Health for Some

Health for Some IN a decade when change, social, ecological, economic and political, and therefore also in lifestyles is the leitmotif, dramatic alterations in the health picture are bound to occur. Some parts of this picture are emerging in better light the increases in life expectancies, uneven but still very impressive even in regions severely handicapped socially and economically. In most countries of the third world, barring a few in Africa, people live longer than they did in 1980. And while there is much to be achieved in this particular part of the health picture, there is movement towards progress. And yet other parts of the picture which in the 1980s were sharp and clear are today being obscured with the same wash of infectious diseases which had been triumphantly pushed out of the canvas. For developing countries on the verge of a health transition this presents what the WHO's World Health Report 1997 calls a "double burden": the comeback of infectious diseases and the new chronic conditions, often caused by lifestyle changes and environmental factors, diseases afflicting particularly, but not entirely, a population that is living longer than it did 15 years ago. In fact the World Health Report 1995 had recorded this, stating that many countries were experiencing not epidemiological transition, but epidemiological polarisation with increasing disparities in health between the rich and the poor.