Who cares? WHO cares.

• Position: United Nations World Health Organization

What will life be like in the twenty-first century?

As it looks towards the early twenty-first century, the World Health Organization (WHO) predicts that the world - already free of small pox - should also be free of poliomyelitis, measles and neonatal tetanus.

Some other infectious and parasitic diseases will be eliminated, and the burden of many more which currently afflict tropical regions should be further reduced.

Most children should be protected from vaccine-preventable diseases through well-established and sustainable immunization programmes, and deaths among small children would be reduced.

At the same time, however, the world is expected to confront an increase in deaths of adults in the age range of 20 to 64 years, while major health problems by the year 2025 are expected to be diseases of the circulatory system, cancers, infectious and parasitic diseases, and external causes. Available data suggests that in some countries, deaths from circulatory diseases are falling, while cancer deaths are increasing.

WHO estimates that about two thirds of global cancer deaths, cancer incidence during 1997 and cancer prevalence in 1997 can be clustered according to four risk factors: diet-related (stomach, colon-rectum, liver, mouth-pharynx and prostate); tobacco-related (lung); infection-related (lymphoma and cervix); and hormone-related (breast). WHO foresees that the overall global situation in respect of cancers of the stomach, liver, mouth and pharynx, the cervix and the breasts will improve in the early 21st century, while those related to the lung, trachea, bronchus, colon and rectum, and prostate, as well as lymphoma, will worsen.

Other aspects of our current lifestyles will continue to have a negative impact on our health. Sedentary living, excessive or ill-balanced diets, smoking and a deteriorating environment will result in an increase in crippling chronic diseases such as diabetes, rheumatoid arthritis and lower back pain. Many will continue to suffer from mental disorders, from the relatively minor to the incurable and life-threatening.

It is also forecast that the 21 million-odd deaths of people under 50 years of age, which are due to infectious diseases, can be prevented through cost-effective interventions such as immunizations and essential clinical care management, personal hygiene, public health and sanitation practices, and the safe processing, preparation and handling of foods. For the first quarter of the century, WHO...