In an ambitious effort to lay out a global agenda for disease prevention, the World Health Organization issued a report cataloging the biggest risks to health world-wide and offering prescriptions for addressing them on a national or regional basis.

If individuals and governments take concerted steps along the lines of those recommended in the 248-page study, "healthy life-expectancy" could be extended by five to 10 years or more, depending on where people live, the authors say. If there is little action, then the number of world-wide deaths annually from tobacco use, for instance, could soar 80% to nine million by 2020. With little or no action, the annual death toll from obesity could rise by more than 60% to five million by then, the study says. "We need to achieve a much better balance between preventing disease and merely treating its consequences," said Christopher Murray, executive director of WHO's Global Programme on Evidence for Health Policy, who headed up the study. While effective treatments for illness and injury are crucial ingredients for healthy lives, "if you go one step back in the chain and look at risks that influence disease, you have a host of opportunities to prevent it before it happens," he said. The report estimates that disease resulted in a loss of nearly 1.5 billion healthy years of life world-wide last year. About 40% of them were attributable to the top 20 risks described in the study. The WHO researchers made a distinction between the contribution the risk factors have on death rates and on healthy years of life to account for the debilitating effects that disease can have on people's quality of life. For instance, in Japan, which at 84.7 years for women and 77.5 years for men, has the highest life expectancy in the world, researchers said healthy life expectancy is 73.6 years for both sexes. In developing countries with high mortality rates, underweight resulting from malnutrition accounted for 12.6% of deaths among males, but 14.9% of lost healthy years of life. The report comes amid the AIDS epidemic in Africa, the growing toll of cardiovascular disease and obesity, and other daunting challenges to public health that affect all regions of the world and all socioeconomic groups. The hope is that individual countries will use the findings to stimulate debate and develop strategies tailored to fight their most important risks. The report, which took more than 150 researchers about four years to prepare, is based in part on a systematic review of hundreds of scientific papers, government reports and other documents dealing with 26 different health risk factors. The study was unveiled at a news conference in London. A summary is also being published in the journal Lancet. The two most significant global health risks, according to the study, are low child and maternal weight -- reflecting poor nutrition, and contributing to such problems as low birthweight, diarrhea and pneumonia -- and unsafe sex. These problems are far more prevalent in developing societies where mortality rates are high, but many other risks among the top 10, including blood pressure, tobacco use, alcohol use, high cholesterol and obesity, affect both developed and developing regions. In a similar effort to catalog global risks a decade ago, blood pressure and cholesterol levels weren't top-tier factors. Lack of necessary nutrients was also a major issue, with iron, Vitamin A and zinc deficiencies all included in the top 20 risk factors. The report details 170 strategies that could be applied in various regions to make headway against health risks. For instance, to combat underweight and nutritional deficiencies, the report recommends that grains and sugars be better fortified with nutrients in developing countries. It also urges aggressive counseling to promote breastfeeding and a variety of public education and medical programs to combat AIDS, tobacco use and cardiovascular disease.

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