RAWALPINDI, Oct 17: The World Health Organisation (WHO) has warned of significant health inequalities particularly in urban areas of developing countries where almost five billion people will live by the year 2030.

Thirty years ago, some 38 per cent of the world’s population lived in cities, while in 2008 it is more than fifty per cent, says the ‘World health report 2008’ released by the WHO.

Most of the growth will be in the smaller cities of developing countries and metropolises of unprecedented size and complexity in southern and eastern Asia. One-third of the urban population today – over one billion people – lives in slums: in places that lack durable housing, sufficient living area, access to clean water and sanitation, and secure tenure.

These cities are where many of the world’s nearly 200 million international migrants are found. They constitute at least 20 per cent of the population in 41 countries, 31 per cent of which have less than a million inhabitants. Some of the countries that have made very significant strides towards ensuring access to care for their citizens fail to offer the same rights to other residents.

As migration continues to gain momentum, the entitlements of non-citizen residents and the ability of the healthcare system to deal with growing linguistic and cultural diversity in equitable and effective ways are no longer marginal issues.

This mobile and urbanized world is ageing fast and will continue to do so. By 2050, the world will count two billion people over the age of 60, around 85 per cent of whom will be living in today’s developing countries, mostly in urban areas. Contrary to today’s rich countries, low- and middle-income countries are ageing fast before having become rich, adding to the challenge.

Urbanization, ageing and globalised lifestyle changes combine to make chronic and non-communicable diseases including depression, diabetes, cardiovascular disease and cancers.

There is a striking shift in distribution of death and disease from younger to older ages and from infectious, perinatal and maternal causes to non-communicable diseases. Traffic accident rates will increase and tobacco-related deaths will overtake HIV/Aids related deaths.

Over the past few decades, health authorities have shown little evidence of their ability to anticipate such changes, prepare for them or even adapt to them when they have become an everyday reality. This is worrying because the rate of change is accelerating. Globalization, urbanization and ageing will be compounded by the health effects of other global phenomena, such as climate change, the impact of which is expected to be greatest among the most vulnerable communities living in the poorest countries.

The report warns that precisely how these will affect health in the coming years is more difficult to predict, but rapid changes in disease burden, growing health inequalities and disruption of social cohesion and health sector resilience are to be expected.

The current food crisis has shown how unprepared health authorities often are for changes in the broader environment, even after other sectors have been sounding the alarm bell for quite some time. All too often, the accelerated pace and the global scale of the changes in the challenges to health is in contrast with the sluggish response of national health systems.

Even for well-known and documented trends, such as those resulting from the demographic and epidemiologic transitions, the level of response often remains inadequate.

Data from WHO’s world health surveys covering 18 low-income countries show low coverage of the treatment of asthma, arthritis, angina, diabetes and depression, and of the screening for cervical and breast cancer: less than 15 per cent in the lowest income quintile and less than 25 per cent in the highest.

Public-health interventions to remove the major risk factors of disease are often neglected, even when they are particularly cost effective. They have the potential to reduce premature deaths by 47 per cent and increase global healthy life expectancy by 9.3 years. Citing examples, the report said premature tobacco-attributable deaths from ischaemic heart disease, cerebrovascular, chronic obstructive pulmonary and other diseases are projected to rise from 5.4 million in 2004 to 8.3 million in 2030, almost 10 per cent of all deaths worldwide, with more than 80 per cent in developing countries. Yet, two out of every three countries are still without or only have minimal tobacco control policies.