5. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
Table of Contents
Abbreviations7
Introduction8
Part I. Health-related Millennium Development Goals 11
Summary of status and trends 12
Regional and country charts 17
1. AARD (%) in under-five mortality rate, 1990–2010 19
2. Measles immunization coverage among 1-year-olds (%) 20
3. AARD (%) in maternal mortality ratio, 1990–2010 21
4. Births attended by skilled health personnel (%) 22
5. Antenatal care coverage (%): at least one visit and at least four visits 23
6. Unmet need for family planning (%) 24
7. AARD (%) in HIV prevalence, 2000–2009 25
8. Antiretroviral therapy coverage among people with advanced HIV infection (%) 26
9. Children aged 5 years sleeping under insecticide-treated nets (%) 27
10. Children aged 5 years with fever who received treatment with any antimalarial (%) 28
11. AARD (%) in incidence of tuberculosis, 2000–2010 29
12. AARD (%) in proportion of population without access to improved drinking-water sources 30
13. AARD (%) in proportion of population without access to improved sanitation 31
Part II. Highlighted topics 33
Noncommunicable diseases: a major health challenge of the 21st century 34
Health expenditures and universal coverage 38
Civil registration and vital statistics systems 42
Part III. Global health indicators 47
General notes 49
1. Life expectancy and mortality 51
Life expectancy at birth (years)
Life expectancy at age 60 (years)
Stillbirth rate (per 1000 total births)
Neonatal mortality rate (per 1000 live births)
Infant mortality rate (probability of dying by age 1 per 1000 live births)
Under-five mortality rate (probability of dying by age 5 per 1000 live births)
Adult mortality rate (probability of dying between 15 and 60 years of age per 1000 population)
3
6. 2. Cause-specific mortality and morbidity 63
Mortality
Age-standardized mortality rates by cause (per 100 000 population)
Number of deaths among children aged 5 years (000s)
Distribution of causes of death among children aged 5 years (%)
Age-standardized adult mortality rate by cause (ages 30–70 per 100 000 population)
Maternal mortality ratio (per 100 000 live births)
Cause-specific mortality rate (per 100 000 population)
Morbidity
Incidence rate (per 100 000 population per year)
Prevalence (per 100 000 population)
3. Selected infectious diseases 85
Cholera
Diphtheria
H5N1 influenza
Japanese encephalitis
Leprosy
Malaria
Measles
Meningitis
Mumps
Pertussis
Plague
Poliomyelitis
Congenital rubella syndrome
Rubella
Neonatal tetanus
Total tetanus
Tuberculosis
Yellow fever
4. Health service coverage 96
Unmet need for family planning (%)
Contraceptive prevalence (%)
Antenatal care coverage (%)
Births attended by skilled health personnel (%)
Births by caesarean section (%)
Postnatal care visit within two days of childbirth (%)
Neonates protected at birth against neonatal tetanus (%)
Immunization coverage among 1-year-olds (%)
Children aged 6–59 months who received vitamin A supplementation (%)
Children aged 5 years with ARI symptoms taken to a health facility (%)
Children aged 5 years with ARI symptoms receiving antibiotics (%)
Children aged 5 years with diarrhoea receiving ORT (ORS and/or RHF) (%)
Children aged 5 years sleeping under insecticide-treated nets (%)
Children aged 5 years with fever who received treatment with any antimalarial (%)
Pregnant women with HIV receiving antiretrovirals to prevent MTCT (%)
Antiretroviral therapy coverage among people with advanced HIV infection (%)
Case-detection rate for all forms of tuberculosis (%)
Treatment-success rate for smear-positive tuberculosis (%)
4
7. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
5. Risk factors 109
Population using improved drinking-water sources (%)
Population using improved sanitation (%)
Population using solid fuels (%)
Low-birth-weight newborns (%)
Infants exclusively breastfed for the first 6 months of life (%)
Children aged 5 years who are stunted (%)
Children aged 5 years who are underweight (%)
Children aged 5 years who are overweight (%)
Prevalence of raised fasting blood glucose among adults aged ≥25 years (%)
Prevalence of raised blood pressure among adults aged ≥25 years (%)
Adults aged ≥20 years who are obese (%)
Alcohol consumption among adults aged ≥15 years (litres of pure alcohol per person per year)
Prevalence of smoking any tobacco product among adults aged ≥15 years (%)
Prevalence of current tobacco use among adolescents aged 13–15 years (%)
Prevalence of condom use by adults aged 15–49 years during higher-risk sex (%)
Population aged 15–24 years with comprehensive correct knowledge of HIV/AIDS (%)
6. Health workforce, infrastructure and essential medicines 120
Health workforce
Number of physicians, and density per 10 000 population
Number of nursing and midwifery personnel, and density per 10 000 population
Number of dentistry personnel, and density per 10 000 population
Number of pharmaceutical personnel, and density per 10 000 population
Number of environmental and public health workers, and density per 10 000 population
Number of community health workers, and density per 10 000 population
Number of psychiatrists, and density per 10 000 population
Infrastructure
Hospital beds (per 10 000 population)
Psychiatric beds (per 10 000 population)
Computed tomography units (per million population)
Essential medicines
Median availability of selected generic medicines in public and private sectors (%)
Median consumer price ratio of selected generic medicines in public and private sectors
7. Health expenditure 133
Health expenditure ratios
Total expenditure on health as a percentage of gross domestic product
General government expenditure on health as a percentage of total expenditure on health
Private expenditure on health as a percentage of total expenditure on health
General government expenditure on health as a percentage of total government expenditure
External resources for health as a percentage of total expenditure on health
Social security expenditure on health as a percentage of general government expenditure on health
Out-of-pocket expenditure as a percentage of private expenditure on health
Private prepaid plans as a percentage of private expenditure on health
Per capita health expenditures
Per capita total expenditure on health at average exchange rate (US$)
Per capita total expenditure on health (PPP int. $)
Per capita government expenditure on health at average exchange rate (US$)
Per capita government expenditure on health (PPP int. $)
5
8. 8. Health inequities 145
Contraceptive prevalence (%)
Antenatal care coverage: at least four visits (%)
Births attended by skilled health personnel (%)
DTP3 immunization coverage among 1-year-olds (%)
Children aged 5 years who are stunted (%)
Under-five mortality rate (probability of dying by age 5 per 1000 live births)
9. Demographic and socioeconomic statistics 157
Total population (000s)
Median age of population (years)
Population aged 15 years (%)
Population aged 60 years (%)
Annual population growth rate (%)
Population living in urban areas (%)
Crude birth rate (per 1000 population)
Crude death rate (per 1000 population)
Total fertility rate (per woman)
Adolescent fertility rate (per 1000 girls aged 15–19 years)
Literacy rate among adults aged ≥15 years (%)
Net primary school enrolment rate (%)
Gross national income per capita (PPP int. $)
Population living on $1 (PPP int. $) a day (%)
Cellular phone subscribers (per 100 population)
10. Health information systems and data availability 169
Most recent census (year)
Civil registration coverage of births (%)
Cause-of-death registration – availability and coverage (%) in most recent year reported
Number of national population surveys of child anthropometry, child and maternal mortality,
HIV prevalence and adult health
Annex 1. Regional and income groupings 174
WHO regional groupings 174
Income groupings 175
6
9. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
Abbreviations
AARD average annual rate of decline
AIDS acquired immunodeficiency syndrome
AFR WHO African Region
AMR WHO Region of the Americas
ARI acute respiratory infection
DBP diastolic blood pressure
DHS Demographic and Health Survey
DTP3 3 doses of diphtheria-tetanus-pertussis vaccine
EML essential medicines list
EMR WHO Eastern Mediterranean Region
EUR WHO European Region
GDP gross domestic product
HAI Health Action International
HepB3 3 doses of hepatitis B vaccine
Hib3 3 doses of Haemophilus influenzae type B vaccine
HIV human immunodeficiency virus
ICD International Statistical Classification of Diseases and Related Health Problems
MCV measles-containing vaccine
MDG Millennium Development Goal
MICS Multiple Indicator Cluster Survey
MSH Management Sciences for Health
MTCT mother-to-child transmission
NCD noncommunicable disease
NHA national health account
ORS oral rehydration salts
ORT oral rehydration therapy
PPP Purchasing Power Parity
RHF recommended home fluid
SBP systolic blood pressure
SEAR WHO South-East Asia Region
WHA World Health Assembly
WPR WHO Western Pacific Region
7
10. Introduction
The World Health Statistics series is WHO’s annual ■■ risk factors
compilation of health-related data for its 194 Member ■■ health workforce, infrastructure and essential medi-
States1 and includes a summary of the progress made cines
towards achieving the health-related Millennium De- ■■ health expenditure
velopment Goals (MDGs) and associated targets. This
■■ health inequities
year, it also includes highlight summaries on the topics
of noncommunicable diseases, universal health cover- ■■ demographic and socioeconomic statistics
age and civil registration coverage. ■■ health information systems and data availability.
The series is produced by the WHO Department of The estimates given in this report are derived from mul-
Health Statistics and Information Systems of the In- tiple sources, depending on each indicator and on the
novation, Information, Evidence and Research Cluster. availability and quality of data. In many countries, statis-
As in previous years, World Health Statistics 2012 has tical and health information systems are weak and the
been compiled using publications and databases pro- underlying empirical data may not be available or may
duced and maintained by WHO technical programmes be of poor quality. Every effort has been made to ensure
and regional offices. A number of demographic and the best use of country-reported data – adjusted where
socioeconomic statistics have also been derived from necessary to deal with missing values, to correct for
databases maintained by a range of other organiza- known biases, and to maximize the comparability of the
tions. These include the United Nations International statistics across countries and over time. In addition,
Telecommunication Union (ITU), the United Nations statistical modelling and other techniques have been
Department of Economic and Social Affairs (UNDESA), used to fill data gaps.
the United Nations Educational, Scientific and Cultural
Organization (UNESCO), the United Nations Children’s Because of the weakness of the underlying empirical
Fund (UNICEF) and the World Bank. data in many countries, a number of the indicators pre-
sented here are associated with significant uncertainty.
Indicators have been included on the basis of their It is WHO policy to ensure statistical transparency, and
relevance to global public health; the availability and to make available to users the methods of estimation
quality of the data; and the reliability and compara- and the margins of uncertainty for relevant indicators.
bility of the resulting estimates. Taken together, these However, to ensure readability while covering such a
indicators provide a comprehensive summary of the comprehensive range of health topics, printed versions
current status of national health and health systems in of the World Health Statistics series do not include mar-
the following ten areas: gins of uncertainty; these are available from online WHO
■■ life expectancy and mortality databases such as the Global Health Observatory.2
■■ cause-specific mortality and morbidity
While every effort has been made to maximize the com-
■■ selected infectious diseases
parability of the statistics across countries and over
■■ health service coverage time, users are advised that country data may differ in
terms of the definitions, data-collection methods, pop-
ulation coverage and estimation methods used. More
1.
South Sudan became an independent state in July 2011 and a
WHO Member State in September 2011. As the reported data
shown here only concern the time before July 2011, the term 2.
The Global Health Observatory (GHO) is WHO’s portal pro-
“Sudan” as used here only refers to the state as it existed prior viding access to data and analyses for monitoring the global
to July 2011. health situation (see: http://www.who.int/gho).
8
11. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
detailed information on indicator metadata is available
in the WHO Indicator and Measurement Registry.3
WHO presents World Health Statistics 2012 as an in-
tegral part of its ongoing efforts to provide enhanced
access to comparable high-quality statistics on core
measures of population health and national health sys-
tems. Unless otherwise stated, all estimates have been
cleared following consultation with Member States and
are published here as official WHO figures. However,
these best estimates have been derived using stan-
dard categories and methods to enhance their cross-
national comparability. As a result, they should not be
regarded as the nationally endorsed statistics of Mem-
ber States which may have been derived using alterna-
tive methodologies.
3.
http://www.who.int/gho/indicatorregistry
9
14. Summary of status and trends
It is now more than a decade since world leaders ad- 2010. Although this rate of progress is close to the rate
opted the Millennium Development Goals (MDGs) and required to meet the relevant MDG target,4 improve-
their associated targets. In that time, substantial prog- ments have been unevenly distributed between and
ress has been made in reducing child and maternal within different regions.
mortality, improving nutrition, reducing morbidity and
mortality due to HIV infection, tuberculosis and malar- Globally, significant progress has been made in reduc-
ia, and increasing access to improved drinking-water ing mortality rates among children under five years old.
sources. These current trends provide a firm basis for Between 1990 and 2010, the under-five mortality rate
the intensified collective actions and expansion of suc- declined by 35% – from an estimated 88 deaths per
cessful approaches now needed to overcome the chal- 1000 live births to 57. The global rate of decline has
lenges posed by multiple crises and large inequalities. also accelerated in recent years – from 2.1% per an-
Although progress in settings with the highest rates of num during 1990–2010 to 2.6% during 2005–2010
mortality has been accelerated in recent years, large (Figure 1). The annual rate of decline in the WHO African
variations in health status persist both between and Region – where almost half of all child deaths occur –
within countries. increased from 1.8% during 1990–2010 to 2.8% during
2005–2010. Despite this improvement, most countries
Childhood malnutrition is the underlying cause of an in the Region are unlikely to achieve the MDG target of
estimated 35% of all deaths among children under five a two-thirds reduction in 1990 mortality levels by the
years of age. The proportion of such children in devel-
oping countries who were underweight is estimated to 4.
MDG 1; Target 1.C: Halve, between 1990 and 2015, the pro-
have declined from 29% to 18% between 1990 and portion of people who suffer from hunger.
Figure 1. verage annual rate of decline (%) in under-five mortality levels, 1990–2010 and 2005–2010
A
AFR
1990–2010
2005–2010
AMR MDG target
SEAR
EUR
EMR
WPR
Global
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5
(%)
12
15. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
year 2015. Globally, 37 out of 143 low- and middle- Table 1. Average annual rate of decline (%) in
income countries will reach that target by 2015 if the maternal mortality, 1990–2010
pace of progress achieved during the period 2005–
2010 is maintained. WHO region 1990–2010
AFR 2.7
In 2010, global measles immunization coverage was
AMR 2.5
85% among children aged 12–23 months. More coun-
tries are achieving high levels of measles immunization SEAR 5.2
coverage, with 65% of all countries either reaching or EUR 3.8
maintaining at least 90% coverage in 2010. Between EMR 2.6
2000 and 2010, the estimated number of measles
WPR 5.2
deaths decreased by 74%, accounting for about one
fifth of the overall reduction in child mortality. Global 3.1
Almost 20% of deaths in children under the age of five To reduce the number of maternal deaths, women
– mostly those due to pneumonia and diarrhoeal dis- need access to good-quality reproductive-health care
eases – are also preventable by vaccines. Efforts are and effective interventions. In 2008, 63% of women
therefore being made to expand interventions. For ex- aged 15–49 years who were married or in a consen-
ample, a rapidly increasing number of countries in the sual union were using some form of contraception,
WHO African Region, the WHO Region of the Americas while 11% wanted to stop or postpone childbearing
and the WHO Eastern Mediterranean Region have in- but were not using contraception. The proportion of
troduced pneumococcal conjugate vaccines in the past women receiving antenatal care at least once during
year with support from the GAVI Alliance. pregnancy was about 81% for the period 2005–2011,
but for the recommended minimum of four visits or
Despite a significant reduction in the number of ma- more the corresponding figure drops to around 55%.
ternal deaths – from an estimated 543 000 in 1990 to The proportion of births attended by skilled personnel
287 000 in 2010 – the rate of decline is just over half – crucial for reducing perinatal, neonatal and maternal
that needed to achieve the relevant MDG target.5 Be- deaths – is above 90% in three of the six WHO re-
tween 1990 and 2010, the global rate of decline was gions. However, increased coverage is needed in cer-
3.1% per annum, with lower rates in the WHO African tain regions, such as Africa where the figure remains
Region, WHO Region of the Americas and WHO East- less than 50% (Figure 2).
ern Mediterranean Region (Table 1). Approximately one
quarter of the countries with the highest maternal mor- About half the world’s population is at risk of malaria,
tality ratio in 1990 (≥100 maternal deaths per 100 000 and an estimated 216 million cases in 2010 led to ap-
live births) have made insufficient or no progress. proximately 655 000 deaths – 86% of these in children
under the age of five. In a total of eight countries and
one territory in the WHO African Region there was a
more than 50% reduction in either confirmed malaria
cases or malaria admissions and deaths. In other WHO
regions, the number of reported cases of confirmed
malaria decreased by more than 50% in 35 of the 53
5.
MDG 5; Target 5.A: Reduce by three quarters, between 1990
and 2015, the maternal mortality ratio. countries with ongoing transmission between 2000 and
13
16. Figure 2. Coverage of reproductive-health services
Unmet need for Contraceptive prevalence Antenatal care coverage: Births attended by
family planning, (any method), at least one visit, skilled health personnel,
2008 2008 2005–2011 2005–2011
100
80
60
(%)
40
20
0
Afr
Amr
Sear
Eur
Emr
Wpr
Global
Afr
Amr
Sear
Eur
Emr
Wpr
Global
Afr
Amr
Sear
Eur
Emr
Wpr
Global
Afr
Amr
Sear
Eur
Emr
Wpr
Global
2010, while downward trends of 25–50% were seen in Globally, the annual number of new cases of tubercu-
four other countries. The estimated incidence of ma- losis has been slowly falling since 2006. In 2010, there
laria fell globally by 1.8% per annum between 2000 and were an estimated 8.8 million new cases – approximate-
2009 (Figure 3). The coverage of interventions such as ly 13% of which occurred in people living with HIV. In
the distribution of insecticide-treated nets and indoor 2010, an estimated 1.1 million HIV-negative people died
residual spraying has greatly increased, and will need from tuberculosis, while an additional 0.35 million died
to be sustained in order to prevent the resurgence of from HIV-associated tuberculosis. Since 1990, mortality
disease and deaths caused by malaria. due to tuberculosis has fallen by just over one third –
though regional variations persist (Figure 4). In 2009, the
treatment-success rate reached 87% worldwide, repre-
senting the third successive year that the target of 85%
Figure 3. nnual decline (%) in malaria incidence,
A (first set by the World Health Assembly in 1991) was
2000–2009 exceeded. Although all six WHO regions are on course
Afr to achieve the relevant MDG target,6 multidrug-resistant
Amr tuberculosis continues to present significant problems.
Sear
Eur
In 2010, an estimated total of 2.7 million people were
Emr
newly infected with HIV – 15% less than the 3.1 million
Wpr
Global
0 –10 –20 –30 –40 –50
6.
MDG 6; Target 6.C: Have halted by 2015 and begun to reverse
(%) the incidence of malaria and other major diseases.
14
17. 01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
010010100110101010110010100101100101111010101001010100101010110001001
01010110001001101001101001011010101011000100110100110100101101010101
01101001100110100110011010011001101001100110100110011010011001101001
101001011001011110101010010101010010110010111101010100101010100101
0010011010011001001101001100100110100110010011010011001001101001
0010101010010101010010101010010101010010101010010101010010101010010101010010101
01101001100110100110011010011001101001100110100110011010011001101001
101100010101100010101100010101100010101100010101100010101100010101
01101001100110100110011010011001101001100110100110011010011001101001
010010101001010101100010011010010101001010101100010011010010101001010101
0110001001101001101001011010100110001001101001101001011010100110001001
100101111010010101001010010111101001010100101001011110100101010010100101
01101001100110100110011010011001101001100110100110011010011001101001
00101001101000101001101000101001101000101001101000101001101000101001
01101001100110100110011010011001101001100110100110011010011001101001
111010010101001010111010010111101001010100101011101001011110100101010010101
01101001100110100110011010011001101001100110100110011010011001101001
100101111010101001011001011110101010010110010111101010100101100101
01101001100110100110011010011001101001100110100110011010011001101001
010010110100001001011010000100101101000010010110100001001011010000100101
01101001100110100110011010011001101001100110100110011010011001101001
Figure 4. Trends in estimated tuberculosis mortality rates, 1990–2010 7
AFR AMR SEAR
50
40
per 100 000 population
30
20
10
0
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
EUR EMR WPR
50
40
per 100 000 population
30
20
10
0
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
people newly infected in 2001. In 22 countries in sub- Figure 5. umber of people with access to antiretroviral
N
Saharan Africa, a similar rate of decline has been ob- therapy and the number of people dying from
served over the past decade, but the number of cases in AIDS-related causes in low- and middle-
this region still accounts for 70% of all those who acquire income countries, 2002–2010
HIV infection globally. At the end of 2010, there were an 8
estimated 34 million people living with HIV – an increase
7 People dying from AIDS-related causes
on previous years. As access to antiretroviral therapy in
People receiving antiretroviral therapy
low- and middle-income countries expands (16 times
more people were treated in 2010 than in 2003), the 6
population living with HIV will continue to climb as fewer
5
individuals die from AIDS-related causes (Figure 5).7
Millions of people
4
Neglected tropical diseases are a group of 17 diseases8
endemic in 149 countries and which affect more than
3
1000 million people. With the exception of dengue and
leishmaniasis, these diseases rarely cause outbreaks, 2
7.
Estimated tuberculosis mortality excludes tuberculosis deaths 1
among HIV-positive people. Shaded areas represent margins
of uncertainty. 0
8.
For a list of the 17 neglected tropical diseases please see: 2002 2003 2004 2005 2006 2007 2008 2009 2010
http://www.who.int/neglected_diseases/diseases/en/
15
18. and thrive in the poorest, most marginalized commu- With regard to basic sanitation, current rates of prog-
nities, causing severe pain, permanent disability and ress are too slow for the MDG target to be met, both
death. Since 2007, a coordinated and integrated ap- globally (Figure 6) and within WHO regions – with the
proach has enabled WHO to reach a turning point in exception of the WHO Western Pacific Region. In 2010,
its efforts to overcome these diseases through the si- 2500 million people did not have access to improved
multaneous use of multiple safe and high-quality do- sanitation facilities, with 72% of these people living in
nated medicines. In the case of dracunculiasis, fewer rural areas. The number of people living in urban areas
than 1100 cases were reported in 2011 which would without access to improved sanitation is increasing be-
indicate that this disease is on the verge of eradication cause of rapid growth in the size of urban populations.
without the use of any medication or vaccine.
Although almost all countries publish an essential medi-
The world has now met the MDG target relating to ac- cines list, the availability of medicines at public health
cess to safe drinking-water.9 In 2010, 89% of the popu- facilities is often poor. Surveys conducted in more than
lation used an improved source of drinking-water com- 70 mainly low- and middle-income countries indicate
pared to 76% in 1990 (Figure 6). Progress has however that the average availability of selected generic medi-
been uneven in different regions. While coverage is at cines at health facilities was only 42% in the public
least 90% in four of the six WHO regions, it remains low sector and 64% in the private sector. The availability of
in the WHO African Region and WHO Eastern Mediter- medicines for the treatment of chronic noncommuni-
ranean Region. cable diseases (NCDs) is particularly poor when com-
pared with the availability of medicines for acute condi-
9.
MDG 7; Target 7.C: Halve, by 2015, the proportion of the pop- tions. In a study of 40 countries, the mean public sector
ulation without sustainable access to safe drinking-water and availability of generic chronic NCD medicines was 36%,
basic sanitation. while in the same facilities the availability of medicines
for acute conditions was 53.5%.10 A lack of medicines
Figure 6. lobal trends in the proportion of population
G in the public sector forces patients to purchase medi-
using safe drinking-water sources and cines from the private sector, where generic medicines
improved sanitation cost on average 610% more than their international
reference price. Such low public sector availability and
100
high private sector prices drive many families into cata-
strophic poverty, particularly those with a family mem-
Global water target ber suffering from a chronic NCD.
80
With less than four years to go before the end of 2015,
Global sanitation target it is clear that much remains to be done if the health-
Proportion of population (%)
related MDGs set out in 2000 are to be achieved. At
60
the same time, the world faces new challenges that will
need to be reflected in the ways in which progress is
measured after 2015.
40
Improved drinking-water source
20 Improved sanitation
10.
Cameron A et al. (2011). Differences in the availability of medi-
cines for chronic and acute conditions in the public and private
sectors of developing countries. Bulletin of the World Health
Organization, 89:412–421. Doi: 10.2471/BLT.10.084327
0
1990 1995 2000 2005 2010 (http://www.who.int/bulletin/volumes/89/6/10-084327/en/in-
dex.html).
16
