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Dr Ebrahim Samba, from Gambia, has been the World Health Organisation's regional director for Africa since 1995

BMJ 1998; 316 doi: (Published 03 January 1998) Cite this as: BMJ 1998;316:7
  1. Fiona Godlee

    What do you see as the major health challenges of the next five years, and how should the WHO address them?

    • Economic: because of the unfavourable economic climate fewer resources are being allocated to health by the national and international communities. Poverty is increasing in the developing world, especially in Africa. The gap between the rich and the poor is widening. With globalisation of the world economy the poor are at a disadvantage.

    • Political: political will is always positive, but it is rarely matched with concrete action. Political instability and civil wars result in millions of refugees and displaced persons, with attendant ill health, disability, and death.

    • Technical: tools and the means for controlling emerging and re-emerging diseases such as AIDS, ebola disease, malaria, and tuberculosis are lacking. We have to pay special attention to the health implications of some technologies in industry and agriculture.

    • Environmental: adverse environmental changes are causing floods, drought, and variations in epidemiology patterns of infectious diseases such as malaria, trypanosomiasis, yellow fever, and meningitis.

    • Behavioural: lifestyle factors, such as smoking, alcohol consumption, use of harmful drugs, and obesity also represent an important health challenge.

    The above are not exhaustive. The …

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