BioEd Online

A chronic shortage of health workers is having a deadly impact on developing countries' ability to fight disease, the World Health Organisation (WHO) has warned.

In their World Health Report 2006, released today, the UN organization says that more than four million extra doctors, nurses and other healthcare workers are needed across 57 countries, to add to the world's current stock of 59 million full-time healthcare workers. Thirty-six of the most needy nations are in sub-Saharan Africa.

"The global population is growing, but the number of health workers is stagnating or even falling in many of the places where they are needed most," says Jong-wook Lee, director general of the WHO.

Health budgets in those 57 countries will have to increase by an average of US$10 per person per year to pay for the extra four million health workers, the report says. The WHO challenges wealthy nations to help meet that goal within 20 years.

The report also criticizes the growing trend of developed nations employing healthcare workers from countries in greater need of their skills. "Increasing numbers are joining a brain drain of qualified professionals who are migrating to better-paid jobs in richer countries," says Timothy Evans, the WHO's assistant director general.

Gender equality

The WHO's report follows an editorial in this week's British Medical Journal, which speculated that 2006 could be the first year since records began where women could expect to live as long or longer than men, on average, in every country around the world¹.

Research has shown that overall, women typically live longer than men. But poor conditions for women, particularly in terms of care during childbirth, can push female survival down in poorer countries. Most European nations have had higher female than male life expectancies since the nineteenth century. As global prosperity improves, researchers expect average female survival to push upwards.

But the World Health Report shows that, according to the most recent data from 2004, there were four countries (Niger, Qatar, Tonga and Zimbabwe) where men could still expect to live longer than women. In Zimbabwe, for example, the WHO reports that women have an average life expectancy of just 34 years, compared with a male life expectancy of 37 years.

No answers

A handful of poor countries are hovering near the mark where women are beginning to match men in life expectancy. So it may not be significant which specific countries fall above or below this line in a particular year's worth of data, says BMJ editorial co-author Anna Barford of the University of Sheffield, UK. But it is disappointing, she adds, that their predictions of women coming out on top have not yet been borne out.

Thomson Prentice, editor of the World Health Report, could give news@nature.com no answer as to why some countries still have lower female than male life expectancies.

Despite the extensive detail of the 200-page report, there are many such questions that remain unanswered. An editorial in the medical journal The Lancet this week criticized the World Health Report for lacking crucial information about the geographical distribution of health workers, and their levels of training². "The patchy and incomplete picture presented in the World Health Report shows just how much of a gap exists between current knowledge and what is necessary to inform policymaking," it laments.

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