Nutrition

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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.

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Globally, the rate of improvement in healthy life expectancy has slowed in recent years, reflecting the increasing burden of NCDs, and the need to strengthen health systems to improve quality of care and meet increasing demands.

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Life expectancy, healthy life expectancy and burden of disease in the light of the COVID-19 pandemic The COVID-19 pandemic has wreaked havoc in population health across the globe.

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The devastating impacts of the pandemic on health, economy, families and society have been observed worldwide since 2020 and are expected to continue to unfold in the years to come.

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The graph only shows the relative composition of the three groups; OPRM is not included.

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In countries that have low-quality vital registration, WHO’s current estimates include a cause of death category, “other pandemic-related mortality” , that likely includes NCD mortality.

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Future work will explore how NCD mortality changed in these countries in 2020–2021 (1).

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Health-related SDGs The World health statistics 2023 revealed that not only have many advances attained in the MDG era (2000–2015) stalled since 2015, but the COVID-19 pandemic has further hampered improvements since 2020 (1).

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The topics covered in this chapter include infectious diseases, risk factors for health, and health systems as a key to UHC.

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Percentage change in HIV incidence rate was calculated from unrounded incidence rates.

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Box 2.1 Malaria vaccine implementation in Ghana, Kenya and Malawi The Malaria Vaccine Implementation Programme (MVIP) was established by WHO to evaluate the public health use of the first malaria vaccine, RTS,S/AS01 (10).

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Through the collaborative effort with the ministries of health in Ghana, Kenya and Malawi from 2019 to 2023, the RTS,S malaria vaccine was integrated into routine child immunization services as part of each country’s national malaria control programme.

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Key findings: substantial public health impact (11) Disease surveillance during 46 months of RTS,S vaccine use and scale-up, as part of the MVIP , showed that malaria vaccine introduction resulted in a 13% vaccine-attributable reduction in all-cause mortality (excluding injury) among children age-eligible for vaccination compared with children living in areas where the vaccine was not in use.

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Quantitative analysis shows that parents understand that malaria vaccine reduces malaria but does not prevent all cases of malaria, and continue to use other preventive and care-seeking measures .

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The MVIP further established that a moderately efficacious malaria vaccine can have high effectiveness and impact and will be accepted by communities and health workers.

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The MVIP also provided critical information to inform the recently updated WHO recommendation for malaria vaccines that applies to both RTS,S and R21 vaccines, and forged a pathway for future malaria vaccine development.

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More than 20 countries have been approved for malaria vaccine introduction support by Gavi, the Vaccine Alliance, and wider implementation began in 2024.

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As of 25 April 2024, eight countries in Africa offer the malaria vaccine as part of their childhood immunization programmes (Benin, Burkina Faso, Cameroon, Ghana, Kenya, Liberia, Malawi and Sierra Leone) and up to 10 additional countries are likely to introduce it this year.

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At least 30 countries in Africa are interested in deploying malaria vaccines as part of their national malaria control plans.

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This means that Egypt has fulfilled WHO’s targets that will set the country up to achieve the reduced incidence and mortality targets of full elimination before 2030.

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Since the early 1990s, the government has put a huge effort into strengthening hepatitis prevention, with programmes covering blood safety, infection control and injection safety.

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Egypt launched a network of specialized treatment centres in 2006 and, with the new antiviral medicines discovered in 2014, hepatitis testing and treatment were made accessible and free of charge for everyone.

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A total of 4.1 million received treatment for hepatitis C with locally manufactured medicines between 2014 and 2022, of which 98% were virally suppressed.

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Box 2.3 Bangladesh eliminates visceral leishmaniasis and lymphatic filariasis as a public health problem In 2023, Bangladesh became the first country globally to be validated for elimination of visceral leishmaniasis, also called kala azar, as a public health problem.

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The disease leads to symptoms such as fever, weight loss, and spleen and liver enlargement and, if left untreated, can prove fatal in over 95% of cases.

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In 2023, Bangladesh was also validated as the fourth country in the WHO South-East Asia Region to eliminate lymphatic filariasis as a public health problem, after Maldives, Sri Lanka and Thailand.

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A series of transmission assessment surveys was carried out by programme personnel between 2011 and 2021, which demonstrated that transmission levels were below the threshold established by WHO for elimination as a public health problem.

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However, in 2023 only 27% of countries reported implementing their national action plans effectively and only 11% had allocated national budgets to do so (25).

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Moderate and severe anaemia are also risk factors for adverse maternal and perinatal outcomes.

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MPO WER is WHO’s technical package that assists countries to implement the evidence-based demand-reduction measures of the WHO Framework Convention on Tobacco Control.

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Box 2.4 Tobacco control in the Netherlands (Kingdom of the) The estimated age-standardized prevalence of tobacco use among persons aged 15 years and older in the Netherlands (Kingdom of the) declined from 34.5% (UI: 27.7–41.2) in 2000 to 27.7% (UI: 23.3–32.2) in 2010 and 21.3% (UI: 17.1–25.5) in 2022.

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2016: Implementation of EU Tobacco Products Directive II, restricting the use of flavourings and dangerous additives, and adding pictorial health warnings on tobacco packs.

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2018: Signing of National Prevention Agreement (NPA) by the government and 70 organizations to address tobacco use (among other risk factors), with the aim that, by 2040, the country would have less than 5% of its population as smokers, and no children or pregnant women smoking.

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In the 2023 WHO report on the global tobacco epidemic , the Netherlands (Kingdom of the) is featured as one of only four countries in the world that have attained best-practice level adoption of all MPOWER measures – WHO’s technical package that assists countries to implement the evidence-based demand-reduction measures of the WHO Framework Convention on Tobacco Control (34).

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Box 2.5 Sex-related inequalities in the global and regional levels of alcohol consumption Globally, there are sex-related inequalities in total APC among persons aged 15+ years, with higher alcohol consumption among men than women.

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Between 2000 and 2019, alcohol consumption did not change substantially among men (from 8.0 litres of pure alcohol [UI: 7.2–9.0] in 2000 to 8.7 litres of pure alcohol [UI: 7.7–9.9] in 2019) and women (2.1 litres of pure alcohol [UI: 1.9–2.4] in 2000 and 2.2 litres of pure alcohol [UI: 2.0–2.5] in 2019).

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The largest absolute sex-related inequalities in 2019 were evident in the European Region (difference of 10.9 percentage points between men and women), followed by the Region of the Americas (difference 8.7 percentage points), the Western Pacific Region (difference 7.2 percentage points), the African Region (difference 5.9 percentage points) and the South-East Asia Region (difference 5.1 percentage points).

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Globally, the age-standardized prevalence of uncontrolled hypertension declined slightly from 28.6% (UI: 28.0– 29.3%) in 2010 to 26.2% (UI: 24.7–27.8%) in 2019, but this pace of decline is insufficient to achieve the global target by 2025 (39).

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Box 2.6 Global sex-related inequalities in hypertension Globally, there are sex-related inequalities in age-standardized prevalence of hypertension among adults aged 30–79 years.

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In contrast to hypertension prevalence, which was 2.8 percentage points higher among men than women in 2019, treatment prevalence was 9.3 percentage points higher among women (47.2%; UI: 43.4–50.9) than men (37.9%; UI: 34.5–41.1) in 2019.

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In 2019, controlled hypertension prevalence was 5.1 percentage points higher among women (23.5%; UI: 20.4–26.9) than men (18.4%; UI: 15.9–21.2).

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Box 2.7 Urban–rural inequalities in access to clean fuels and technologies, globally and by WHO region, 2000–2022 Globally, there are urban–rural inequalities in access to clean fuels and technologies for cooking, with higher access in urban than rural areas.

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In 2022, access to clean cooking was 34 percentage points higher among urban (88.3%; UI: 85.4–90.0) than rural areas (54.4%; UI: 49.3–58.7).

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Until 2023, a limited number of Pacific island countries submitted a SPAR regularly, making it difficult to identify, address and strengthen health security in the region.

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One of the Pacific island countries with a complex set of challenges is Kiribati, which comprises 33 atolls scattered across the equator and over 5 million square kilometres of water.

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Progress towards WHO Triple Billion targets The WHO Triple Billion targets, outlined in and as the foundation of the WHO GPW13, are a set of ambitious goals aimed at improving global health by 2025: one billion more people benefitting from UHC, one billion more people better protected from health emergencies and one billion more people enjoying better health and well-being (1, 2).

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Functioning as both an impact measurement tool and a policy strategy, they are an integral part of the GPW13 Results Framework.

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The greatest improvement has been in the South-East Asia and Western Pacific regions.

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However, such progress is still not sufficient to achieve the HEP billion target by 2025.

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Box 3.1 Strategic and integrated capacity-building of the health information workforce in the Western Pacific Region Strategic use of data for decision-making is critical for measuring and driving progress towards global and national health indicator targets.

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To systematically assess such capacity gaps, the WHO Regional Office for the Western Pacific, with support from WHO headquarters, country offices and in collaboration with partner organizations, launched the DMCF in May 2023 (9) .

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Key issues and trends in global health The global population and economic growth, the advancement of science and technology, and the ever increasing interconnectedness of the world have brought about enormous societal changes along with unprecedented progress, but also multiple and complex challenges affecting the health of billions of people worldwide.

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Crude prevalence is used for children and adolescents aged 0–19 years, and age-standardized prevalence is used for adults aged 18 years and older.

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Box 4.2 A dramatic reduction in childhood stunting in Peru Since 2000, few countries have reduced the prevalence of stunting among children under 5 years of age as dramatically as Peru.

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It is estimated to have declined from a very high prevalence of 31.1% (UI: 29.4–32.8%) in 2000, to 10.1% (UI: 9.5–10.8%) in 2022, which is considered a medium prevalence.

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In 2022, obesity prevalence among women was a third or 4.3 percentage points higher among women (17.9%; UI: 17.3–18.5%) than among men (13.6%; UI: 13.0–14.2%) (Fig 4.5) (2).

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“Difference” is the difference between the median estimate values for persons with severe disability and persons with no disability.

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“Ratio” is the ratio between the median estimate values for persons with severe disability and persons with no disability.

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“Difference” is the difference between the median estimate values for persons with disability and persons with no disability.

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“Ratio” is the ratio between the median estimate values for persons with disability and persons with no disability.

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Box 4.4 Intimate partner violence against women with disabilities A systematic review of 26 studies, mainly from high-income countries, concluded that the prevalence of all forms of IPV (including physical, psychological/emotional, sexual and financial) was higher among women with disabilities than among women without disabilities (23) .

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For example, analysis of data from seven violence-prevention programmes in low- and middle-income countries indicated that women with disabilities were nearly twice as likely to report past-12-month IPV than women without disabilities (24).

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WHO has been supporting the successful implementation of the MDS in more than 15 countries to date, providing a comprehensive assessment of the situation of persons with disabilities, and contributing to better public policy.

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The survey found that one in six (16.7%) people aged 2 years and older in Chile had disabilities in 2015 (20.0% of adults and 5.8% of children aged 2–17 years).

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Migrants were also 1.7 times as likely to have material and social deprivation (defined as not being able to afford certain goods, services and social activities), twice as likely to be overburdened by housing costs as a portion of their income and 2.6 times as likely to be living in overcrowded conditions.

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However, there was little difference overall between migrants and non migrants in terms of unmet needs for medical examination, though this varied across countries (18, 21) .

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Box 4.7 Mixed-methods data-generation approach provides insights into health status and needs of refugees from Ukraine in Poland The outbreak of war in Ukraine in 2022 led to an immediate and unprecedented influx of millions of refugees fleeing from Ukraine to other countries in Europe and beyond, with Poland hosting up to 3.5 million refugees at the height of the crisis.

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A mixed-methods approach was adopted in the border provinces of Poland, through a representative household survey and behavioural insights research, initiated in 2022, and repeated in 2023.

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Civil society organizations play a crucial role in providing support, particularly for specialized care and mental health services.

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