Global interest in health for all people has continually increased in recent decades.4 The WHO, founded in 1948, is the United Nation's specialized agency for health. The constitution of the WHO, adopted in 1946, states that the health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states.5 Its goal is "the attainment by all peoples of the highest possible level of health."6(p2) Policy directives and priorities for WHO's work are reviewed and adopted annually at the World Health Assembly (WHA). The WHA, WHO's governing body, is made up of representatives from all WHO member states, and it is through this mechanism that individual countries join together to develop policies. Global health continues to gain world attention as government and organizations develop programs and initiatives to reach out to other nations.
At the International Conference on Primary HealthCare, held at Alma-Ata, USSR, in September 1978, a need to change care from an emphasis on Western technology in favor of an emphasis on primary care was articulated.7 Primary healthcare is defined as essential healthcare based on practical, scientifically sound, and socially acceptable methods made universally accessible to individuals and families in their communities through their full participation. The objective is to bring healthcare as close as possible to where people live and work. One of the essential elements of primary healthcare as stated in the Alma-Ata Declaration is "the education of people in developing countries about the prevailing health problems and the methods of preventing and controlling them"(Alma-Ata conference Declaration).8 In addition, healthcare must be available at a cost that the community and country can afford and can maintain. Since the Declaration, progress in the implementation of primary healthcare has not evolved as planned because of the multiple differences between communities and countries and the political, economic, social, financial, and bureaucratic constraints each country must address.8-10 Initial efforts to increase global health focused on communicable diseases, such as tuberculosis, malaria, and AIDS. More recently, noncommunicable diseases, such as cancer, cardiovascular disease, diabetes, and chronic respiratory diseases, began to be recognized as universal problems. Efforts to include these diseases as part of the current global health status picture creates what is sometimes called the "double burden" of disease.11(p577) The WHO does not prioritize among the four noncommunicable diseases but actively proposes an integrative approach of surveillance, prevention, and management because all four diseases share many of the same risk factors associated with etiology. Five risk factors-unsafe sexual practices, alcohol use, indoor air pollution, occupational exposures, and tobacco use-account for 20% of the global disease burden.11
Eighty-five percent of the world's population lives in developing countries; therefore global health must take into account the variable needs of everyone. Cancer occurs in all countries and will continue to increase as the world population grows to a projected 6.9 billion in 2010 and the proportion of the population aged 65 or more increases by 61% in 2010.12 At the beginning of the 21st century, the WHO predicted that global cancer rates could increase by 50% to 15 million new cases by 2020 (Fig 1).13,14
A recent 2002 research article by Shibuya points out that in 2000 more than 60% of cancer deaths and about one half of all new cases occurred in the developing world.15 There is evidence, however, that cancer survival rates are improving even for the developing world and many cancers of the developing world are potentially preventable.15(p26) Lung cancer continues as the most common cancer in the world, followed by breast, colorectal, stomach, liver, cervical, esophageal, and head and neck cancers.
Developing and Developed Countries
Developing countries of the world are usually considered to be the underdeveloped nations of Asia, Africa, the Middle East, Latin America, East Europe, and the former Soviet Union. They are mainly characterized by low standards of living, high rates of population growth, low income per capita, and general economic and technological dependence on developed economies.
Developed countries of the world include the now economically advanced capitalist countries of Western Europe, North America, Australia, New Zealand, and Japan. These were the first countries to experience sustained long-term growth.16
To be more aware of national health needs and to facilitate identification of regional health priorities, the WHO is organized into 6 regional offices (Table 4). Programs and activities are carried out through the 6 regional offices and the WHO headquarters in Geneva, Switzerland.17
The 6 regional offices are:
1. Africa (AFRO), in Brazzaville, Congo
2. Americas (AMRO), in Washington, DC, USA
3. Eastern Mediterranean (EMRO), in Alexandria, Egypt
4. Europe (EURO), in Copenhagen, Denmark
5. South-East Asia (SEARO), in New Delhi, India
6. Western Pacific (WPRO), in Manila, Philippines
The emerging recognition of cancer and other noncommunicable diseases in the developing world and the initiation of International Conferences for Cancer Nurses in 1978 brought the global nursing community together for the first time to address the multiple issues of cancer care. The trends that emerged from the 1978-1984 international conferences highlighted the need to report and monitor cancer statistics carefully, to prepare medical and nursing professionals in cancer care, and to develop cancer prevention, early detection, and control programs in developing nations. With sufficient training and institutional support, it was clearly articulated that nurses could have a significant impact on global health, including cancer care, worldwide.18-20