|HEALTH FOR ALL: REDIRECTING THE VISION
- by Lothar Wedekind, based on reports by Ms.Jordanka Mircheva, Robert Parr, Ms. Carla Fjeld, John Castelino, Vitomir Markovic, G. Ghopinathan Nair, David Kinley, and Paisan Loaharanu
Noble and all too needed, the goal of "health for all" into the next century has driven the medical profession to new heights throughout the past decade. In its latest global status report, the World Health Organization reports significant progress in campaigns against a body of major human diseases - including smallpox, polio, leprosy, and the disabling Chagas disease.
But changing patterns of how and where we live have brought other, in some ways more troubling, challenges to national and global health agendas. Many problems are attributed to negative ripple effects of urbanization - overcrowded cities, polluted air and water, poor and unsafe living conditions, and strained health resources, especially for preventive care. Cancer became a serious and more visible problem in developing countries. So, too, did "hidden hunger", or malnutrition, particularly in children; illnesses linked to food contamination; deaths from re-emerging infectious diseases such as malaria; and sickness caused by health dangers in our environment.
At the start of the 1990s, more than 600 million men, women, and children lived in large cities in developing countries that are threatened by lack of food, water, and adequate health care. More than half of the developing world's citizens could be concentrated in urban areas when this decade closes. Undeniable interconnections between political, social, and economic conditions, and the state of our health, emerged magnified from the decade.
The fast-developing picture accelerated the need to find out more about the detection, prevention, and treatment of diseases. More countries turned to the IAEA's expertise and specialized health and analytical services. IAEA health-related projects today number 175, up seventy-five percent over the past fifteen years. The investment is valued at nearly $48 million over that period for improving national health-care capabilities at hospitals, clinics, and laboratory facilities. By the mid-1990s, most of the Agency's 125 Member States had set up medical programmes involving uses of nuclear tools, ranging from radiopharmaceuticals, to nuclear analytical techniques, imaging systems, and radiotherapy.
Especially in the 1990s the Agency's programmes in human health have adjusted to better fit the changing needs and conditions. Outreach efforts were broadened and objectives finetuned for specific problems that can best be met by nuclear techniques. Among them stand the early diagnosis and treatment of cancer, the assessment of nutritional deficiencies in women and children, the timely detection of communicable diseases, and the accurate measurement of radiation doses to patients.
The upswing in demands and related programme adjustments are opening new windows of opportunity for better health care through nuclear applications in more countries. They also identified new doors that must be unlocked to sustain progress.
- Diagnosis and treatment of cancer has advanced considerably over the past decades. In industrialized countries, "cure" rates have doubled since the IAEA was formed in the 1950s, achievements generally attributed to earlier and better diagnostic screening and to advances in surgery, radiation, and chemotherapy treatments. In developing countries, however, more help is needed as cancer takes a stronger hold. With national research teams, the IAEA is coordinating clinical trials in radiotherapy to improve treatment and control of the disease. New treatment centres also are being supported. In Mongolia, nearly 2400 patients were treated at a new teletherapy centre within its first five months. In Ghana, the first of three planned radiotherapy centres now serves cancer patients who otherwise had to seek expensive treatment overseas, or go without it. To evaluate radiation treatments against global standards, a joint IAEA/WHO programme has expanded its network of services.
- In Thailand, Uruguay, and other countries of Asia, Latin America, and Africa, communities need help for potentially crippling children's health problems. Some notable strides are linked to greater use of highly sensitive nuclear techniques, sometimes teamed with biomedical methods. Their reliable and affordable application now is supporting effective national screening programmes of all-too-common thyroid deficiencies in newborn babies and children.
Photo: Children in Viet Nam. (Tuong Linh for UNESCO/ACCU)
- Because its effects are too often masked and overlooked, "hidden hunger", or malnutrition, can take on serious proportions. By the mid-1990s, health experts reported that nearly 800 million people in developing countries were chronically undernourished. Most at risk are women and children living in poverty. Though nuclear-based techniques are no substitute for nutritional deficiencies, they do support improved health monitoring and research programmes to uncover and prevent cases of hidden hunger. Joining with global partners, IAEA-sponsored research and field projects now extend to more than thirty countries. The work has identified improvements to the dietary treatment of severely malnourished children and alerted health practitioners to specific diet deficiencies of protein, vitamins, zinc, iron, and iodine needed for proper nourishment and growth. As importantly, it has led to stronger public health programmes in more countries, including Chile, Sri Lanka, and Venezuela, for setting nationally recommended nutritional requirements. Now planned is distribution of a "toolkit" of proven isotope techniques that countries can readily use in their nutrition programmes.
- More needs to be known about the causes and health effects of environmental pollutants contaminating our air, water, and food. Over the past decade, more than forty countries have intensified cooperative research and analysis of non-radioactive pollutants, including mercury and pesticide residues, through Agency programmes. Air pollution, particularly fine particles, has drawn close attention, since particulates can settle deep in lungs, potentially causing serious illness or death. Findings add to valuable data shared through an established global network of centres that collects and analyzes airborne samples. The work helps health and environmental authorities more effectively identify and monitor pollutants as part of health protection measures.
- In different ways, other types of radiation technologies are being used to remove pollutants from industrial emissions before they enter the atmosphere. One method, known as electron beam processing, gained ground over the past decade through demonstrations in several countries with Agency support. In Poland, an industrial-scale demonstration plant for removing sulphur dioxide and nitrogen oxide - causes of "acid rain" and linked to respiratory diseases - from emissions at coal-burning power plants. Demonstrated costs of the cleaning process are lower than conventional systems. Other countries now interested include Brazil, Bulgaria, China, and Mexico.
- Alarming reports of food contamination over the past decade became a driving force for greater interest in the technology of food irradiation. Foodborne illnesses traced to contaminated poultry and meats led the United States to approve food irradiation's commercial use for the products, since the technology cleans them of contaminating microorganisms. At the international level, Golden Rule #1 of the World Health Organization's ten-point food safety advisory issued in the 1990s encourages consumers to choose poultry treated with ionizing radiation whenever they can.
- Medical research laboratories worldwide continue to be tested by new and resurging infectious diseases. In Latin America and Africa, IAEA-supported work initiated over the past decade aims to improve diagnostic capabilities. Researchers are being trained in the use of biomedical techniques, including radioactive DNA probes, for more effectively diagnosing communicable diseases, as a step to help control them. Chagas disease in parts of Latin America, malaria in Africa, and tuberculosis in other regions are among diseases under study.
Progress is important: the re-emerging threat of malaria, for instance, still is known to strike more than 300 million people in 103 countries and claimed the lives of one million children alone in 1995. Against Chagas disease, the fight is gaining ground: WHO reports that ongoing efforts in Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay soon will eliminate the disease.
- In Asia, eye surgeons have long been served by Sri Lanka's eye bank. More than 10,000 Sri Lankans have regained their vision with the bank's help, and surgeons in sixty countries have received tens of thousands of corneas needed by their patients. With the IAEA's assistance through a regional project of thirteen Asian countries over the past decade, such medical services are expanding. They include a new medical bank in Colombo that sterilizes membranes, tendons, and other tissues needed to treat severely injured patients such as burn victims. The bank is intended to serve health needs throughout the region.
Sri Lanka's facility reflects heightened interest among more countries in radiation sterilization of medical products for hygienic and safety reasons. By the mid-1990s, the technology had become the preferred method to sterilize about half of all the disposable needles, scalpels, and other medical supplies used in hospitals, clinics, and medical centres around the world.
Through these and other avenues, vital progress is being made to more strongly arm countries against emerging and re-emerging dangers to human health. In key applications, nuclear and related techniques can give doctors unparalleled insights into what is happening in the human body without the need for incisions or surgery. Other tools enable researchers to track and analyze causes and sources of potential health hazards, so that steps can be taken to prevent them. In no small measure, the work is helping to extend the reach of key medical technologies, to bring into closer view the global vision of health for all.
Photo: Patients being helped at the National Cancer Institute in Bogotā. (Perez-Vargas/IAEA)