The figure at the top of each column indicates the number of countries reporting. Circles and figures in columns indicate the number of countries listing the particular health problem as a major concern; a black circle indicates regional consensus that the problem was one of the most important. The vertical line arbitrarily separates less developed from more developed regions. The horizontal line separates diseases of greatest concern to less developed regions from those of greatest concern to more developed regions.

In discussing this chart, Dr. Bryant addressed himself chiefly to national health concerns and how the disease patterns change with modernization and industrialization, "Each country", he states, "is edging toward modernization, and health is locked into the process ... Hidden within a declining crude death rate, for example, can be a downward plummeting of some diseases and an upward trend in others. The changing causes of mortality in Hong Kong are an illustration of such changes. Here the decreases in the percentage of deaths due to infectious diseases and the increase in vascular and neoplastic diseases are reminiscent of the differences between some of the less developed and more developed regions." 25 To confirm the changing patterns in major health trends by a picture of mortality statistics, we invite the reader to examine the graph on Hong Kong in Appendix A of this report on the ten leading causes of death and the percentage of deaths from each cause during 1966.

To facilitate the comparison of regional health profiles and the strict mortality data in this study, we have compiled a chart (Figure 12, which follows) that represents the ranking of the ten leading causes of death in each nation. The causes are ranked in order from No. 1, the most frequent cause of death, to No. 10, the cause of death among that country's "top ten" which has the lowest percentage. Deaths listed in Appendix A under the category "All Causes" are not represented in this figure; the bold vertical lines divide the countries. into three ordered groups: developed, transient and developing

nations.

The following Figure 12 depicts the rank orders of "Ten Leading Causes of Death" by nation:

This chart summarizes the data presented in Appendix A, where the specific percentage for each rank in each country can be found. This figure can be read in many ways: reading across the chart for a particular cause of death gives the reader an idea of the rank order of that disease in many countries; reading down the chart for a particular nation gives

It will be noted that a number of differences exist between major health concerns of nations during the 1961-1964 time period when compared to the strict causes of death presented in the 1964-1966 data. Data for 1961-1964 (Figure 11) was developed from a questionnaire reported by the World Health Organization and is arranged by geographic regions; Data in this 1964-66 study (Figure 12) represents statistical information provided by the World Health Organization and published in 1970. These data state the leading causes of death for each country:

1. Across the board, Figure 12 reveals that heart disease ranks as the No. 1 cause of death in 26 of the 36 countries. The remaining 10 countries rank this cause of death as No. 2 in 5 countries, as No. 3 in 2 countries, as No. 4 in 1 country, as No. 5 in 1 country and as No. 6 in 1 country.

2. Among the developed countries, malignant neoplasms ("cancers")

the reader the rank order of each disease for that nation. Countries are arranged alphabetically; diseases are arranged according to frequency, with the most frequently occurring cause of death at the top of the chart.

rank second or higher in 24 of 26 countries. Stroke ranked third or higher in 25 of 26 countries. In the developing nations, these two causes of death rank between 1 and 8 as a cause, and all developing countries consider these two causes among their "top ten". (Heart disease, as such was not identified in the earlier data.)

3. Accidents of all kinds ranked 4 (19 countries), 5 (6 countries), and 6 (7 countries); in no respect were these ranks specific to the developmental status of the countries. These data suggest that accidents in all countries have increased as a cause of death to the point of surpassing many previously identified health problems.

4. Pneumonia and influenza rank as fifth or higher as the leading cause of death in 29 of 36 countries, from all regions and including the United States. Mexico, the Philippines, and Chile listed it as the

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IX. SUMMARY

What one sees in the statistics and discussion presented in this study is a continuing burden of certain generally unresolved diseases and death-producing conditions in the world. The task at hand is to lighten the burden by more intensified efforts towards prevention as well as treatment.

Many developed countries are known to be engaged in expensive, highly visible, unilaterally funded research programs on "killer" diseases and conditions, especially cardiovascular diseases and malignant neoplasms. These two specific causes of death are attacking populations which having survived the first trimester of life, are being snuffed out at middle age at totally unaccepable rates in terms of their otherwise normal life expectancy. Accidents fall in an even younger age group, and perhaps half of these could be prevented by cooperative regional or global efforts in research, training, and engineering design.

In Section VII of this study it was mentioned that the IARC (International Agency for Research on Cancer) is the first impressive move towards international or regional organizations for research on a leading "killer" disease. However, the data of this study clearly reveal that heart disease outranks cancer as the No. 1 cause of death in the developed countries. Yet, no international satellite organization of the World Health Organization or the Pan American Health Organization like that of IARC,* now exists for epidemiological research in cardiovascular diseases. This same void exists in strong cooperative, regional organizations for most of the leading causes of death. The IARC provides a good, though modest, example of an international research organization with a continuing basis for operation. There is an urgent need for a similar organization to focus international research on the cardiovascular diseases in Europe, the United States and Japan. In addition, the data of this study suggest that the countries of the Western Hemisphere, for instance, those members of the Organization of American States, may also be in need of a permanent central service, like the International Agency for Research on Cancer and perhaps under the Pan American Health Organization, to coordinate epidemiological and preventive medical research on cancer and heart disease.

Indeed, the data in this study indicate a number of major health concerns for the countries of the world. These countries might gain a great deal from formalized regional agreements for coordinated attacks on these problems. Of course, meaningful cooperation among governments for biomedical research would necessitate appropriate treaties or agreements among governments in the international political and economic councils. Science and medicine are inherently in

"The International Agency for Research on Cancer (IARC) is the first international blomdical research body with its own laboratories and epidemiological programme." World Health, August-September 1972, page 38.