- Agenda for the 21st century
 

Welcome to the 21st century and may I offer my best wishes to readers of the IOTF's first Bulletin of the new millennium.

It seems almost the stuff of science fiction to be talking of health in the 21st century and much of the present debate in the field of medicine seems at times so fanciful that it might well have been inspired by the science fiction genre.

The great scientific achievements in mapping the human genome, the advances in cloning technology, and the enormous possibilities of gene therapy and a host of other startling medical advances seem to augur well for the future of the human race.

While medical science makes inroads in our understanding of the "fine print" of our very existence, what can we say about the bigger picture in a real world of six billion people? Many still live in circumstances where the benefits of esoteric research are unlikely to be felt for many generations, but where it is clear the impact of late 20th century lifestyles will make continue to make a major impression.

More than two thirds of the world's population are concentrated in Asia; they are making one of the most rapid transitions from rural to urban life imaginable and face serious health consequences as a result. 

In India which I visited several times last year it is clear that there are huge new problems emerging in public health terms which cannot be solved easily. The incidence of overweight is three to six times greater among middle-aged urban Indians compared to their rural counterparts and other risk factors for heart disease are also multiplied. Adults seem vulnerable to a particularly vicious form of abdominal obesity. Unsurprising then that the incidence of diabetes is now three to four times greater among the urban population.

During several visits to China last year I discovered how rapid development there is leading to very predictable "lifestyle" health risks with a significant level of childhood obesity and increasing levels of adult overweight. As a result, the IOTF convened a special workshop on Asian BMI, held in Milan last June, where we were shown remarkable new data providing clear evidence of the impact of weight-related metabolic diseases occuring at much lower levels of BMI.  The proceedings of this workshop will be published later this year. 

Recognizing that action is urgently needed, the IOTF is working to support proposals for an obesity task force in China this year and will benefit from Dr Tim Gill, the taskforce scientific secretary, returning shortly to Australia where he will co-ordinate the IOTF's activities in the Asian and Pacific regions. 

In the developing countries of Latin America there is also a growing concern about the impact of overweight and obesity. Last year the IOTF assisted in the formation of a Latin American Obesity Task Force and will be supporting an obesity summit conference scheduled to take place in Rio de Janeiro in June.

Within the Commonwealth countries there is an awareness of the need for action to deal with obesity after health ministers attended a IOTF briefing. Practical proposals for 2000 include staging IOTF workshops in the Caribbean and the Pacific to help develop real strategies and policies with the benefit of a blueprint guide prepared by IOTF.

Across Europe the IOTF has engaged the support of national obesity associations in 
pursuing the Milan Initiative and is seeking a Europe-wide analysis of prevalance data to be discussed at the next European Congress on Obesity at Antwerp.  The Taskforce is also co-ordinating with the actions of NAASO in North America to ensure we maintain a truly global influence.

With so much to be done on the world stage, the IOTF has successfully re-established its secretariat at its new headquarters in London.  We thank everyone who has helped us in the past and are a grateful for your continued support. We look forward to the challenges the 21st century will bring.