Fewer children at risk for deficient vitamin D

Under new guidelines from the Institute of Medicine, the estimated number of children who are at risk of having insufficient or deficient levels of vitamin D is drastically reduced from previous estimates, according to a Loyola University Chicago Stritch School of Medicine study.

The study, led by Holly Kramer, MD, MPH, and Ramon Durazo-Arvizu, PhD, is published online ahead of print in the Journal of Pediatric Endocrinology and Metabolism.

New Institute of Medicine guidelines say most people get sufficient vitamin D when their blood levels are at or above 20 nanograms per milliliter (ng/mL). The Pediatric Endocrine Society has a similar guideline. However, other guidelines recommend vitamin D levels above 30 ng/mL.

Loyola researchers studied vitamin D data from a nationally representative sample of 2,877 U.S. children and adolescents ages 6 to 18 who participated in the National Health and Nutrition Examination Survey.

The study found that under the Institute of Medicine guidelines, 10.3 percent of children ages 6 to 18 are at risk of inadequate or deficient vitamin D levels. (This translates to an estimated 5.5 million children.)

By comparison, a 2009 study in the journal Pediatrics, which defined sufficient vitamin D levels as greater than 30 ng/mL, found that an estimated 70 percent of people ages 1 to 21 had deficient or insufficient vitamin D levels.

Under previous guidelines, millions of children who had vitamin D levels between 20 and 30 ng/mL would have needed supplementation. Under the Institute of Medicine guidelines, children in this range no longer need to take vitamin D supplements.

The new study found that children at risk of vitamin D deficiency under the Institute of Medicine guidelines are more likely to be overweight, female, non-white and between the ages of 14 and 18.

The Institute of Medicine's new vitamin D guidelines are based on nearly 1,000 published studies and testimony from scientists and other experts. The IOM found that vitamin D is essential to avoid poor bone health, such as rickets. But there have been conflicting and mixed results in studies on whether vitamin D can also protect against cancer, heart disease, autoimmune diseases and diabetes. Moreover, excessive vitamin D can damage the kidneys and heart, the IOM found.

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Twenty-five percent of breast cancer survivors report financial decline due to treatment

Four years after being treated for breast cancer, a quarter of survivors say they are worse off financially, at least partly because of their treatment, according to a new study led by University of Michigan Comprehensive Cancer Center researchers. In addition, 12 percent reported that they still have medical debt from their treatment.

Financial decline varied significantly by race, with Spanish-speaking Latinas most likely to be impacted. Debt was reported more frequently in English-speaking Latinas and Blacks, the study found. Results appear in the Journal of Clinical Oncology.

"As oncologists, we are proud of the advances in our ability to cure an increasing proportion of patients diagnosed with breast cancer. But as treatments improve, we must ensure that we do not leave these patients in financial ruin because of our efforts," says study author Reshma Jagsi, M.D., D.Phil., associate professor of radiation oncology at the University of Michigan Medical School.

The researchers surveyed women in Detroit and Los Angeles who had been diagnosed with early stage breast cancer, based on data obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results population-based registry. Women were surveyed about nine months after diagnosis and again about four years later, with 1,502 women responding to both surveys.

The surveys asked about patients' perceptions of whether they were worse off financially since their diagnosis, and whether that has caused long-term challenges. For example, patients were asked if they had altered their medical care because of financial concerns, by skipping medication or by missing a doctor's appointment or a mammogram. Other questions looked at broader hardships, such as going without health insurance, having utilities turned off or moving out of their home.

Blacks and English-speaking Latinas were more likely than Whites to have experienced one of these issues. Other factors that made a woman more likely to experience these hardships include age under 65, household income under $50,000, part-time work at diagnosis, reduced work hours after diagnosis, lack of substantial prescription drug coverage, breast cancer recurrence, and undergoing chemotherapy.

"These patients are particularly vulnerable to financial distress," Jagsi says. "We need to ensure appropriate communication between patients and their doctors regarding the financial implications of a cancer diagnosis and treatment decisions to help reduce this long-term burden."

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State-of-the-state on genetic-based testing, treatment for breast cancer revealed

Dartmouth researchers at its Norris Cotton Cancer Center have compiled a review of the role that information gathered through genetic testing plays in the diagnosis and treatment of breast cancer. The paper entitled "Personalized Therapy for Breast Cancer" was accepted on March 17, 2014, for publication in Clinical Genetics. The paper discusses targeted therapies, new biomarkers, and the quality of commercially available testing methods.

Genomic testing is changing the way breast cancer is diagnosed and treated. By examining a woman's genes to look for specific mutations or biomarkers, treatment can be personalized to the tumor cell's biology and a woman's genetics.

"A personalized approach increases the precision and success of breast cancer treatment," said Gregory Tsongalis, PhD, director of Molecular Pathology at Norris Cotton Cancer Center and lead author of the paper. "Molecular profiling exposes a tumor's Achilles' heel. We can see what messages the tumor cells are receiving and sending. It is a biological intelligence gathering mission in an attempt to interrupt the disease.

According to Tsongalis large scale genetic testing of breast cancer is not yet part of routine clinical care as it is with lung and colon cancers, even though he and his team run a genetics laboratory for routine cancer care. Genetic testing according to Tsongalis is a powerful weapon in the diagnosis and treatment of breast cancer.

With results from the genetic testing of a tumor cell's biology, clinicians categorize breast cancer in ways that allow them to select the most effective treatments. Based on genetic biomarkers, there are three categories of breast cancer:

1. ER-positive breast cancer needs hormones, such as estrogen to grow. Estrogen fuels cancer cell growth, stops cancer cells from dying, and helps the cells lay down roots to maintain blood supply for tumors. ER-positive cancers are less aggressive and often treated with drugs that are selective estrogen receptor modulators (SERM), such as Tamoxifen, Raloxifene, Toremifene and aromatese inhibitors (AIs) such as Letrozole, Anastrozole and Exemestane. SERM drugs block estrogen from telling cancer cells to divide and grow; they have been shown successful in treating as well as preventing ER positive breast cancer. AIs block intake of estrogen in the system and reduce estrogen levels in serum, tissue, and tumor cells. AIs are commonly used in post-menopausal women.
2. HER2 -positive breast cancer cells contain large amounts of protein that help them grow and multiply. Medications turn off the production of protein to stop tumor growth and kill cancer cells. HER2 treatments include Trastuzumab, Laptinib, Pertuzumab, and Trastuzumab Emtansine.
3. Triple negative (ER-negative/PR-negative/HER2-negative) breast cancer is the most aggressive type and has the poorest clinical outcome. There is no approved personalized therapy for triple negative, but research has identified six subtypes of tumors. This is the first step in identifying biomarkers that can lead to the development of personalized treatments.

"Genomic testing of breast cancer has expanded our understanding of the disease process and has proven more effective than traditional laboratory tests," said Tsongalis. "At NCCC all of our breast cancer patients are tested for abnormal copies of the HER2 gene using specially designed DNA probes. New biomarkers and the reclassification of cancers based on these biomarkers has led to the development of new, effective treatments that can be personalized to an individual breast cancer patient."

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Plasma tool for destroying cancer cells

Plasma medicine is a new and rapidly developing area of medical technology. Specifically, understanding the interaction of so-called atmospheric pressure plasma jets with biological tissues could help to use them in medical practice.

Under the supervision of Sylwia Ptasinska from the University of Notre Dame, in Indiana, USA, Xu Han and colleagues conducted a quantitative and qualitative study of the different types of DNA damage induced by atmospheric pressure plasma exposure, the paper is published inThe European Physical Journal D, as part of a special issue on nanoscale insights into Ion Beam Cancer Therapy. This approach, they hope, could ultimately lead to devising alternative tools for cancer therapy as well as applications in hospital hygiene, dental care, skin diseases, antifungal care, chronic wounds and cosmetics treatments.

To investigate the DNA damage from the so-called non-thermal Atmospheric Pressure Plasma Jet (APPJ), the team adopted a common technique used in biochemistry, called agarose gel electrophoresis. They studied the nature and level of DNA damage by plasma species, so-called reactive radicals, under two different conditions of the helium plasma source with different parameters of electric pulses.

They also identified the effect of water on DNA damage. To do so, they examined the role of reactive radicals involved in DNA damage processes occurring in an aqueous environment. They then compared them to previous results obtained in dry DNA samples.

The next step would involve investigating plasma made from helium mixtures with different molecular ratios of other gases, such as oxygen, nitrous oxide, carbon dioxide and steam, under different plasma source conditions. The addition of another gas is expected to increase the level of radical species, such as reactive oxygen species and reactive nitrogen species, known to produce severe DNA damage. These could, ultimately, help to destroy cancerous tumour cells.

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WHO opens public consultation on draft sugars guideline

5 March 2014 | GENEVA - WHO is launching a public consultation on its draft guideline on sugars intake. When finalized, the guideline will provide countries with recommendations on limiting the consumption of sugars to reduce public health problems like obesity and dental caries (commonly referred to as tooth decay).

Comments on the draft guideline will be accepted via the WHO web site from 5 through 31 March 2014. Anyone who wishes to comment must submit a declaration of interests. An expert peer-review process will happen over the same period. Once the peer-review and public consultation are completed, all comments will be reviewed, the draft guidelines will be revised if necessary and cleared by WHO’s Guidelines Review Committee before being finalized.

New draft guideline proposals

WHO’s current recommendation, from 2002, is that sugars should make up less than 10% of total energy intake per day. The new draft guideline also proposes that sugars should be less than 10% of total energy intake per day. It further suggests that a reduction to below 5% of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around 6 teaspoons) of sugar per day for an adult of normal Body Mass Index (BMI).

The suggested limits on intake of sugars in the draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.

Much of the sugars consumed today are “hidden” in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of sugars. A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of sugar.

The draft guideline was formulated based on analyses of all published scientific studies on the consumption of sugars and how that relates to excess weight gain and tooth decay in adults and children.

• Read the draft guideline and submit your comments

Note to editors

Papers published with findings of two systematic reviews (analyses of published scientific studies) commissioned by WHO that informed the development of the draft guidelines:

• Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies
  Conducted by the University of Otago, New Zealand) published in the BMJ
• Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines
  Conducted by Newcastle University, UK) published in the Journal of Dental Research

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

Glenn Thomas
WHO, Geneva
WHO Communications Officer
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail:thomasg@who.int

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Message from WHO Director-General on International Women’s Day

On this day, WHO joins others in celebrating women’s achievements. These achievements are inspiring, and they can inspire change. In health development, as in many other areas, women are agents of change. They are the driving force that creates better lives for families, communities and, increasingly, the countries they have been elected to govern.

As I have learned from my discussions with parliaments in several countries, women are increasingly winning top leadership roles, in rich and poor countries alike, and this helps shape entire societies in broadly beneficial ways. Every time a women excels in a high-profile position, her achievement lifts the social status of women everywhere.

To inspire change, all women need to be free to achieve their full potential. This means freedom from all forms of discrimination, freedom to pursue all opportunities, including education, freedom to earn and spend their own income, and freedom to follow the career paths they decide they want.

The health sector can do much to free women by ensuring they have access to all the health services they need, including sexual and reproductive health services. Participants at last year’s London Summit on Family Planning achieved a breakthrough commitment to halve the number of girls and women in developing countries who want modern contraceptives but have no access. This commitment will give 120 million additional women the right to decide whether, when, and how many children they want to have. This, too, is freedom.

Throughout history, women have been associated with care and compassion. Worldwide, up to 80% of health care is provided in the home, almost always by women. This should inspire our admiration, but it should also underscore the need for change. Most of this work is unsupported, unrecognized, and unpaid.

Polio is on the verge of eradication largely thanks to the millions of women – from vaccinators to administrators to medical doctors and mothers – who have made the vaccination and protection of children their life’s mission. On this International Women’s Day, let me thank these women for a level of dedication that can improve the world in a permanent way.

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WHO issues new guidance on how to provide contraceptive information and service

6 March 2014 | GENEVA - In advance of International Women’s Day on 8 March 2014, WHO is launching new guidance to help countries ensure human rights are respected in providing more girls, women, and couples with the information and services they need to avoid unwanted pregnancies.

An estimated 222 million girls and women who do not want to get pregnant, or who want to delay their next pregnancy, are not using any method of contraception. Access to contraception information and services will allow better planning for families and improved health.

WHO guidance recommendations

“Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health.”

Dr Flavia Bustreo, WHO’s Assistant Director-General for Family, Women, and Children’s Health

The guidance recommends that everyone who wants contraception should be able to obtain detailed and accurate information, and a variety of services, such as counselling as well as contraceptive products. It also underlines the need for no discrimination, coercion or violence, with special attention given to assuring access to those who are disadvantaged and marginalized.

Other key measures are scientifically accurate sex education programmes for young people, including information on how to use and acquire contraceptives. The guidance states that adolescents should be able to seek contraceptive services without having to obtain permission from parents or guardians. It also recommends that women be able to request services without having to obtain authorization from their husbands. It emphasizes the importance of respecting the privacy of individuals, including confidentiality of medical and other personal information.

“A lack of contraception puts 6 out of 10 women in low-income countries at risk of unintended pregnancy,” says Dr Flavia Bustreo, WHO’s Assistant Director-General for Family, Women, and Children’s Health. “Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health. These unintended pregnancies can pose a major threat to their own and their children’s health and lives.”

Access to contraception

In low- and middle-income countries, complications of pregnancy and childbirth are among the leading cause of death in young women aged 15–19 years. Stillbirths and death in the first week of life are 50% higher among babies born to mothers younger than 20 years than among babies born to mothers 20–29 years old.

Access to contraception allows couples to space pregnancies and enables those who wish to limit the size of their families to do so. Evidence suggests that women who have more than four children are at increased risk of death from complications of pregnancy and childbirth.

Many people who cannot currently access contraception services are young, poor, and live in rural areas and urban slums. Efforts are under way to address this need. The 2012 London Summit on Family Planning committed to extend family planning services to at least 120 million more people by the year 2020.

“Global targets are stimulating much needed action to increase access to modern contraception,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “But we have to be careful that our efforts to meet those targets do not lead to human rights infringements. It is not just about increasing numbers, it’s also about increasing knowledge. It is vital for women—and men—to understand how contraception works, be offered a choice of methods, and be happy with the method they receive.”

The International Conference on Population and Development held in Cairo in 1994 highlighted the importance of a rights-based approach to family planning. The past 20 years have seen a large amount of work demanding and defining a rights-based approach to health services—including contraception. Yet there has been comparatively little practical advice how to do so. WHO’s new guidance aims to address that gap.

The guidance also suggests ways to improve supply chains and affordability, recommends additional training for health workers, and outlines a series of steps to improve access in crisis settings, in HIV clinics, and during pre-natal and post-natal care.

The new guidance complements existing WHO recommendations for sexual and reproductive health programmes, including guidance on maternal and newborn health, sexuality education, prevention of unsafe abortion, and core competencies for primary health care.

For more information, please contact:

Glenn Thomas
WHO Communications Officer
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

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Many countries lack capacity to prevent and treat hearing loss

28 February 2014 | GENEVA - Many of the countries who responded to a new WHO survey lack the capacity to prevent and care for hearing loss, according to a report published on International Ear Care Day, 3 March.

Results of the survey

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level.”

Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability

WHO estimates that over 5% of the world’s population – 360 million people - has disabling hearing loss. The highest prevalence is found in the Asia Pacific, South Asia and sub-Saharan Africa. About half of all cases of hearing loss worldwide are easily prevented or treated.

A leading cause for hearing loss in younger ages, particularly in low- and middle-income countries, is untreated ear infections, which often presents with discharge from the ear. Vaccine-preventable infectious diseases such as rubella, meningitis, measles, or mumps can also lead to hearing loss.

Just 32 of the 76 countries who responded have developed plans and programmes to prevent and control ear diseases and hearing loss. According to the report, many lack trained health personnel, educational facilities, data and national plans to address the needs of those living with ear and hearing problems. The information received also indicates that the gap between need and services is greatest in sub-Saharan Africa.

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level,” says Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability. “The programmes must aim to benefit all, including disadvantaged parts of the population who are least able to access hearing services.”

Prevention and treatment of hearing loss at primary level

Good ear care practices, such as reducing exposure to noise and avoiding insertion of objects into the ears, can prevent many from developing ear and hearing problems. A large percentage of people living with hearing loss can benefit from early identification and appropriate treatment.

For example, screening programmes for infant hearing can minimize the impact of hearing loss on a child’s development.

“Ear and hearing problems and the use of hearing aids are often associated with myths and misconceptions”, says Dr Shelly Chadha of the WHO unit for the Prevention of Blindness and Deafness. “National programmes should therefore not only focus on prevention and service provision but also on awareness raising.”

The national plans that already exist in some countries can serve as a model for countries that still lack strategies to better address disabling hearing loss. However, each country needs to develop a unique plan based on its specific situation, the prevalent causes of hearing loss as well as the available health infrastructure.

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

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Progress in diagnosing multidrug-resistant tuberculosis

20 March 2014 | Geneva - Almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of access to quality diagnostic services.

But with an innovative international project, 27 countries are making promising progress in diagnosing MDR-TB, says WHO in the lead-up to World TB Day, 24 March.

The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

“Earlier and faster diagnosis of all forms of TB is vital,” says Dr Margaret Chan, WHO Director-General. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

World TB Day 2014: Reach the 3 million

"Earlier and faster diagnosis of all forms of TB is vital. It improves the chances of people getting the right treatment and being cured...”

Dr Chan, WHO Director-General

The theme for World TB Day 2014 is “Reach the 3 Million”. One third of the estimated 9 million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than 2 months to get results.

But the situation is beginning to change. New technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours.

“The MDR-TB story is being transformed by a fertile mix of collaborators, including those working on access to diagnosis,” says Philippe Meunier, the French Government’s Ambassador for the fight against HIV/AIDS and communicable diseases. “Increased capacity and reduced prices mean more patients can be served, and global health risks would be diminished.”

In 2009, UNITAID provided US$ 87 million to support the EXPAND-TB multi-partner project to enable effective and sustained access, and use of recommended new TB diagnostic technologies in 27 low- and middle-income countries. These countries together carry 40% of the estimated global MDR-TB burden.

The project delivers positive results

The project has delivered impressive results. Over 30% of the MDR-TB cases detected globally in 2012 were from EXPAND-TB countries. 90% of India’s detected MDR-TB cases were through EXPAND-TB supported services. Use of these tests requires strengthened laboratory services. By the end of 2013, 92 laboratories were fully operational. From 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

The project has enabled more patients to be treated with quality-assured second-line TB medicines. Through that demand, the project has helped to reduce the price of individual medicines and MDR-TB treatment regimens by one third. Prices have also dropped for diagnostic commodities.

Project partners are WHO and the Global Laboratory Initiative (GLI), the Stop TB Partnership’s Global Drug Facility and FIND. Project funds have been used to purchase testing equipment and commodities, and to train laboratory technicians.

The EXPAND-TB project complements investments in laboratory infrastructure and diagnostic services from international partners, including The Global Fund to Fight AIDS, TB and Malaria, The World Bank and the United States Government.

“The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB,” says Dr Mario Raviglione, Director of WHO’s Global TB Programme.

Ministries of health are now working on securing domestic funding for the medium-term and working with partners to fill financing shortfalls for quality diagnostic tests and services.

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Note to editors

EXPAND-TB Partners, and additional quotes from participants in the 20 March press briefing

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

UNITAID is a global health initiative launched in 2006 by the Governments of Brazil, Chile, France, Norway and the United Kingdom to provide sustainable funding for the fight against HIV/AIDS, malaria and tuberculosis. About 70% of UNITAID’s funds come from a small levy on airline tickets. Through implementers, UNITAID finances the purchase of quality-assured drugs and diagnostics for patients in poor countries, using its market power to expand supply, promote development of new and better products, cut delivery lead times and reduce prices.

Dr Philippe Duneton, Executive Director a.i., UNITAID said, “The EXPAND-TB project has been an important part of UNITAID’s TB investment portfolio as identifying cases has been, and remains, essential. To reach the missing three million, we must continue to find and use ever-better diagnostics technologies, but also enable access for low- and middle-income countries to the new medicines now available.”

The Stop TB Partnership’s Global Drug Facility (GDF) coordinates and manages procurement and delivery of TB commodities like quality assured medicines, diagnostic equipment and supplies to eligible countries, offering as well technical assistance for building more sustainable supply chain systems. The GDF has procured and distributed diagnostics and laboratory equipment for the project and, by pooling the global demand for Second Line anti-TB Drugs within one single procurement platform, has reached up to 32% cost reduction for MDR-TB treatment, bringing a broader basis of suppliers producing quality assured medicines and allowing more market competition.

“We need to ensure that diagnostics are accessible and closer to people. This project is a successful multi-partner strategic approach where diagnostic, treatment capacity and medicines supply have been linked together, showing the path for a stronger fight against MDR-TB " said Dr Joel Keravec, GDF Special Advisor.

FIND is an international non-profit organization that drives development and delivery of innovative diagnostic solutions for poverty-related diseases. As the main implementing partner for EXPAND-TB, FIND works closely with national TB programmes and multiple international and local partners to build laboratory capacity, accelerate uptake and establish the know-how needed for correct use of new TB technologies. FIND helps ensure that all the key components that are needed for successful diagnostic implementation are put in place, and aims to maximise patient impact.

Dr Catharina Boehme, FIND’s Chief Executive Officer, said “Without diagnostics, medicine is blind. The EXPAND TB project is critical for scaling up the capacity to detect TB drug resistance. It has also laid the ground for rapid uptake and proper use of future diagnostic innovations that are urgently needed to effectively fight TB and drug resistance. Continued commitment from the global health community in support of new tools, especially point-of-care diagnostics, should remain a high priority.”

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For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Tel.: +41 22 791 5099
Email: jasarevict@who.int

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7 million premature deaths annually linked to air pollution

25 March 2014 | Geneva - In new estimates released today, WHO reports that in 2012 around 7 million people died - one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.

New estimates

In particular, the new data reveal a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischaemic heart disease, as well as between air pollution and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases.

The new estimates are not only based on more knowledge about the diseases caused by air pollution, but also upon better assessment of human exposure to air pollutants through the use of improved measurements and technology. This has enabled scientists to make a more detailed analysis of health risks from a wider demographic spread that now includes rural as well as urban areas.

Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.

“Cleaning up the air we breathe prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly...”

Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health

“Cleaning up the air we breathe prevents noncommunicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly,” says Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health. “Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves.”

Included in the assessment is a breakdown of deaths attributed to specific diseases, underlining that the vast majority of air pollution deaths are due to cardiovascular diseases as follows:

Outdoor air pollution-caused deaths – breakdown by disease:

• 40% – ischaemic heart disease;
• 40% – stroke;
• 11% – chronic obstructive pulmonary disease (COPD);
• 6% - lung cancer; and
• 3% – acute lower respiratory infections in children.

Indoor air pollution-caused deaths – breakdown by disease:

• 34% - stroke;
• 26% - ischaemic heart disease;
• 22% - COPD;
• 12% - acute lower respiratory infections in children; and
• 6% - lung cancer.

The new estimates are based on the latest WHO mortality data from 2012 as well as evidence of health risks from air pollution exposures. Estimates of people’s exposure to outdoor air pollution in different parts of the world were formulated through a new global data mapping. This incorporated satellite data, ground-level monitoring measurements and data on pollution emissions from key sources, as well as modelling of how pollution drifts in the air.

Risks factors are greater than expected

“The risks from air pollution are now far greater than previously thought or understood, particularly for heart disease and strokes,” says Dr Maria Neira, Director of WHO’s Department for Public Health, Environmental and Social Determinants of Health. “Few risks have a greater impact on global health today than air pollution; the evidence signals the need for concerted action to clean up the air we all breathe.”

After analysing the risk factors and taking into account revisions in methodology, WHO estimates indoor air pollution was linked to 4.3 million deaths in 2012 in households cooking over coal, wood and biomass stoves. The new estimate is explained by better information about pollution exposures among the estimated 2.9 billion people living in homes using wood, coal or dung as their primary cooking fuel, as well as evidence about air pollution's role in the development of cardiovascular and respiratory diseases, and cancers.

In the case of outdoor air pollution, WHO estimates there were 3.7 million deaths in 2012 from urban and rural sources worldwide.

Many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply be added together, hence the total estimate of around 7 million deaths in 2012.

“Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains,” says Dr Carlos Dora, WHO Coordinator for Public Health, Environmental and Social Determinants of Health. “WHO and health sectors have a unique role in translating scientific evidence on air pollution into policies that can deliver impact and improvements that will save lives.”

The release of today’s data is a significant step in advancing a WHO roadmap for preventing diseases related to air pollution. This involves the development of a WHO-hosted global platform on air quality and health to generate better data on air pollution-related diseases and strengthened support to countries and cities through guidance, information and evidence about health gains from key interventions.

Later this year, WHO will release indoor air quality guidelines on household fuel combustion, as well as country data on outdoor and indoor air pollution exposures and related mortality, plus an update of air quality measurements in 1600 cities from all regions of the world.

For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Telephone: +41 22 791 5099
E-mail: jasarevict@who.int

Glenn Thomas
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Nada Osseiran
Communications Officer, Department of Public Health, Environmental and Social Determinants of Health
Telephone: +41 22 791 4475
Mobile: +4179 445 1624
E-mail: osseirann@who.int

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