percent in Africa, 7 percent in the U.S.S.R., 4.7 percent in South America, and the remaining 0.5 percent in Oceania. It may be noted that only 9 countries in the world have estimated populations which exceed 50 million persons: Million China (mainland)_640 India_392 U.S.S.R_204 United States_ 174 Japan_ 91 Million Indonesia_ 87 Pakistan___ 86 Brazil_ 63 West Germany_ 52 United Kingdom_ 52 ESTIMATED WORLD POPULATION - 1957 THE STATUS OF WORLD HEALTH 3 o u i < — -O "D O O C c 4) •- o oo ^ O 13 < O O O Q O O O O Q Q Q O CN O 00 ^ ^ CN suoi|||\/^/ Uj uoi4D|ndo. *5 35048—59 3 PROJECTION OF ERWIN RAISZ 6 THE STATUS OF WORLD HEALTH D. RATE OF GROWTH OF WORLD POPULATION BY REGION 1952-56 The world population has been growing at an accelerating rate imder conditions of a relatively stable birthrate and a declining death rate. The rate of growth for the entire world is about 1.6 percent per annum, or more than 40 million persons per year. The fastest rates of increase are occurring in Middle America (2.7 percent), southwest Asia (2.5 percent) South America (2.4 percent), and Oceania (2.4 percent). The smallest rate of change has occurred in Europe, especially Northern and Western Europe (0.6 percent). The data presented on the accompanying chart show the average percent increase per year as determined from the mean of the annual increases and the mean population over the 4-year period 1952-56. RATE OF GROWTH OF WORLD POPULATION BY REGION, 1952 - 1956 THE STATUS OF WORLD HEALTH * on oo Z) < y on LU < 1X191^400^ |DJ4U83 uja4sa/v\ -j uj9H4JOn 4S03 4$D9L|4no5 |OJ4U93i{4no^ 4$9Mif4no9 LU 91^400$ 9|PP1W UJ9l{4JO|s^ 0191^4005 *5 lODjdojj^ UJ9lJ4JO|s| I_I_I_ 0000 ci 409;^ jad asoaJ3U| 4U93ja(j Sources: 1957 UN Demographic Year Book UN Report on World Social Situation *1951 - 1955 8 7’HE STATUS OF WORLD HEALTH E. PERCENT AGE DISTRIBUTION OF ENUMERATED POPULATION Birth and death rates over a period of time largely determine the age composition of the population. Based on data for the most recent year since 1950 the proportion of the population in the pro¬ ductive ages as well as in the older age group is greatest in the more industrially advanced countries of the West. In other parts of the world, comparatively high proportions of the population are children. In those countries which have a higher proportion of older persons, the degenerative diseases are likely to contribute most to the overall death rate. With many of the infectious diseases which formerly caused so many deaths virtually brought under control in these countries, more people survive childhood and early adulthood, later to become victims of heart disease, cancer, and other degenerative diseases. In contrast, the less-developed countries which have the highest proportion of children also are those which have the greatest incidence of infectious diseases. PERCENT AGE DISTRIBUTION OF POPULATION BY REGIONS THE STATUS OF WORLD HEALTH 9 10 THE STATUS OF WORLD HEALTH PART 2. HEALTH INDICES A. ANNUAL CRUDE BIRTH AND DEATH RATES BY REGIONS About 90 million births and approximately 49 million deaths are estimated to occur annually in the world population. The differ¬ ence between the births and the deaths along with the amount of migration determines the rate of population growth in any given re^n. With the exception of Oceania, migration has played a relatively small part in population growths. In Oceania, it is estimated that almost a third of the population increase is accounted for by net immigration into the two major countries of that area, Australia and New Zealand. The data set forth in the accompanying chart are those which were available for the most recent year since 1952. 12 THE STATUS OF WORLD HEALTH B. RANGES OF INFANT MORTALITY BY REGION Year for year, the most hazardous period of life is infancy. Birth injuries, congenital malformations, and the lack of maturity in the development of the infant often take their toll shortly after birth. In addition, the infant is exposed to a new environment and is sub¬ jected to infections and problems of infant feeding and care. Mor¬ tality of infants is frequently regarded as an index of sanitation applicable to many countries. On a worldwide basis, the range of the death rate during the first year of life varies considerably. The infant mortality rate for most of the western countries has declined to a relatively low level, but it is still high in many of the other countries. If complete data were available, the range of infant mortality rates would undoubtedly be greater than shown by the black areas and recorded figures on the accompanying chart. For each of the bars shown, the figure at the base of the black section is the lowest reported mortality rate for any country in that region, and the numeral at the top of the bar is the highest reported for any country in the region. Reported rates from other countries fall between these two extremes. RANGES OF INFANT MORTALITY BY REGION THE STATUS OF WORLD HEALTH 1 35048—59 4 North Tropical North Middle South South- South- South-East Northern Central Southern & South west central east &• Western AFRICA AMERICA ASIA EUROPE OCEANIA USSR Source: UN Statistical Office, 1958 14 THE STATUS OF WORLD HEALTH C. CHILD MORTALITY UNDER 5 YEARS OF AGE BY REGION After the first year of life, the death rate drops sharply among young children in economically developed areas. However, mortality rates continue at a relatively high level after infancy in many coun¬ tries. Thus, deaths of children from birth to 5 years of age as shown by the black area on each bar graph, range from one-third to two- thirds of the crude deaths at all ages reported in various countries in Africa, Asia, Middle and South America. RANGES OF PROPORTIONATE MORTALITY UNDER 5 YFARS BY REGIONS THE STATUS OF WORLD HEALTH 15 < 4ua3J9d ui sa6D ||d 40 si{409p 04 g japun uajp|ii^a jo si{4DaQ 16 THE STATUS OF WORLD HEALTH D. LIFE EXPECTANCY OF WORLD POPULATION The death rate is a measure of population loss. It reflects the health of the population, but it is also affected by the age composition of the population since the risk of death is higher during the early and later periods of life. An overall index of mortality which is adjusted for the differing age composition of the population is the life expectancy at birth. This figure is based on current mortality rates and indicates the num¬ ber of years, on an average, which a baby born today may be expected to live. Of a total 2,790 million population of the world, 801.3 millions or 28.7 percent have an estimated average life expectancy at birth of 50 years; 278.5 million or 10 percent, between 50 and 64 years; and 713.9 million or 25.6 percent, 65 years or more. For more than a third of the world's population, 996.3 millions, data are insufficient to make an estimate. Since mortality data are not good enough to compute satisfactory life tables for most countries, many computed values used to derive this chart are questionable. However, they do indicate the magnitude of the problem for about 65 percent of the world's population. For the remaining 35 percent, although statistics are unknown, under existing disease conditions the chances of survival to old age are poor. LIFE EXPECTANCY AT BIRTH THE STATUS OF WORLD HEALTH 00 •o « u oo lO o. Z o 3 Q- o a. oc o < I— o IX o IX »o CO r*. O CM c o *A 0 c to 0 z 0 — c 0 -J _l E CO — 0 • *E 0 •o CM CO 1 00 rv 0 w> k. CM liJ 1 — 0 1 c — r ^ i CO •>0 o. cs o u 2 i/1 z 3 » u 3 <5? CO V M o 0) >» y o io « > o c o u c o *m o « d. X 4 ) 0 -0 o> c *■ X 0 0 c It M <0 X 0 u 0 OJ c *- X 0 0 •n 0 «o >0 0 ) CL X X X u U 4 ) c c 0 0 4 ) kt- u 0 — 0 4 ) a. CL ^ X 0 ) X ^ 0 ) « ^ kk. 0 _j Q 18 THE STATUS OF WORLD HEALTH E. LIFE EXPECTANCY AT BIRTH BY GEOGRAPHICAL AREAS As is to be expected, life expectancy rates are highest in the more industrially advanced countries of Europe, North America, Australia, and Japan. Norway tops the list with 73, and Sweden, the Nether¬ lands, the United Kingdom, Denmark, U.S.A., New Zealand, Israel, and Australia have all reached 70 or more. The reported rate for U.S.S.R. is 66 years. The 50 to 64-year-age group includes most of Central America; the southern half of South America, plus Ecuador and British Guiana; Spain; Portugal; Eastern Europe and Turkey; the Sudan and South Rhodesia in Africa; Ceylon, Thailand, Malaya, and the Philippines. The under 50 group includes the rest of Central and South America; probably (though exact data are lacking) most of Africa, as well as southwest Asia; south and southeast Asia plus Taiwan, and Korea. India, with nearly 400 million people, has next to the lowest reported life expectancy rates, 32 years. Northern Rhodesia is lowest with a life expectancy rate of 28 years. Others in the under 40 group include Haiti, 33; Burma, 35; Pakistan, 35; Guinea, 36; Uganda, 37; Congo, 39; and Egypt, 39. 35048 0 - 59 (Face p. 18) TIC C E A N aGUAM IAN TXLEBCS \^INeA\ A N ^NEW '^CALEDONIA NEW ZEALANt Source: U. N. Statistical Office, 1958 LIFE EXPECTANCY AT BIRTH 0 ) o cd it) oo o it) GREENLAND 'SPITZ- BERGEN NOVA ZEMBLA SIBERIA UNION OF SOVIET SOCIALIST REPUBLICS ICELAND RusgiA OF CAKAOA FliJLAfrfO N SCOTLAND ITHONJA DENMARtOffi hAjyiA 1 ^NGUyVD A >/; IRELAND NEWFOUNDLAND MONGOLIA FRANCE \ swir, UNlTeO $tATe$ hjMA* \ 7 ) SINKIANG 'JAPAN ALGERIA ; w CHINA AFGHAN ISTAN TIBET ISRAE; iMOROCCpI 'JORDAN LIBYA SAUDI ARABIA FRENCH WEST AFRICA \ HAINAN iS VIETNAM y FRENCH EQUATORIAL I AFRICA ISLANDS .GAMBIA 0GUAM ■^^LANO NIGERIA TRINIDAD GUIANA SURINAM SIERRA' LEONE CAMEROOl CEYLON FR GUIANA LIBERIA In BORNEO KENYA ECUADOR ASCENSION INDONESIA JAVA ANGOLA LaFRICA rSECHUANA \ ). LAND y UNION OF S. AFRICA 65 years or more 50-64 years less than 50 years expectancy expectancy expectancy Data unavailable Source: U. N. Statistical Office, 1958 JTTJAMIL ajflOV/ '30 inuv 02 ' / eMMjaoH'i MSAaeia oi^ioaqa .?; tjiah A" >fOlAl/[ illJO'I afHT Hi TXIAHIl/0n:i5f*l .A . rraojo :tjit p.xjrra HaTiTAiiHai/aiT >1*107/ oHi jO HO?)rr(ihr.:;|, •)iilqijj^oos f)i\i 111 ntiol i{oiii7r>fiOfv^n V.jol O'JAI ryv)i:! //*W'oriT oi ^‘n'i\noiy:)(i o'j/j .odohi, o/lj. i>ni“7'.i ^f\Uu\ 0 7jt'jij(f0o iifol Yid’Siuo'i ) {•J'tiqoq l/iloi o[[t siU'fr s'Hf P (J’) n.^i{(lffiiaoH rriodfioH ofli lh tj'm.jf t .noiifiuf UdC 7('d.;rfTf>onqq« fl ,10/0 jlA^i/o'idi iyju'fj I'r-ii') l^i b'diii J odj Jfi'.O'rj.iP! Wii i{ilo*i)r.iiA 'to iioilibhu oiit difv/ Jiruptl. oi :»i;iho ,7 o'Uifii;) od.) iii nol).ftfuqc)<) orlJ liffd • iiomoqo-jq hnit ,.(iohiA irn )ifO'> ,nno //ny .uno/ydooil * /oof , r I • ^ * .^rlrdqYft Imir U aobub/u JiJil.t qrrl^ obi A/ m poij Mfod 0.7] 0^-d) tioov/)oH (1:) ft bffo uiiudo/i.fll^ ..riho;ri8 ,1^.^:! 7/;6/ oiji /i7iOo.o‘nojf>>U no/jiijuqoAi infot u f(ti// ,4if!id^) io lo .1oj;q■ iiMo^j^ov/dnon iili.u/ 0 fq sowiiordii odj ot iioiiibbii ni .fiodli/ii (tVfl yloti^unxo'K^qit or^Rbioo bftfl 'ri‘>tn.o«y]> jf/roil B'loTioa nonm p.iii : .aivriA fnoo/;[fy£r ,oii,i /ri , w.OttlOlbjiOlt 7jlf:;*)0‘jao ovo j>n7j iihlp. trod lo n/nj inoiiti;o?; oirt?jTi7o eiit a ?hnhnj tif'x.f fnotnfjuc odT \p) !t .iioillfni^S lo* ooijfdjojoq ‘oil jiliw nuiilA b/iij iionojnV^ liilqya ^fei2oli/^>'lO(!£^^ eij\nopli(iL ^'l'»7ol bn>jji|y) oo-ii 2o^ii^>Kfb T^riilffivoiq •) '’^-noiroolrri ifi'jov/jfbif-m brrji, U' 1 ,r no b‘>Aj!d jK>ijj5lui|» CL CO Q Vi -§ X w'— ^ c o c >- CO >» W) o x: CT> -J ?.E O 3 O ‘-:g ^ o C3 ^ ^ p c u. o E ^ £ o _ o o 1 - 0(0 o JZ o a Oi c Ql O C all' I-."? ^ » 3 -i 5 o — 3 = Jr O' O) 2 o>- d z o-p o 5 o) o o ^ §(OQ c c 3 B E § «n" o»— — 3^0 B >>-§. 3 "o 4> H o § a> u) ► X ^ — k- o ^ g OQ. Q. 2 t o u O) o o a> c ci..2 or o CO or x: tr o o c,“ w E 55 ^ (/)" tl g O-x: o °= F o O “ F O o o h- .V} o_ .C QQ O U -Q. - 2 S o _Q x: O) ‘ V) E o ? XJ c >; t 2 o < Q or >;E.g h- ' 24 THE STATUS OF WORLD HEALTH C. INSECTS CARRY DISEASE Many of the diseases which are prevalent in the less-developed areas and which have, in fact, inhibited the development of the coun¬ tries involved, are transmitted by various species of arthropods, in¬ cluding mosquitoes, fleas, lice, ticks, mites, and various species of flies. When one considers such diseases as malaria, yellow fever, filariasis, plague, endemic and epidemic typhus, kala-azar, bacillary dysentery, sleeping sickness, trachoma, and others, the control of insects assumes major importance in international health programs. The method of transmission by arthropods varies tremendously with the different diseases. In some cases, purely mechanical trans¬ mission of pathogenic organisms on the feet or mouthparts of the insect occurs, such as in bacillary dysentery and cholera carried by flies. In others, there is a complex relationship in which the insect is necessary in the life cycle of the disease agent—malaria, yellow fever, and filariasis in mosquitoes, sleeping sickness in tsetse flies, and others. The control of each insect-transmitted disease presents a separate problem based upon a complete knowledge of the arthropod and the disease agent. In many cases, this imposes a heavy burden of expense on many of the poorer countries where the need for specific knowledge and efficient application is greatest. THE STATUS OF WORLD HEALTH 25 26 THE STATUS OF WORLD HEALTH D. EXTENT OF THE MALARIA PROBLEM Malaria is a chronic, debilitating disease transmitted by species of the Anopheles mosquito. It is estimated that at least 250 million people annually suffer clinical attacks of malaria and that each year perhaps 2.5 million of them die of the disease. Though often a direct cause of infant mortality and an indirect cause of deaths of all ages by lowering the resistance to other infections, the greater impact of malaria on a population lies in its debilitating effects. By limiting the number of conceptions and by causing abortions and stillbirths, malaria affects the birthrate as well as holding down the level of life expectancy. For those patients who survive clinical attacks, it is a continuing drain on physical energy and undoubtedly results in mental retardation. In those countries where malaria is highly endemic, it unquestionably retards the economic development and productivity of the nation. Nearly half the population of the world (well over a billion persons) live in areas where they are exposed to malaria. Under the WHO malaria eradication and control programs, some 466 million people (17 percent of the total population) are, to a greater or lesser extent, protected against the risk, but the remaining 700 million or so (25.7 percent) as yet have no real protection. THE STATUS OF WORLD HEALTH S.O £2: c o c o c o Wl c o if 5 O' rj hs 05 CS «o m ■o c o o o. o o »— v« i c o CN R ■tj o « o w Q. D CD O w O. o Z w £ C o c o E. S. S- o o. o O- o a. hx lO O' o ’C G C *o c o o G ■4^ o k- o. o c o « c o "O G U w o o t/5 28 THE STATUS OF WORLD HEALTH E. DISTRIBUTION OF MALARIA Though the regions in which the population is exposed to malaria are gradually being restricted, there are still vast areas in which it is a major health problem. Malaria is particularly prevalent in certain countries of the Western Hemisphere situated 15° either side of the Equator, in Asia south of 40° north latitude, in Indonesia, in the southwest Pacific, and in Africa. Malaria is also endemic in Mexico, Central America, and the Caribbean area; in Portugal and Spain; in the Balkans; and in a large segment of southeast Russia below the 60th parallel. 35048 0 -59 ( Face p. 28) C E A N I C 0 N ( AUSTRALIA (orld Problem" by Pompano and Russell, WHO 1955 35048 0 -59 (Face p. 28) MALARIA DISTRIBUTION OF C T I C C E A N arctic C £ A N , TERR. OF I F 1 C C E A N ^Sledonia C E A N NEW ZEALAN Areas of high endemrcity Areas of reduce(j endemicity, but control operations still necessary Areas where malaria has never occurred ,or has been essentially eradicated Source: Adapted from "MoloriQ-A World Problem" by Pompooa and Russell. WHO 1955 WHO Publications ' •-'os.r ICA unpublished data hj'.ia;-.;: u,ij;()..' •=!<) ;nn DR \ . > r ^-f- ! ' . li ,r, ‘ % zoita;){(ia>i:? /it^ajak io .'i ni ii^ Rm,,!7^K**iq ft'inov Tn.nin -roq ^. 'iJ onMul C^« j // nl .i)h<)w odi \o feoiilfruoo Bi/id’F'v n; 4 ' I‘ .;;J 1^' {fijoj O}/) vfotBffij’j?i; i)*.ir}iM r)wyr:4ft •dfT<,;)q nrilfMu got.l '.;P lo .^'Or lo^^A ;><»q ^i) /toiffinr ::o »ffr>,in (;:i/j t>- ^ in.dJfm a>nn -./ij nw.;} hwV M>nhv m /.itnngor; idoal ;.C iri’0.* rmq L JfiOdj^) Xiodh;n ? ItMi-iOfTi. ’iij;> •]*:.>] J/r;>/rLq.i{r< , d) lo vna.'8ifj} .b'^nxi^fiq jQ/ned o'Tfj ^uncii^u Ai .^o^•)ftr^H^ i j nvtrU Vv .♦c^oioq 1^8 wo») Mla.-Ki fiodtjia 0{i> Tyu> 'n ^>7it ;*mfn^y»q yq.' Mijfh • Wril,f;/u /no/'i^ -ad f^yitiiif.o') n. olhn •» » • .r . -OMfdp ?.jrinn/'iq faij ni .J )Y D/Tomojl Dvifijl'.iiyx *5'v/xii V'diiivl'iorii briB 'Vj^ibitbio/’n fti'ixdxu/t ftmq ^noiTdltiiTi dqjA'mTql.'d fy>od «ftd ahiiinia oah t. i'Btl ,riUTq\<) ,oiidv) ^jxfi'dtxO xi'fiiofH ]>n'{ e,nw nl adydsosuY bna .A.h.'J UiU ixmd,yLM»ijU InjR jsibvii at b3UiVd ^no^./K odJ hnu v,>di toa '•d>ofn xd bntqjjTiofru ?j'>jqiq£,;io'^ jala i-lsd r.f>;f fumAdi^.n’^n^ .c.Fu)'dJ^jTi'. d' -qf')/; '.'tii jiu ;y/ 8i'’iIuTon !'«74 >j,;) u,ii'iPo(i Olio w ;'.&7f.ri'>-:noi od ,';:iii:: flijg i^-ii-.i'am .iojlnoo kD iii .ibjon uo- d smold.nq lUlu**!! JiTj>t;o..jmi oiij V. .idiow «■■:) j-.i ifow onj i « > '.1 •P ! i)liOVV 0/1.t T } t. f «. 35048-59- -6 I 1 ' ■ / 1 30 THE STATUS OF WORLD HEALTH F. STATUS OF MALARIA ERADICATION For many years malaria control programs have been in operation in various countries of the world. In 1955, WHO launched a program aimed ultimatelv at the total eradication of the disease. %/ As of September 1958, of the 1,168 million people formerly exposed to malaria, about 52 million (4.4 percent) in 9 countries have been essentially freed from the risk and 589 million (approximately 50 percent) in 53 countries are benefiting from programs in various stages of development. For still another 125 million (about 10 percent) m 14 countries, programs are being planned. This leaves slightly over 400 million people (some 34 percent of the population at risk) in 64 countries for whom malaria eradication programs are not yet in the planning stage. Either malaria morbidity and mortality have declined tremendously or else malaria has been eradicated in formerly malarious parts of Brazil, British and French Guiana, Chile, Cyprus, Greece, Italy, Mauritius, Venezuela, the U.S.A. and Yugoslavia. In wide areas of Bombay and the Mysore States in India and throughout Ceylon, transmission has been almost completely interrupted by modern control methods. Despite the tremendous advances on a global basis which have been made in its control, malaria still must be considered as one of the most acute, if not the worst, of the important health problems in the world today. STATUS OF MALARIA ERADICATION ON 1 SEPTEMBER 1958 THE STATUS OF WORLD HEALTH C o CO IV. CN C o i CO tn C o i o <0 ■o E ut V •o »o c o o D a. o Ql. w> o $ O o o E 9 ) sz «/> o a> o c ^ - o O) E V fl) _Q o >> C o c 0 ) *- o O 4) 3 Q. <« O o O- -jc o a> _a -a a> o E 4/1 LU V4 lO c "D Q> O a> o L. O- o D u < c o o 3 Q. O a. "O 0 ) o E * 31 Source: WHO Report of Expert Committee on International Quarantine. International Protection Against Malaria WHO/IQ/67 - Oct. '58. 32 THE STATUS OF WORLD HEALTH G. INSECT RESISTANCE The early successes with DDT and other new insecticides after World War II led to optimism and the hope that at least some of the insect vectors of disease might be eradicated. In 1947 and 1948, it became apparent that some insects of public health importance were becoming resistant to DDT. Starting with houseflies, which have since been reported resistant in more than 30 countries, the phe¬ nomenon was observed in other species of insects, including mos¬ quitoes, lice, fleas, bedbugs, and cockroaches, with a total of 46 species now having been reported as resistant to one or another insecticide. This has had a definite impact on the progress of control operations against insect vectors. For example, important vectors of malaria (nine species of Anopheles), in 17 different countries have been con¬ firmed as physiologically resistant to insecticides. For this reason personnel must be continuously at work developing new insecticides which will be economical, nontoxic to man, and adaptable to exist¬ ing or new techniques of insect eradication. THE STATUS OF WORLD HEALTH 33 o oe: t— z o u UJ cn < LU I/) 5 O 5 UJ CO o cm a. O Z o O' UJ 5 o o c o g. E o 0 ) _c u -Q w. g.-s o — £ Sc ■si V A) _D 2. ^ o 0 ) o 11 D .2 ii- U Q. o u 1 o ’si _c Q. “D 0 ) c o u «> § .2 8 i o E ^ o E C 3 O ^ O 0 ) 0 ) >•> o c "5 B B .!2 c 2 Countries; Burma/ El Salvador/ French West Africa/ Greece * Includes flles/ mosquitoes/ bedbugS/ lice, fleas and Guatemala/ India/ Indonesia, Iran, Iraq, cockroaches Lebanon/ Liberia, Mexico, Nicaragua, Nigeria, Saudi Arabia, Trinidad, United States Sources: WHO Publications PHS Records 34 THE STATUS OF WORLD HEALTH H. FILARIASIS The term filariasis encompasses a group of parasitic worm infections, two of which (Bancroft’s filariasis and Malayan filariasis), involve the lymph glands and may result in tremendous swelling of the limbs and genitalia—termed elephantiasis. This deformity may partially or completely incapacitate the individual for productive work. More than 250 million people in the tropical areas of the world are believed to be infected. The greatest prevalence occurs in central Africa, parts of South America, southeast Asia, and the South Pacific islands. It is also reported in Central America and the West Indies, some parts of southern Europe, the Mediterranean coast of Africa, and in Japan and Korea. Durmg World War II this disease assumed military significance when troops stationed in the South Pacific became infected. Experimental studies carried out in the Pacific area show that the disease can be effectively brought under control by the use of pipera¬ zine derivative drugs, provided treatment campaigns are organized on a mass basis. So far, however, the overall effort has been limited. Eventual success for worldwide control will depend upon the avail¬ ability of funds and medical personnel to organize such campaigns in the various countries involved. 35048 O - 59 ( Face p. 34) jiANTIASIS) A R C T ^ OCEAN loses- Plate 4, American Geographical Society, 1952 35048 0 -59 (Face p. 34) DISTRIBUTION OF FILARIASIS (PRODUCING ELEPHANTIASIS) ARCTIC OCEAN A R C T 1C OCEAN TERR. OF Source: Adapted from Atlos of Distribution of Diseoses-Plote 4, Americon Geogrophicol Society. 1952 'if, - iiTwIAaii lUHOV/ "-fO fil/TAT*! :iH'r r»£ -»r 1 }! f > ■ .'Vi; ' ^ 'V’.‘ ei8Ai3jiM:)OH0/:o .1 ..„if,„if<|, Hi8„br,ooihi.O 55 »?^'f ■ !ri ■f-.i-vf.qB lOTrtvss Yd hsjjiifi.i.Kll 4'-.pj,..>H, - .IT -'tf'.'’'lT’''M SgsgipipsiS 'frF V ,r \ ^ iHJiP.roiriiiO lu h')Jji^c o Ip &.>niA irl '.iipjpxoifv / lo ilOf j'lpq ifi'rj/h)*>-r(t'r{)fi .»{■» .i.' i vt 'frr i • mmmmMrn «srnS .1)0 to «Yn.>i ni tojitin. Mood 'oH ( 9 ^^"/ujuR 10 /lojjxjofbiTi ofiro« ihu/ jiV-ilA In 1 “i 'I. . i:‘ < f' £ i’. • r I !'■ .J ,*1 ■'i ] ' ,) a# * ' . » ■■ 36 THE STATUS OF WORLD HEALTH L ONCHOCERCIASIS Onchocerciasis (blinding filariasis, river blindness), is caused by a small worm which causes nodules in the skin, usually on the head and trunk. Hundreds of thousands of tiny embryos (microfilariae) are released from the nodules into the surrounding tissues. When these microfilariae migrate to the eye, impaired vision and frequently total blindness result. The disease is transmitted by several species of gnats (Simulium) which breed in rapidly flowing streams—^hence, the name “river blindness.^’ Onchocerciasis affects nearly 20 million people in Africa, Central and South America, involving up to 80 to 100 percent of the population in limited areas. In Central America, the disease occurs on the Pacific slopes of 3 states in Guatemala and 2 in Mexico. In South America, it is localized in the north-central portion of Venezuela. In Africa, onchocerciasis extends from Sierra Leone and Liberia southward through Ghana, Nigeria, and the Cameroons to the Belgian Congo; then east across central Africa to Uganda, Kenya, Nyasaland, and Tanganyika with a northward extension up through Sudan and western Ethiopia. Through the use of new drugs in mass campaigns, considerable progress has been made in the control of the disease in Africa and the Americas, and surgery has helped reduce its damaging effects in Guatemala and Mexico. Insecticide campaigns to exterminate the disease-carrying flies have been initiated in Kenya and other parts of Africa with some indication of success. THE STATUS OF WORLD HEALTH 37 38 THE STATUS OF WORLD HEALTH J. AFRICAN SLEEPING SICKNESS Sleeping sickness (trypanosomiasis) is prevalent in most of Africa? south of the Sahara, except the southern part of the Union of South Africa. It is a particularly virulent disease, transmitted by the tsetse fly, which numbers many people among its victims. The forms found in man also affect animals, particularly cattle; certain other species affect animals only. The overall effect of sleeping sickness among the rural population and their domestic animals constitutes one of the greatest barriers to African economic progress. It so debilitates and kills the infected individual and his stock that productivity is seriously diminished. Large segments of the population have tended to migrate to areas relatively free of the tsetse fly. This, in turn, has served to over¬ crowd areas having an already low per capita agricultural yield. Populations are deprived of needed animal protein in the diet, of the service of draft animals for work, and of fertilizer needed to cultivate the fields. Formerly, sleeping sickness was almost inevitably fatal. Now, however, the use of drugs makes possible a cure in the early stages. Modern chemoprophylaxis and public health measures have reduced the incidence of the human disease in many endemic areas. In other regions the use of residual insecticides has reduced, and sometimes eradicated, the tsetse fly. Despite these gains, the toll from sleeping sickness is high. THE STATUS OF WORLD HEALTH 39 DISTRIBUTION OF SLEEPING SICKNESS Source: Adapted from Global Epidemiology 40 THE STATUS OF WORLD HEALTH K. YELLOW FEVER Yellow fever, no longer a scourge of mankind that it once was in Europe, Africa, and the Americas, continues to be a serious menace to health on both sides of the Atlantic. Classic urban yellow fever, which was responsible for devastating epidemics prior to about 1910, has been brought virtually under control in most of the New World countries by intensive eradication campaigns aimed at the domestic yellow fever mosquito, Aedes aegypti. This same intensive effort, however, has not been employed in the endemic areas in Africa. Jungle yellow fever, basically a disease of forest animals but caused by the same virus, was recognized about 25 years ago. This presents a more complicated epidemiological picture in which the disease is perpetuated in monkeys and primarily transmitted by species of forest mosquitoes which breed and bite in the forest canopy. Humans work¬ ing or living in jungle areas may be infected by the bites of these mos¬ quitoes, and may carry the disease back to urban areas where Aedes aegypti is present in sujfficient numbers to sustain an epidemic. In some areas, this presents the constant threat of the reestablishment of the vicious epidemic type of yellow fever. Jungle yellow fever is thoroughly entrenched in much of central Africa, and in the Amazon Valley in Brazil and other parts of South America. From 1947 to 1956,1,350 fatal cases of jungle yellow fever were reported from 13 American countries. Recent years have seen the northward movement of this disease in animals from Panama into Guatemala with occasional human cases. 35048 0 -59 (Face p. 40) MAN GOES H ARE PRESENT 35048 0 -59 (Face p. 40) 'Aedes Aegypti JUNGLE YELLOW FEVER (Adapted from Karl F. Meyer, '55) HAEMA60GUS SOUTH AMERICA j A AFRICANUS CYCLE MAN . A AEGYPTI • MAN CYCLE CYCLE CYCLE haemagogus and A. SI MRS ONI A. AFRICANUS 1 PROBABLY OTHER j 1 MONKEYS MAN 1 A. AEGYPTI kHO i MAN MONKEY 1 AND POSSIBLY . 1 MOSQUITOES 1 MARSUPIALS? 1 PROBABLY other! 1 OTHER AEDES 1 MONKEYS MARSUPIALS? MAN INFECTED BY ENTERING JUNGLE URBAN JUNGLE TO MAN GOES INTO JUNGLE, BECOMES INFECTED, RETURNS HOME, AND IF A. AEGYPTI ARE PRESENT MAT INITIATE THE URBAN OR MAN-MOSOUITO-MAN CYCLE MONKEY AEDES man RARELY INFECTED IN JUNGLE JUNGLE TO URBAN MOSQUITOES NEAR HUMAN HABITATIONS BECOME INFECTED FROM MA¬ RAUDING MONKEYS AND IN TURN INFECT MAN, THUS INITIATING MAN- MOSOUITO-MAN CYCLE ■HTJA3ftr! I [•\i . r'* ; '?• f • ' .• 4 “y f* t '• V . .. fi "g wf ^blTUaiHTRTa •J..?'' ? i ftl J b'>MA lc;>i(}()7i lo Jfn vfijilja^^ ' - j \ V- -1* Y w i‘fi;>j<|c)'ii io Jlo vlwija£»ie^ , -iro;)^9(A.,'!fio lo iiortioq « rfJiw sf«)!a .sbljr&i{(‘> d-uotljlB, (3ianj;^lura oMiw !«)T:>f,iiir iv>r‘bi« ■ . {. W :' 8>^'. mwL# f tSSSftirrirff) -iyi-t l.-inonoi ,]o n m9J?jj£^Ton^4fX'rijtB,jt.^(J[av itiui^ nl , <' flti8WB ?^i),'f.,l j k. nr,ol alsmii m!T .ftijjay in-Aoi .jj rodSo.arij lo aiisji fK 16 ^jicq aedio bua y >il«7 iio.-MiuiA «i ^-'• -yi dJioo ih 1 oibbil/i tq bji« .lisaid ^^niiiiotba e->ii)iuiw ?wSqu-^h ■iol|^itaflny}o<|’ aJi xri JoJUloq Jl;o.t)^^? ai yovo? w?UeY*^ ! ■ ■JirawB'iJ )o^^iJi.,f,K.,|, t«i0jo((,,3bi-/? edT i,xmoroi.:oo hWa oboyi J 8«o(nj,q'f[oy-< ,{Jiw o5«o »;i> .o-jlu^f^om -niJ ^ ‘TOJiWMrviH Ofij o^.4,y7 4»«.kib:^,0 fo.hcqa.TaVt ' .?vwoI(fyojjmoii|^^f. k^jiih 3(1) ip vjUitliiqifa srij ^oqa(Tini .Boab/TB ,(B OHi>i,o rfoi^M'i ta^oi:9.ij oJdi bowb • . .y(.1n<»9/ %))j.)qoi nonfl tmy ifpi/fyc ni ajtoq biovu ui v> i 1 i i 'V,' u .. -■s'- -3 T- « ' ■ ’ w < I •• i' i X^, - .■« 42 THE STATUS OF WORLD HEALTH L. DISTRIBUTION OF YELLOW FEVER Essentially all of tropical Africa between 15° N. latitude and 10° S. latitude, along with a portion of Northern Rhodesia, can be con¬ sidered as infected with yellow fever (urban and jungle) although numbers of reported cases vary considerably from year to year. In South America urban yellow fever has been almost nonexistent in recent years. The jungle form of the disease still persists, however, in the Amazon Valley and other parts of Brazil, in parts of the other countries adjoining Brazil, and in Middle America as far north as Guatemala. Yellow fever is without parallel in its potentialities for disrupting trade and commerce. The wide natural distribution of the transmit¬ ting mosquito, the ease with which persons exposed to the disease may be transported to distant ports within the incubation period and the capabilit}^ of the virus of producing explosive outbreaks if intro¬ duced into the local mosquito population cause air and sea transport to avoid ports in which the disease has been reported recently. THE STATUS OF WORLD HEALTH 43 / Source: Ackipfed from WHO supplement to weekly epidemiological record, R.E.H. No. 300, 1952 44 THE STATUS OF WORLD HEALTH M. HOOKWORM Hookworm infection traditionally has been associated with popula¬ tion groups of low economic status living in tropical and subtropical climates and, in terms of its incidence, distribution, and clinical effects, has long been rated as mankind’s worst worm disease. Worldwide in distribution, hookworm probably infects upward of 400 million persons. Areas most severely affected are countries in Middle and South America and the West Indies, tropical and southern Africa, and much of south central, southeast and east Asia. The infection also occurs in more temperate areas, such as Southeastern United States, the Balkans, and in Poland. Infection is acquired by penetration of hookworm larvae living in the soil, usually through the skin of the feet. Thus, the wearing of shoes is an important factor in preventing infection. Linked with deficient diet, even moderate infections of these blood-sucking worms produces anemia, weakness, and listlessness. The infected individ¬ ual’s ability to produce is greatly lowered with a resultant cut in earning capacity. Mass treatment campaigns coupled with improved environmental sanitation and health education activities have been shown to be effective in reducing the hookworm burden of a population to a minimum level, although complete eradication has not been achieved except in circumscribed areas. 35048 0 -59 (Face p. 44) A c : 0 C £ I c C E A N r^NEW '^CALEDONIA NEW ZEALANC 'Q Source: Adopted from American Geographical Society Atlas of Distribution of Disease 35048 0 -59 (Face p. 44) DISTRIBUTION OF HOOKWORM GREENLAND 'SPITZ- BERGEN NOVA ZEM8LA SIBERIA ALASKA SWEDEN ICELAND UNION; OF SOVIET SOCIALIST REPUBLICS 'FINLAND \ DOMINION OF CANADA ;thonia y^TVIA j DENMARK ENGLAND IRELAW ;OANIA ILLANO auM MONGOLIA NEWFOUNDLAND FRANCE UNITED STATES ipUMA A NIA ) SINKIANG IU3ARIA SPAIN TURK AZORES CHINA AFGHAN ISTAN TIBET ISRAEl rakistJ LIBYA SAUDI ARABIA RENCH WEST AFRICA j FRENCH equatorial t^AFRlM ffGUAM [IETNAM SUDAN GUINEA^ sierra” LEONE TRINIDAD ^RR GUIANA yW SURINAM llOPliOi CEYLON In BORNEO f R. GUIANA LIBERIA INDONESIA ECUADOR kNGAN yikaJ ASCENSION [ANGOLA 'rhooesia n Mfc^YASALAM IafriCA .'SECHUANA \ ) LAND / AUSTRALIA union of S. AFRICA Source^ Adapted from American Geographical Atlas of Distribution of Disease Society ‘ H rjA:iH aujiov/ lo auTATa airr 0> n V * • f.l ■4»»' ^ (• if* S V ■>^ P w^ Y -A • 5 » :'/■* HiaAii/:oaoT8m38 ( V, j>iuq 9f{«J ni anofiieq noflilro OSI b^Ktamilso na ^iir^^Iovni ,8!5i«Tflio^>j8Trfo8 ^0 ii) «>f||ri8-r/gq :!^aiJij;}jIjdob ^ fi .eoiqcnjdua bna aoiqu^\ ^ .io 9 qa {aTftvJMJ ^ Jl bikif. ! ibsJA' 9ff) gaolii .aoMa bi >iqoxi sgojoa iimluvaiq,;^oyn ^ l&T'r.i'l ynaij>9qe9) yeb^Y nx ; qitflif!‘{ exb 1u.jtt|.?4isoJ>nvB ruKjXjT, ni ^bnoldianxi jBxiiddf .odj lo ^ moJfiW ui bim ,ijI^irj:sxt9V ,a*>iH hxfbaA ^fslmalal j 1 V ^^mxiqBtoH j drtisHjbfl lo a©j5©'ij«fi9i^ yd b'niiip^a ai annow foa'xdi 4^w aob^^lrtj | ItJ Bf)i.‘>9q£-^»ork8Y .Xiida eidi fexaiol lav^al Tjlixtffte oxil xii evil ^'aiiow jlciba odT Isjatyd^oix^ibafniaJ As rnsa ji o^ino^oxii ni bluest baa y^bbafd ^ilt lo anibdoJrii odi io thsssv bqoM f ynaaoiaR’^o biiA efll m ^arkna auapi.; 3i97f)a oS ‘ -jUo^ jioilxsb^UT X i!£ Jfa«97 anor^j3ldj\yapH/’'fvbod olL) Io eJiaq lodio ^ .ifiiiobiiovo boa ^uoll'»ol{ti isiOo oi^'^jjtxirdiJaaoBLra h98iioi'>x!x \ lo uqiXuti^niiijxio.) iioqi/ ebc^q^b ^doiJioslflx sisoxJi )o noxiaiXtjQqisSL ? id ^3qpiq io vJtiidallxid'a^ili boa Bogia/ioaib Ixjosl riirw lelav/ f 7fd i'i‘d3*f 4{ eim ^Uooixii odT ,afiafla i I r -^ . TdidiSgHiiiaa fa^naainodr/ne lo odi lo^xaSci I -000 ixiflj Oh 87U03^40 ool Joa J>^ toVhfiowoKL ] io Jooit;) 88io^?ba IiiitoVo'’Xfe4l^jQ0fw'.H]fesxxacK9oi^bioav^^^ .8Jbj|f8i^ tt^iai odjtai/i:f mall5&o id'doiixiloqoq odi \o • lo^OioIdoTrq Alaod orMuq bhow n as ' ■ 'r' A , • 1^ i. v*^ A*- m _w^.. ■ f- ■'. f A P \ \ AU.HTjR s;J4 \* ■ - ■ TS. wrN /T r " Y ' 7' ' - 4 ^ <*; 5 ■„ . TT'.' rt 'i V ;/, V : «I ^ i 46 THE STATUS OF WORLD HEALTH N. SCHISTOSOMIASIS Schistosomiasis, involving an estimated 150 million persons in the tropics and subtropics, is a debilitating parasitic disease caused by several species of small worms, called blood flukes. The disease is most prevalent across tropical Africa, along the Mediterranean coast, in the Nile Valley (especially the Nile Delta), along the Yangtze River of the China mainland, in Japan and certain of the Philippine Islands, and in Puerto Rico, Venezuela, and Brazil in the Western Hemisphere. Infection with these worms is acquired by penetration of aquatic larval forms through the skin. Various species of snails (mollusks) serve as intermediate hosts. The adult worms live in the smaller blood vessels of the intestine or the bladder and result in moderate to severe tissue damage in these areas, in the liver, and occasionally other parts of the body. Heavy infections result in emaciation, weak¬ ness, increased susceptibility to other infections, and even death. Perpetuation of these infections depends upon contamination of water with fecal discharges and the availability of proper species of snails. The infection rate in any area can be regarded as a reliable index of the level of environmental sanitation. Treatment is difiicult, expensive, and not too effective so that con¬ trol depends largely on snail eradication and education of the people. Newer molluscicides have been used in some areas with encouraging results. However, schistosomiasis, with its overall adverse effect on large segments of the population of certain countries, must be ranked as a world public health problem of major importance. 35048 0 -59 (Face p.46) 35048 0 -59 (Face p.46) DISTRIBUTION OF SCHISTOSOMIASIS C T I C GREENLAND /SPITZ- BERGEN A R C T ! C E A N OCEAN O 'NOVA- ZEMBLA SIBERIA ALASKA TERR. OF ‘«0 HAWAII A C v\ A DOMINION OF CANADA NORTH - UNITED STATES AMERICA J '^^FOUNDLAND ■A / \ 'SWEDEN S ) DENMAR ENGLAND ( fRNLAND N ) STh^lA vi i^TVlA ) .SPAIN AZORES o ( ^ .'GERMAW ^ f 0 P E ■France J 4usf^ VUGO- NIA I AVlAr- '^LGARIA CGREEce. Turkey SlO / ( I UNION'v^F SOVIET SOCIALIST REPUBLICS \. ASIA \ ) r "V. / \ / MONGOLIA a r' J. . ) SINKIANG J L A N I C CRETE. ISRAELtJ ^ .Jbr {■^vctjcuMs m U I LIBYA /JORDAN AFRICA ) GH WEST AFRICA ! i SAUDI IVRABIA / S Iafghan- / 7 / ISTAN ’ 7 i,-/ ; r PAKISTAN' N \ ZL TIBET INDIA prfkis^.'' ^ \ ••NKflfeEA ^k/RMOSA FRENCH w ( m^lLAM^'j (7 HAINAN BOQilAj /TOINIDAD ^BR. GUIANA SURINAM -FR GUIANA GUINEA^ SIERRA LEONE LIBERIA' ASCENSION o '0 npHUJPPINES lETNAM C. CEYLON (JTANG* I N IAN i ■> Jbouvia ■^MEi 5/' C E A N ELEBES \^N£A\ IjlAY] C E A /^IRGENTINA ( S.W. I [AFRICA iBECHUANA-y \ LAND I UNION 06 S. AFRICl 0 c E A N AUSTRALIA I C C E A ^SLoonia NEW ZEALANI Source: Adapted from Atlas of Distribution of Diseoses, Plate 4 American Geographical Society, 1952 ir« •••«•* ITIMAM I n.IFOV;' ’io 8 trTAT 8 'IHJ? PI f ^ . •V YHOn'VAd .<) ii‘iiu\tnh biintril Imn iiriuv/ iii iin> io xi'Hi'Whit lo pj>Uv\ sdT Oili io Ynani i .vliovoc^ ixij>iiib'/^ox*>'i97o il jivx i >•, i -ms xiiijnio'i lo f)iJj Juox:iiiiooiq oiiioH 1<> oJ ol ifioo^ iuiouM! j/‘)'iijtnot‘3b yiovoH oxli ot ^vldiiqooftu^ oiorn ocf ot Tftoqqxx !>n.{j (vX qxKnq nvyfjp. s^[qooi[ i)oJ(ioxa^^k[ yW'ijjb onm/ib ojfj lo iirtul .olfliiqOwa \lfai*joqao oJ ol 'ui-iqf[a xioiididO .Xnxol blixu o/i) qolovob JoaxTO pJi 107-fit vain a^ib/ioi -dof) v;i.»uorb fjjiiB Iflo^uxbhxjoxdixji ^IdiaaoH oil.) lo Vfiiiiii iii'ixi‘jItl xioi|liai 111 oi ^ bi*K>v/ oxfj xii mam odt lo axroiiijj^ylifijua v.Hiio lixiii Joai oxil oj ,Hiioaa9'j TiflJo >^xioiiiJi /xub ill .aiijov Tqt bosiagoo'ti oib*raxu qolovob oaaoaib odi lo Hkoxigixib vjifiy 70l bofoo’iib 9ia aojiiaxtoai ,aoiiJiijioo lyoin .rfOiiolJx/g lo oaxi 9j{j ^^iiibijloxii ^vqaiedj JqniO'iq bxTXi oaxioaib 4 ,7 S* .. 5 48 THE STATUS OF WORLD HEALTH O. LEPROSY f The highest rates of infection occur in warm and humid climates associated with overcrowding and poverty. However, many of the preeminent factors affecting the distribution of leprosy remain un¬ determined. Racial factors seem to be of some significance. Europeans and Mongolians appear to be more susceptible to the severe form of the disease whereas darkly pigmented peoples seem prone to develop the mild form. Children appear to be especially susceptible. Possibly malnourishment and dietary deficiencies may favor its onset. Leprosy still remains an important health problem in many of the underdeveloped areas of the world. Estimates of the total number of cases in the world range from 2 to 12 million. Such a wide range is due, among other reasons, to the fact that early manifestations of the disease develop insidiously and may not be recognized for years. In most countries, measmes are directed toward early diagnosis of the disease and prompt therapy, including the use of sulfones. 35048 O - 59 ( Face p. 48) A R C'I c OCEAN 35048 0 -59 (Face p. 48) DISTRIBUTION OF LEPROSY C T I C OCEAN arctic OCEAN C E A N '^ML£D(».IA E A N LEGEND Rates per 1,000 inhabitants 0 - 1.0 1.01-6.0 6.01 and over NEW ZEALAN Adapted from Atlas of Diseas Plate 7, American Geographic( Society, 1953 HTJA 3 H aJilOV/ ’iO ?^UTATfi MIT Oc; ft c .ot'M?ooTiq5 .,ji- 7(1 h^>'U;fiO -J lr.'i‘>rr'tv jort I'Tiuon't b^iiorovob^burj r-i vli-jMnhq hnn^i .;^.tliriqv;^ lo jiij a)' •i«nfrfiF> *)nfx ^rrmi \o Lit,?, ;/oi n (iJiw L'))ai’)0<^f:8 bi o^B,nof:ih >jdj ,?ioItTrjii’oii .\.yj ybfwi.»hov?^ .8 : onV ‘io<>u hUi d^iro/{*l8 .lOJiiUi):?! Off) h> )i.>i^ t>jILo to ; rj t>,Lha ;t>:o I)iiB fjibfj.1r ?ii -p'j N oiit Lut fiv :on\/, Ln?n^:'i'n! l>t:i;ol .«sr!iqqi{iii-[ 4 »jf{) ni iv^ii ,i;ij,7f.);.«i7 biU; ,^:!ln^ii^£l.T rl ./iiouitS Ifit if ll// '^ tioUHUii (O ;''i') !j8 lli ij J-Mf]; >7^ fiV/ftT T t ' . , 08 L,'.-iiilB-jipqKi.'f) oT'.'i'i tvji r jir-iAU - ''b’>voij,oo ofT hfJfi hnui 8bn7[)[!dO . . i/iilA'(.](j mtvil (mb if/;.; ^ifiofrnriovoi IX/’ ;7rrir . fioi t -a i i qi;oy( ) Lh’,V/ Oi!^ iiOfioJqmoo Li ..i .. ;• pi‘ir!-;-r vnu-i HU ffrll'o.'.rroq hit-xj iiilj xDiin vJmV( rr' biro ^bo/JbjnT .wMiiobrj bil;7l oi .8bn/;,0-.i oiLdtH r ’ J*? tf. 6 ■F-'- I ^ ' ( 4 50 THE STATUS OF WORLD HEALTH P. YAWS Yaws, though not a veneral disease, is caused by a spirochete similar to that of syphilis. Found primarily in underdeveloped countries, the disease is associated with a low standard of living and poor sanitation. The highest prevalence occurs in a worldwide belt extending 15 degrees on either side of the Equator, although it is also found in Central America and the West Indies, in northern India and Burma, in Thailand, Laos, and Vietnam, and in the Philippines. Yaws occurs most frequently in areas of very high humidity with an annual average temperature of 80 degrees. An estimated 50 million cases are believed to exist today. In rural areas of some countries the extent of infection may be 10 to 30 times greater than available statistics would indicate. The disease is highly disfiguring, decreases the potentiality for productive work, and begins to take its toll in early childhood. The eradication of yaws has been a major objective of many national governments with aid from the United Nations Children's Fund and the World Health Organization. Programs using mass examination and penicillin therapy techniques are in various stages of completion in Haiti, Indonesia, Thailand, Laos, and in West Africa and the Pacific Islands. 35048 O - 59 ( Face p. 50) s A R C \ ^ C E A N r^NEW ^CALEDONIA NEW ZEALANC SIBERIA ALASKA JST REPUBLICS Sw' N MONGOLIA FORMOSA NES BORNEO INDONESIA LEBtS AVA cGUAM 0 ,, TERR, a Y ^Ith Organization Monograph Series No. 15 , 1953 35048 0 -59 (Face p. 50) GEOGRAPHICAL DISTRIBUTION OF YAWS C T ! C OCEAN ARCTIC C £ A N I F ! C TERR. OF C E A N '^^WUDOHIA C E A NEW ZEALANI Yaws widely prevalent I Yaws known to be present No known cases of yaws Source: Adapted from World Health Organization Monograph Series No. 15, 1953 > f ^ irfjAstr ctj5iow %o atrrATa 'tot n> . ‘A' ys'.i v ''". r ' -Br' I* V ’■ • *' \. M ;■ i'f yc ;'fo' .^;( W f i . i f' > /;'4'-A''■?'"%'’■ '// ^ V-■ ''■>.■ ■'■ I ?«. . :iD 'r=:'- I A ; AMOH'^AHT .Q . ©itt 8iiivi4i>ffiiiii^^^ has ^ofbiiiT/;iL:^ 5Ff ’ l>ni5 ft«^AhniW lo BTVvkiO ir V ' ' no'74'r ■ffjt ‘ . ■ / ^ aoij] "ill: B M;'' . yja|.j,,71 jH*>iJojirx(| xftiqH [Of) ; ^iioirta ^!>i4n a^sorff iooil ^ihduMa at 6il/t0f' .ino*»'pq bOi dt OT ^ ''pq 001 dHJY ^xni JdJiioft^Q’iv^ ^ a bot»voDxuj::ii/;v/jA5P bsfbj^en ^varf ’’ ^ ^ teb: to .i:#j=ji>Kf^ :inoxna A!)/w)J)i^j[jii jndTigta <{i^ _ .cjuryax)^^>,C^\ ; ''^liaooo'i bow/ooerb qadif .^iW |IWiJ»l ';j|l®^ nf)ec( afsd axHorbailT a airi^J gi ^gingl^ ! Aljld ^ja*J^baJ)nU adJ lo Jnaq /rfutReiNX^Doa ' ^ iiqfiiiifnuja Jxjvoiqjni ri^umxU ta#" ^nawia ] ^o6‘>oiop^^ ::flmUo'i.1nui^i)hidiiwi feoa ' ' ffe b?>)aiiiiri ov^iio,;^ 'ialimiS .aiairtixT F m \ m ..A - * -.. AiA'l — vJr A—,! 1 .m' • .•4ii *. J ':’lijv; it^th • ^•; ,aivalB 03 uy biia ,iiit?q8 1 /' .'• ' i » jxI* y' < .'. . ' , r . NlW' i/ 1 A. 1/ (. Xv^:tfi;:i!SI^^Wf-- :/ ■•■ -■Vh 4 -■ •■'iv'A'V * . "‘^' ;,r^ lai »>*»fe ■ •' r'iSi ?4' .i- r* t . ' i ^<7 ^'4'! TOI?'. X) : ' .t'' y. . >■'*^•*’‘*'^1 •■''-■ flU Fir J r» ■< , • f;'T <■, ii. •■ j ■ -A- VW ! ,' ■ : .L/ ' :■'■}' .; /• K ' ■,'^ . ' / V . • ^‘'h ''. . ■ i * ..uim ■f> <. t Jii''' ,; l;-,. :VX'-f~I‘(^ ■ A' < . 4 52 THE STATUS OF WORLD HEALTH Q. TRACHOMA Trachoma and infectious conjunctivitis are communicable diseases which produce a high percentage of blindness and disabling eye lesions if neglected. Only fragmentary statistics are available, but it is esti¬ mated that more than 400 million people—over one-seventh of the total world population—are affected. Of these an estimated 10 million will become blind. These diseases are essentially associated with poverty, poor sani¬ tation, and ignorance. Although they affect all age groups, the inci¬ dence in children may be especially high in certain areas. In some sections of North Africa, where practically the entire adult population is suffering from these diseases, the rates among children of preschool age are sometimes 70 to 100 percent. In India, rates in some localities have reached 78 percent and a recent survey in Taiwan uncovered a 48 percent incidence among children. New areas of endemic!ty have been discovered recently in South Africa and western Australia. Trachoma has been known for many years among Indians in the southwestern part of the United States but is rapidly vanishing in this country through improved sanitation and treatment. Obviously, these diseases impose a tremendous economic burden on any country in which they are prevalent. Blindness or badly im¬ paired vision reduces greatly the earning power and productive capac¬ ity of population groups. In Tunisia, for example, a country of 3.5 million persons and an infection rate of 40 to 50 percent, these diseases cause the loss of 25 million working days a year. Beyond that, the cost of caring for these individuals serves to further increase the burden. Mass campaigns employing sulfa drugs and antibiotics have shown good results in controlling these diseases in Morocco, Taiwan, and Tunisia. Similar efforts have been initiated in Egypt^ Indonesia, Spain, and Yugoslavia. 35048 O - 59 ( Face p. 52) 35048 O - 59 ( Face p. 52) DISTRIBUTION OF TRACHOMA ( Based on Incomplete Data ) A C T I C GREENLAND /SPITZ- BERGEN A R C r I C E A N OCEAN '1^ O 'NOVA- ZEMBLA SIBERIA ALASKA TERR. OF HAWAII A C A C E A DOMINION OF CANADA NORTH - UNITED STATES ¥ I AMERICA //NEWFOUNDLAND A T L A N {■{h^CUMS ^ ECUADOR JJRINIDAD 1 „r. TV BR. GUIANA i,yENE2UELA^.^ \ Sur inam ■-T V 7~T^FR. GUIANA TX.rl.c/> ^>/^i brazil SOUTH \ - i 'Y jeouviA ■>MEiRI« ICELAND /v^ ) / "r 'SWEDEN ) DENMAR ENGLAND STHONIA I^TVIA ) EP/UTH-^ i -■ ^ J^NIA, , ."GERMAN pX ! XEUftOPE ^ANCE ITZ%^'-vy/^GARY I SWIT2 , ^^'XlTALY I _/RUMA- YUGO-''.^ NIA BULGARIA AZORES o / C CRETE< L.J / LIBYA \ AFRICA FRENCW-.AiWEST AFRICA ri y'^'GERiA GUINEAX,—, / turkey ISRAELI / ( UNION( OF SOVIET SOCIALIST REPUBLICS \ . A 'V.. SAUDI ARABIA SORIAL ( ERICA SIERRA \ /\ LEONE ^ I LIBERIA ASCENSION o Amerooi \ f-—^ V C E A N ,/ /BELGIAN / CONGO -V ') /KENYA Y ■- jTANGAN- ^ YIKA Iangola YVoi:1 ^'r- ■RHODESIA ) T nYASALAW CA/ I .#/ 1 N m SW I \ ) A I ^ [AFRICA .'gECHUANAy' p I LAND A I / [V-' UNION OF S. AFRICA / MONGOLIA \ / /' v.. TIBET PrfKIsij^ / 1 r\-/ ^RM/^aoS (' " W^ii ^FORMOSA a HAINAN Vietnam ^0 CEYLON rWuPPtNES A 'N BORNEO IAN /INDONESIA JAVA C E A N IJAPM oGUAM AUSTRALIA A C I F I C C E A N '^cHUoONIA NEW ZEALANC Sources • World Population and Production by Woytinsky ft Woytinsky WHO Publications Public Health Service Records in jfAaH altritAV/ %6 R\TtA,»ra -i»9 V, S -s Y 1 * ' : V- IL* * M'. XOSJaAlfe .Si *1' ■• M * 4 .•..iiicAp f »vv/ Toaf’^nrua .'^QSl di uoiiiiniXifiV lo'^woaaib siolyH 3 t« ''Ja brw 2fj^d n*a-ecniJoiv «1i lo o "5^ ^''^hLoT !bnild r ,m,BHmh gooijpoi/n Iia 0 i{lU»iiil>0r ^ fto « xbqliara;^ i jl -.'■fi^^'j %q offash^^y ,qi; ifoid’ff m ina^ ,oSnk'^iiiiOiTioil bol|^.Mi-fr,M.i avtid *<;i^sp on CTflor, bir/ !o id ^Jiohiwbde qb^id :;j .fifooseH9,>r bofi aiaA leii* jb>'>ii Bitold-uotril acil b«a p^, njoil a‘xxi?>bnia douiw niajiivo tdfcbi diaa 'amwobdl *ab (biialiaill noi^^ aiil.duiv/) 397 ,dft ■obfiafRui-lol ^ 7 q 6 i ql ^ 8 gitMi/oo r ^ ' C L .'lobanprd tii m l>flB «ii>al ni boiioq-n a^ao .«i.aA 1 »hU • h )iiriiai)«wl ;x3i Bmzn amal ’i^dio qtb 97^d| 7,jfoirn'>bi:dF oHdjIs ’ ) ./oqlia/neejodw .-liaq^l. baa aetq^ T^fdbtrbni SKA E i^'oJ :.A 6«. ,«i4u ^ >A'•: „ , . V--.. '" *c ■0^ '♦ f * » i .a^»l t '.•> • <■'r*-,. •- i| , * “ #t.v t. tm i ;> l«» k »t »s ♦ « A 54 THE STATUS OF WORLD HEALTH R. SMALLPOX Before the discovery of vaccination in 1796, smallpox was a scourge that swept back and forth over every country of the globe, killing at least one-fourth of its victims and leaving its survivors scarred, pitted, and often blind. Today, it is one of the most easily preventable of all infectious diseases. However, smallpox is still a serious menace to the life and health of vast segments of the world’s population. A single case may result in an outbreak which quickly builds up to epidemic proportions. It is also a constant object of quarantine vigilance because of its ready transmission by international travelers. Only rarely is smallpox now found in Europe, North America, and Australia. Its endemic area is receding year by year and in the last several years, no cases have been reported from Chile, Mexico, Peru, and Venezuela. But it has a high endemicity in that area of Asia which stretches from Iraq and Iran through India and southeast Asia (with the exception of Thailand) to Indonesia; and also in certain countries of South America. In 1957, for instance, there were 66,706 cases reported in India and 744 in Ecuador. There are other large areas in Latin America, Africa, and Asia, including Korea and Japan, where smallpox, though of low endemicity, constitutes a very real continuing threat. For large areas in central Brazil, the U.S.S.R., and parts of Africa, no data are currently available. 35048 O - 59 ( Face p. 54) I F I C C E A N ^NEW ^CALEDONIA :B 2I/WP/2I Jan. 1958, Campaigns Against Smallpox Publication ons in the No. 40, June Americas 1958, Four Year Reports on 35048 O - 59 ( Face p. 54) D SMALLPOX ENDEMICITY, 1954-1957 C E A N ARCTIC 0 C E A TERR. OF HAWAII ^NEW '^CALEDONIA NEW ZEALAND Areas where smallpox is absent or only sporadic or imported cases occur Areas of low or moderate endemicity Areas of high endemicity Source^ WHO Bulletin EB 2I/WP/2I Jan. 1958, Campaigns Against Smallpox PASS Scientific Publication No. 40, June 1958, Four Year Reports on Health Conditions in the Americas Data not available 'fJO >UT ./ 8ia0iJ05FMUT (kl 8m»ii)TOfjo-Kf obiwhhov/ vlii’it ve/io^ih a )o eao 8orfutiJ'X> -fol hnn ^ohJauoM brji^cn) i>n« j-i(|nioj iiimi nj ,\K^* oofiir: .odois eiii lo lin vflBoiJoaiiq li lo eortUi-/^ iMtio ^i^^ok/DTodiJ^ iri eallaob ?)j) ^orii d) .fi if‘»od sfid ?)'j.>dt nr boDubt/i^ni J8'id vqin'3£i1(’nx9xf'> lo lidi ol vnrjro 0iil iholS@U3 O'Dil ti Aod'a aUd'- orlun^irfiuot,) odT .juv/ iu'it -liiiVB e-i»i 0T'>d7.' ?.;^h;iiHoo lor vlfro b-i a r^n-Or.fU .TlOf ino'tl IvoubioL;*:! If * >]fi'JTL> n'irii oJ bbr.r/ir ‘ifiil.H'b od'P .til-Jfi «^'j!n'U /liittii '■ -'. '^Mwi aiTfXAfir^‘7 ai^ob.i.'nsiiUi? »T^>'rq kidj vlio-j^CT fiixiJ'or) ni .^jllftjiofrr ‘^ul'J’ .ioUifo*) I/uroiit(in’i,‘v1/ri odl nl odJ 'yronvr uiJ'w'i ./ij.>iii vl')ffi07Uo iL'i^ o’lm <”*>htoi/oa yaaifi "Jo Ofii ‘Maij O'j^vjibui j''.i jf :i;a> 3ji ,. xiixmoar iti oiub')b eeiilm/oo ai/ioa iri f i [.• aii‘Ti'>o}> aoii opmetib'd? lo -III a7/0ifA lo uodnurii oxll oMidiir/w ^rus •‘litfci.jxita vJibfdnoM' q'd/Iv/ 6iin vlilBi’iOiXi ofil Ji'oodj iiovo .l> »aj\'notu •'[jra;>7ij find anaBO aijoi)-»ol yxrjim ni nx>iudirqoq lo nofJtiviaxjJ'or ^ 4 oi//oi<.> 'oi I' .ho'iowoj oood >jiii .tfjiiioaii) odl lo '>}|J aJBi/lo >o.“/t ol p.'rnvy aol'jlirrioo -Jo Jon oiB aohtrijjo') i>^>(fob7')i>xoh/iu oJj lo O'.oa-, itf istjuh ^iojiii Jl cjiaoIxmoJaJ id oouobioai >fii JfvtU a ihaaioo, fd ai ji hnn ,*fl0]i!un7'>‘i<] ■Jr v/^-'da affU5*i:5o*rq noij ai aapoioq St ;ftj’bni ^yaiJinoG iU Jiiuo-ioq .‘V lo Cl qi.ori;.> oyA 'xo't jno’JToq U6 ;fiB7/i:B'r lo feoiJiniifnaxoD loxj u; ^dt el )o,j'n‘j({ JO jToiqjnjT oaoJT .Tob/ii/J^Cd £ii JxToo'ioq0^ b/?B ni inoo'ioq So iBiv^bo^uY iii -'lobfiu'ono ni JimToti lo omgil b xiaiv/ f)ii/vqfno> od yxjixi ^.■>iJni - / ' .yJiO }rioY Y/oV^'lo nuilooa ij?>'^oijvriq iBauxib Si xnoil :Djrjlj7iixifb yiljxqrn ai i(r j/ioui‘>:gB{iftXii od r hfiR alxio^fl'^iiixiiiix/iixof lo oJj : /i-)> • ’.ijj'jcjimxil boix L:i joafyilqO'Ki i} 3"' 5. i:. i’ji) i \»n\ j l^n?r ixjeP^ei itroiJriiuiioqX l y p-r? r.-jOJ 1 S.Tl . M S ..‘It' 5.T i^.t£ « nx ! .iS \'x * i ,0^ £M Q.8I ..Y'j •»v; V.H' (jc‘n 1 i?MI ■ ‘.iwr '^*t« ^ ■ * -«. . * '^irj • P..»7 O.W (.*« 5>.St e',Ct U.^R i.£3: . \ __fivIttV/ao6 ImrusP'X I . __.. .iji'':,'-;-;] ,' ri .... ' _•. (ni:'*-;’;a H 'J .liZ __■-I'iJ. ; : (t’-'Y/ X ‘.'.T- -. ’ if M3 .. r I .il __‘:iri:ixwj;v,' j Xi .-v r .1,_ _ L..:4lf;.'n{*>0 • J.i ...:l ... .. li r J I ■ IT, _-^ ~, vaMio V. I, ■: X '■ '■ •;! XX' 1 li I AX' >: .a ■ ;'5’i ix*:-, « y t- > rt oAfy w 14: X q «-■ .4^”‘ ft ".M n .1 _ H*- ' - ..pl’i-'-’fO . . , __ _.on .iPi . J.-,.. wii a/. .. .olXiO .. ... . ..i __- ..._ JjtvX . . .eUrtriitiA ......... . . ..IdOiIf <#S .V /■ . n'r.jeV. 1 ..-.. > I---- a .. ■ boa t , 6 i -IC'V toiiiJtrAP. If Ji / bnt Ift^IsnloluiffW^Sl Oli //“ ^a, 56 THE STATUS OF WORLD HEALTH S. TUBERCULOSIS Tuberculosis is a disease of truly worldwide proportions occurring in both temperate and tropical countries and for centuries one of the chief causes of death in practically all areas of the globe. Since 1947, however, there has been a dramatic decline in tuberculosis mortality owing to the use of new types of chemotherapy first introduced in that year. The comparative data shown here are for the years 1950-54 and only for those countries where good statistics are avail¬ able. The decline would be even greater if calculated from 1947. Despite this progress, tuberculosis remains one of the main targets in the international disease control. The mortality rates in certain areas of many countries are still extremely high. Furthermore, the decline in mortality, as such, does not indicate that the prevalence of the disease has decreased in the same measure. In some countries where morbidity statistics are available the number of known in¬ fectious cases has actually increased, even though the mortality rate has been lowered. The growing urbanization of population in many countries serves to accentuate the danger of the disease. Reliable data in most of the underdeveloped countries are not ob¬ tainable, and it is in these countries that the incidence of tuberculosis is probably the heaviest. Recent surveys incident to BCG immuniza¬ tion programs show the prevalence of previous tuberculosis exposure for age group 15 of 77 percent in Bombay, India; 72 percent in Tangier; 66 percent in the urban communities of Taiwan; 59 percent in Yugoslavia; 52 percent in Egypt, and 49 percent in Ecuador. These ratios may be compared with a figure of 9 percent in one under¬ privileged section of New York City. The management of tuberculosis is rapidly changing from a clinical to a public health approach through the use of immunizing agents and prophylactic and therapeutic drugs. Mortality from tuberculosis, all forms [Deaths per 100,000 population, 1950 and 1954] Country 1950 1954 Canada_ 26.2 10.3 United States___ 22.5 10.2 Puerto Rico__ 129.1 38.2 Mexico__ 41.0 27.9 Chile___ 152.9 69.8 Colombia___ 36.2 26.1 Egypt---- 48.9 26.2 Israel_ 14.8 9.3 Australia_ 20.5 10.0 New Zealand__ 34.9 14.5 Japan_ 146.4 62.5 Ce’ylon___ 53.3 23.6 Singapore___ 145.5 82.7 Country 1950 1954 England and Wales_ 36.4 17.8 Ireland_ 80.2 34.3 Belgium_ 43.3 26.4 Netlierlands_ 19.0 7.5 France_ _ 58.1 32.4 Italy_ 42.6 23.0 Switzerland_ 35.1 22.1 Germany_ Denmark_ 13.8 7.7 Finland_ 93.6 40.4 Norway_ 29.0 15.3 Sweden_ 22.1 13.0 Source; “WHO Epidemiological and Vital Statistics Reports,” vol. 10, Nos. 2 and 4, 1957. MORTALITY FROM TUBERCULOSIS, ALL FORMS, IN SELECTED COUNTRIES 1950 and 1954 THE STATUS OF WORLD HEALTH }Q lti H il H» ltll i ii l H » H uoi4D|fxlod 000'OOl *44090 3HHD NVdVr ivoniiiod ONVINId ONVIBdl 3DNVdd ODIX3// idA03 viawoioD NOTA3D AlVil aNV3d3ZilMS S31VM aNV10N3 AVMdON aNV3V3Z M3N N3a3MS VOVNVD S3ivis a3iiNn vnvdisnv 13VdSI >ldVWN3a SaNVlil3Hi3N 57 Source: WHO Epidemiological and Vital Statistics Reports, Vol. 10, Nos. 2 and 4, 1957 58 THE STATUS OF WORLD HEALTH T. THE CONTROL OF INFECTIOUS DISEASES There are four chief methods by which the spread of infectious diseases can be controlled. Immunization, or vaccination, is an essential in any attempt to control smallpox, typhus, whooping cough, pohomyelitis, typhoid fever, tuberculosis, influenza, cholera, plague, and yellow fever. Nearly all the vaccines in use today are highly effective. The main problem is to make sure that all the people who may be exposed to any of these diseases are properly vaccinated. Prophylaxis and/or clinical treatment of the disease, is indicated for yaws, malaria, leprosy, tuberculosis, syphihs, bejel, pinta, and trachoma. Effectiveness depends on the number of clinical centers and medical personnel available and the utilization of these services. Control or eradication of the disease-carrying insect, through mass spraying campaigns or other methods is fundamental in the attack on malaria, trypanosomiasis, plague, typhus, encephalitis, oncho¬ cerciasis, and fllariasis. Though sometimes expensive to carry out, these control campaigns have, generally speaking, proved highly effective. Control of human waste disposal is primarily a pubhc health service sanitation operation, and is basic in any attempt to control schistoso¬ miasis, hookworm, roundworm, cholera, amebiasis, and dysentery. THE SPREAD OF INFECTIOUS DISEASES CAN BE CONTROLLED BY THESE ACTIONS THE STATUS OF WORLD HEALTH 59 9 I o o o p v> o 1.1 >%CL 0) CD c s in O in Control or Eradication of Insect Vectors of Control of Human Waste Disposal,Preventing Malaria, Encephalitis, Trypanosomiasis, Schistosomiasis, Hookworm,Roundworm, Plague, Onchocerciasis, Filariasis,Typhus Cholera, Amebiasis, Dysentery 60 THE STATUS OF WORLD HEALTH U. HEART DISEASE Degenerative heart disease is now the most frequent cause of death in North America, in most of Europe, and among the more pros¬ perous segments of the population in many other parts of the world. It affects chiefly middle-aged and older people, and its incidence and resulting mortality rates in particular countries are, therefore, affected to a considerable degree by the age distribution of the population. Generally speaking, those countries having a high life expectancy rate, and consequently a larger proportion of older people in the population, will have a higher rate of cardiovascular mortality. However, there is evidence to suggest that the richer diet and more intensively paced life of the industrially advanced and higher income areas are in part responsible for the heavy prevalence of these dis¬ eases. The United States, for instance, with an average life expect¬ ancy of 70 years has one of the highest reported cardiovascular mortality rates—460 per 100,000 of population—whereas, Ceylon with the very respectable life expectancy rate of 60 has a rate roughly one-seventh as high (about 68). Mortality from cardio-vascular diseases [Rates per 100,000 population] Countries 1950 1954 Countries 1950 1954 Australia_ 437.2 441.9 Italy_ 354.2 Canada (excluding Yukon and Japan__ 183.5 Northwest Territories)_ 382.8 370.5 Netherlands_ 262.4 291.4 Ceylon... 77.5 67.7 New Zealand (excluding Maoris). 459.7 439.2 ChUe_ 231.6 152.8 Norway_ 348.8 Colombia__ 94.6 Poland_ 224.0 Denmark_ 392.1 Portugal____ 292.5 Egypt (localities with health Sweden__ 438.6 biueau)_ 94.0 95.7 Switzerland__ 425.7 El Salvador_ 38.2 United Kingdom; Finland_ 317.9 382.3 England and Wales_ 540.1 549.9 France_ 363.3 363.0 Scotland__ 572.6 601.8 Germany (Federal Republic).. __ 365.8 TTnitfid Statft5? of Amorica. 467.4 460.0 THE STATUS OF WORLD HEALTH 61 «o U) UJ «/> < UJ O c 3 O U a: < t u « « Z> u CO < > c I o - — « o Of < u o 0£ o I /-N l§ o o u z (/) UJ CO CO z 3 O Z S N 3 lu < Z Q z 3 z s S N CO CO li UJ ^ Q IZ > <1 z s •< UJ u O U z > < >- < io CO O z 3 tt: UJ X X u Q. > O < flO 5 O z o O UJ u U Source: UN Report of World Social Situotion, 1957 62 THE STATUS OF WORLD HEALTH V. CANCER MORTALITY Cancer is one of the major causes of death in the heavily indus¬ trialized countries of North America and Europe, and also Japan, Australia, and New Zealand. As with cardiovascular diseases, these are the countries which have the largest proportion of older people in their populations. The highest mortality rate per 100,000 of population in industrial¬ ized countries is to be found in Scotland (206.2) and in England and Wales (205.5) and the lowest in Portugal (84.1). The United States has a rate of 145.8. In less industrialized countries where data are available Ceylon has the lowest rate (18.1) and Chile the highest (90.2). Mortality from all forms of cancer is much greater for men than for women. The sharpest rise occurs after the age of 40, and the inci¬ dence is particularly heavy after the age of 60. Cancer of the digestive system accounts for a little more than half of cancer deaths. In recent years, however, there has been a rather startling increase in deaths from cancer of the respiratory system, chiefly among men where the rise has ranged from 21 to 50 percent. Overall cancer mortality rates have steadily increased over the past several decades. The chief exception has been in certain forms of cancer in women where improved diagnosis and treatment have to some extent arrested the rise. In general, the overall rise is accounted for by better diagnostic methods permitting the detection of more cases, the aging of the population, and the decrease in the number of deaths from other causes. There is evidence which suggests that heavy cigarette smoking and various types of air pollution in urban- industrial areas may be contributing factors to the increase in cancer of the respiratory system. Mortality from malignant tumors [Rates per 100,000 population] Countries 1960 1954 Countries 1950 1954 A nstralia _ _ _ 127.4 129. 2 Japan_ 77.4 85.3 Canada (excluding Yukon and Netherlands. 146.9 156.3 Northwest Territories)..— 127.7 129.8 New Zealand (excluding Maoris). 147.7 146.6 Ceylon_ 14.0 16.9 Norway_ 159,7 Chile. 83.6 90.2 Poland_... 91.0 Colombia_ 38.9 Portugal_ 75.3 Denmark_ 190.0 Spain_ Egypt (localities with health Sweden_ 158.9 tmreau)_ 19.9 24.5 Switzerland_ 188. 2 El Salvador_ 21.4 United Kingdom; Finland.._ 138.4 145.3 England and Wales_ 194 5 203.5 France_ 173.1 181.9 Scotland_ 193.8 205.0 Germany (Federal Republic). 186.5 TTnitftd of Amfirica . 139.3 145.8 Italy__.l.-.r... 124.1 MORTALITY FROM MALIGNANT TUMORS - SELECTED COUNTRIES, 1954 Rates per 100,000 population THE STATUS OF WOHLD HEALTH 63 Source: UN Report on World Social Situation, 1957 64 THE STATUS OF WORLD HEALTH W. FOOD PRODUCTION Since World War II, there has been an impressive increase in food production throughout the world, and the increase has been especially- marked during the past several years. For the entire world, the index figure (based on the 1934-38 average=100) has risen from 107 in 1951 to 120 in 1955. The greatest gains between 1951 and 1955 have been made in Western Europe (103 to 124), Latin America (124 to 139), the Near East (115 to 138), and Africa (123 to 142). North American has reached the highest index figure of gain over the prewar level (138 to 145), though its proportionate gain during these years was far less spectacular than in other countries. The smallest percentage increase from 1951 to 1955 has been in the Far East (a 10-point rise from 99 to 109) and in Oceania (112 to 116), both of which are below the worldwide average rise. In some of the less developed countries, however, these increases have by no means kept pace with the increases in population. In Latin America, as of 1955, the per capita production of food has fallen below the prewar level by 6 percent; Oceania by 13 percent; and the Far East, with almost half of the world’s population, by 14 percent. The most striking gains have occurred in Western Europe, which by 1955 had converted a 6-point per capita loss to a 9 point gain; and in the Near East, which moved from minus 3 to plus 6. North America has raised its per capita index from 113 to 118, and Africa from 103 to 109. For the entire world, the index figure has moved from 5 points below the prewar level in 1951 to 1 point above in 1955. TOTAL FOOD PRODUCTION HAS INCREASED WORLD-WIDE THE STATUS OF WORLD HEALTH 65 8 II CO CO uoj43npojjj pooj |D 40 j[ jO sjaqujn|s( xapu) Source: UN Report on World Social Situation, 1957 66 THE STATUS OF WORLD HEALTH X. CALORIE INTAKE In all of Europe, North America, and Oceania, the calorie intake is 10 to 12 percent above the estimated requirements for a satisfactory diet. Also, on the plus side are Turkey, the Union of South Africa, Argentina, and Uruguay. Of the other countries, approximately half of the people manage to achieve their estimated requirements; the other half have calorie deficiencies of varying degrees. India and Peru have an 18 percent calorie deficiency, closely followed by Ceylon with 14 percent and the Philippines with 12 percent. In Many Countries Calorie Intake is Below Estimated Requirements THE STATUS OF WORLD HEALTH 67 puDjoa^ Ma|vg oi |OJ 4 Sny 534045 p 34 !un opDU 03 dssn DjAD|So6n/^ ujop 6 ui>| pa 4 !uf| pUO|J3Z4IM5 U3p3M5 XoMJOfsJ SpUD|J3q43|sJ X|D4| 3O33J0 30UDJJ pUD|UIJ >|JOLUU3Q Uin|6|3g 0|3nZ3U3/\ XonBnjpi nJOj ootxayy oqn^ Diqujo|o^ a|!HD lIZDJg oui4U36jy ooujv -S 'ufl 0 >| jXuD 6 uDJ[ $nj 4 {jnDyy DOUjv ‘N •■'d Xs^jjnj^ tdXSg smdX^ S3U!ddi|!qd UD4S!>|Dd uodof D!pU| UO|X35) VINV3DO vDiyawv HiyoN 3doan3 VDId3WV Hinos >9 3300IW VDIildV iSV3 dV3N 1SV3 dVd Source: UN Report of World Social Situation, 1957 68 THE STATUS OF WORLD HEALTH Y. PROTEIN CONSUMPTION Per capita consumption of animal protein—fish, meat, and milk— is a measure of quality of the diet in a given country as contrasted with calorie intake which is primarily a quantitative measure. Broadly speaking, those countries which have a calorie intake greater than their estimated requirements have also a high per capita protein consumption. But there are important exceptions; for example, the calorie intake of the United States, Canada, and Australia differs little from that of Greece, Italy, and Yugoslavia, but the difference in protein consumption is very great. India, which has the highest calorie deficiency, has also the lowest protein consumption. Other countries like Brazil, Chile, and Egypt which have important calorie deficiencies, are comparatively low in protein consumption. Of the three proteins here covered, the proportion of animal protein in the diet is a fairly dependable index of its quality since foods rich in animal protein are good sources of many other essential nutrients. Also these foods are usually expensive, and their presence in large amounts in the diet reflects, in general, the wealth of the country. ANIMAL PROTEIN CONSUMPTION IN SELECTED COUNTRIES - 1953/54 THE STATUS OF WORLD HEALTH 69 vnvyisnv -C «o lO idA93 00 VIQNI Avnonyn 311 HD iizvyg VNIiN39yV i S3iViS a 311 NO VaVNVD VIAVlS09nA woa9Ni>i a3iiNn aNVld3ZilMS N3a3MS AVMdON SaNVld3Hi3N AlVil aNV13ill 3D33d9 3DNVdd QNVlNId >iavwN3a wni9139 viaisnv I o § 1 8 i 8 j o o o LunuuD jad D4jdD0 jad SLUDj6o|j)^ 70 THE STATUS OF WORLD HEALTH PART 4. HEALTH RESOURCES A. DISTRIBUTION OF PHYSICIANS Physicians, as defined here, are those with a recognized status as licensed or limited-license medical practitioners. Broadly speaking, the distribution of physicians reflects the degree of industrial development and per capita income of a country. Four groupings are shown. I. Less than 1,000 inhabitants per physician. This category is made up predominately of European and North American countries, plus Argentina, Uruguay, Australia, New Zealand, Japan, U.S.S.R., and Israel. Excluding Israel (which has a heavy concentration of refugee physicians) there is a range of 1 physician to every 610 people in Austria and U.S.S.R. to 1 in 960 people in France. The U.S.A. lies between with a ratio of 1 physician to every 790 people. II. 1,000 to 5,000 inhabitants per physician. This category in¬ cludes the remaining European countries and the majority of South and Central American countries. Africa is represented by Egypt and the Union of South Africa; the Near East by Turkey and Syria; the Pacific area by a few small countries or territories with close associa¬ tion with the Western powers. III. 5,000 to 20,000 inhabitants per physician. This category includes the remaining Central American countries; various countries in Africa, the Near East, Far East, and Pacific area, including India, Burma, and Pakistan. IV. Over 20,000 inhabitants per physician. This category is made up of underdeveloped countries in central Africa, Saudi Arabia, and Yemen in the Near East, Vietnam, Cambodia, and Laos in the Far East. 35048 O - 59 ( Face p, 70) A R ( 0 C A N SIS^IA MONGOLIA CHINA ISLANDS "ETNAM oGUAM In BORNEO INDONESIA union Of SOVIET $i?0*u5T RERIMiCS INHAi NEW ZEALAN ■atistical Office of the United Nations, December 1958 blic Health Service Records HO First Report on the World Health Situation 1958 ^CAL£DONIA 35048 O - 59 ( Face p. 70) RATIO OF POPULATION TO PHYSICIANS ARCTIC 0 C E A C £ A N TERR. OF C E A N INHABITANTS PER PHYSICIAN Less than 1,000 1,000 to 5,000 5,000 to 20,000 Over 20,000 No data NEW ZEALAND/::;::? Source: Statistical Office of the United Nations, December 1958 Public Health Service Records WHO First Report on the World Health Situotion 1958 I.'TJAHH nanov/ -90 "BlITA'iVs aH'l’ £T f'' ■ ■■: ■ *y^ ‘ . ''^' • - 'V • A. - rnm^ ■ ' •V. «JsV -k < ' -A. (■-'Av • \ 'i . ►* l/V « - t' r •> • . - ' < y' '-*■ ,Jt - A :X> '■ N-> / . • j f . , i * .JAaK!r'?fc,'3:o "•i:ouuuraT?;m .a «« - ^-ov/l ^rroda 7d X)C‘I >i;'rVdo%i j.'hov; 7(i:i lo‘.Im/lj-ono .iurxfA noiJaokoxb lo ^Iriiift bodobvob '^lliiyififbiAO Jo d/ri. ui. jj->i tu rf Isn/KVioq Looibexii lo boqoiavob-fceol iii ii>d.i ^quibC'f i '"i ii‘>iiafiiA xlJ'JoM io SMfUnuoo i ^ . ^ ^ ' b>ui firaA vhiiiuoiiam'i br>timil feftd jioii/ibjqoa ol oJdn6iki6nifii«^i9oa/i lo iioUluodlib eiil io G«irjij>9d viinfn or oon/rjj'bri^ia asiiinuoo vaBOi .oal/* .aQoivioft iroilj lo iioiiuxHib/baii xioinrWhjW}) o/l.r -iisili !j:f ixrtii ^niaixtxl sdl vci aj’iU iGiia njiioiaviiq uili 07 it>a oi ^unrrii o-ixt hiiR rdaA ,3aii,ofliiioa nl .aiG>t*iow dliooii biixj Ixiaifxrai 7 ’ix;iji/jijx lo iioi.J vjiiio OJ boar/ •;ioi)i7x oixs ^rediovx VT/dbziiij oaorSJ .vilfriouqao .JxoiriA .iioijxilnqpq lo ,a)vlWi>h': rvy?;: olj i;} pr ,q Lf>}r^or/ •' mOa-to ,ei‘;wr!;*u!) vi .'-iU o v, (J a; Ui Q .rvrj f/tK'lB dSlffilMh .-.d^rOi'- t-, ■ - 7 -'.'O. ««,« a ■ «w ■•T'' .•■** T^' A-*. *. •'Ik .. •i *K 'r' ■ f . ■ S ■ r- ■ *■•'If’hi''''. .%Ji* ■ A' .A -‘it-' ■s.l -. .’ V • ' . .A (■ l' d'rtCJ'^ KUTLOilS-'i-S ■•« T <■ ^ 72 THE STATUS OF WORLD HEALTH B. DISTRIBUTION OF MEDICAL PERSONNEL ' About one-third of the world population is served by about two- thirds of the medical personnel. As might be expected, the proportion of medical personnel is much higher in the economically developed countries of North America and Europe than in other less-developed areas, particularly Asia and Africa. The number of physicians proportionate to population has limited significance in many areas, because of the difficulties of ascertaining the distribution and utilization of their services. Also, many countries are trying to solve the physician shortage by the training and utiliza¬ tion of auxiliary medical and health workers. In southeast Asia and Africa, especially, these auxiliary workers are widely used to carry on the functions of physicians. However, no one can question the gross insufficiency of physicians in the underdeveloped parts of the world, where, in some countries, the ratio is as low as 1 to every 50,000 of population. » Medical personnel, as used here, includes physicians, dentists, licensed midwives, and pharmacists* Nurses are dealt with elsewhere. Data were Inadequate to include sanitary engineers, sanitarians, or other categories. * Includes physicians, dentists, midwives and pharmacists Source of data; Statistical office of the United Nations 74 THE STATUS OF WORIiD HEALTH C. CHARACTER OF MEDICAL PERSONNEL In the less developed countries of Asia, Africa, South America, and Oceania midwives constitute 40 percent of the available medical per¬ sonnel; physicians, 38 percent; pharmacists, 14 percent; dentists, 8 percent. In the economically developed countries of Europe, North America, and in the U.S.S.R. physicians are the predominant with 62 percent, followed by 14 percent for dentists, 12 percent for pharma¬ cists, and 12 percent for midwives. Midwives, as included in this chart are those who have undergone specific training and are licensed by their governments. They are not to be classed with untrained individuals who practice midwifery without benefit of modern medical knowledge. Includes only Physicians, Midwives, Pharmacists, and Dentists Europe and North America Asia, Africa, South America and Oceania Source: UN Statistical Office. 1958 76 THE STATUS OF WORLD HEALTH D. DISTRIBUTION OF MEDICAL SCHOOLS There are 634 medical schools throughout the world, of which 356 (56 percent) are located in the industrially developed countries of Europe (including U.S.S.R.)? North America, and Oceania, while 278 schools (44 percent) serve the remaining countries. In the developed countries, Europe (including U.S.S.R.) leads with 253 medical schools. North America is next with 97, and Oceania (Australia and New Zealand) have 6. In the less developed countries, east Asia has the largest number with 94, followed by South America with 53. Africa and southwest Asia have the smallest number, with 10 and 14, respectively. Considering the ratio of population served to number of medical schools, the pattern changes somewhat. North America leads with 1 medical school for each 1.9 million people. Middle America, South America, Europe (including U.S.S.R), and Oceania are all comparable with 1 medical school for each 2.2 to 2.5 million persons. Asia, with a ratio of 1 to 8.3 million, and Africa with 1 to 22.4 million are far below the world average of 1 school for each 4.4 million people. In 1955 an estimated total of 66,722 physicians were graduated from medical schools throughout the world, about two-thirds of them graduating from the schools in the industrially developed countries. DISTRIBUTION OF MEDICAL SCHOOLS - 1957 (Countries distorted on a scale proportionate to population) THE STATUS OF WORLD HEALTH Source: WHO Directory of World Medicol Schools PROJECTION OF ERWIN RAISZ Summary of Four Yeor Reports on Heolth ' • | Medical School Conditions in the Americas, PASS 1958 78 THE STATUS OF WORLD HEALTH E. NURSING SCHOOLS Throughout the world there are 4,910 nursing schools or nearly 8 times the number of medical schools. Almost half of them, or 2,230, are located in Europe, and of these, 1,619 are in Northern and Western Europe. North America has a total of 1,360, of which 1,115 are in the United States. Asia has 704; the U.S.S.R., 164; Africa, 144. South and Central America report only 58, though data from Mexico and some other countries of Middle America are lacking. Oceania has 308. Populationwise, the uneven distribution of nursing schools among the more and the less developed countries is obvious. The United States, with 1 school for every 150,000 of population, is in sharp con¬ trast with India where the ratio is roughly 1 to 2.2 million persons, or Iran where it is 1 to 5 million. For all of South America the ratio is 1 to 1.2 million. In Africa, where more than two-thirds of the schools are concentrated in the Union of South Africa, the ratio for the rest of the continent is roughly 1 to every 5 million of population. Sparsely populated Oceania leads the entire world with a ratio of 1 nursing school for every 50,000 persons. DISTRIBUTION OF NURSING SCHOOLS - (Countries distorted on a scale proportionate to population) THE STATUS OF WORLD HEALTH 79 80 THE STATUS OF WORLD HEALTH F. SCARCITY OF NURSES The shortage of nurses in the United States is a perennial subject of concern, but the worldwide shortage is an even greater problem. In proportion to its population, North America has 8 times the number of nurses that are to be found in South America or Asia, and 12 times the number in Africa. Europe is only shghtly behind North America in this respect. The disproportionate shortage of mmses in the underdeveloped countries is due largely to the fact that women have a low social status and nursing is not considered a profession. Nursing is looked upon as low-grade manual labor which no woman of the educated classes would undertake, and few women have sufficient basic educa¬ tion to take nursing training even if they were so minded. The fact that nursing involves the care of both sexes constitutes a further barrier. The full use of nurses has never been demonstrated in these coun¬ tries. Neither the public nor the local physicians are accustomed to nursing service or have any appreciation of its value. The situation will improve only as the basic education of the population improves and a better understanding of the importance of nursing service develops. THE STATUS OF WORLD HEALTH 81 A WOULD WIDE SHOUTAGE OF NURSES 500 wm oo w. ooow '4,000/i 6,000 MAFPA SOURa> UNPUNISHED OaUMINT. PUBUC HEALTH SECVICE o .'■ 1.8 i^b: tsaXf 'i 5?^’;:.. ’•k . , A }lTjA:iK <> JnO ^ ‘«TJTAT8 'miT * f . u V .:,' ',■ . '’• /' '.b‘' • -f ■ .• - ■ if' t>*^. ST? - .' • ~ ,- s?'' ' I. * . ' ■■ ■ . flJ ■*■•.- , I ^ .‘V , .,• ' ,> • • < ■ i : ' ■ , 1 ^ > , V i •v' r>-:m ■ . / t ■ .-^ '■^j - ,'’ • •''w :;. ,. r.,; ‘.t vj . , ■h ,:2?2flUM 10 JOATSOHa.5GjV\^ajqQW ‘y t*' V' 4* * . . 7;’ . lU' ij. ,, ...<•',y-,>. rfV.4Ti^ ^ -■ “A, i .^* ^ v4^.VCi^^ '--•''tfe •' . 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