While life expectancy increases in most of the world, in AIDS-ravaged parts of southern Africa adult mortality is higher than 30 years ago, the World Health Organisation said tonight.
In 14 African countries, the UN agency said in its annual World Health Report, child mortality is higher than it was in 1990, with over 300 children out of every 1,000 born in Sierre Leone dying before the age of five.
The 194-page report, which examines a range of causes of death road traffic deaths to polio and AIDS, also warned of a growing gulf in health care and exposure to disease between the poorest nations and the rest.
"Today's global health situation raises urgent questions about justice," WHO Director-General Lee Jong-wook, wrote in an introduction.
"In some parts of the world there is a continued expectation of longer and more comfortable life, while in many others there is despair over the failure to control disease though the means to do so exist."
Of the 57 million premature deaths in 2002, 10.5 million were among children of less than five years of age and 98 per cent of those were in developing countries.
In Zimbabwe, the average life expectancy for both sexes was 37.9, in Zambia 39.7 and in Angola 39.9, while in Switzerland it was 80.6, in Sweden 80.4 and in France 79.7. A baby girl born now in Japan could expect to live 85 years, while one born at the same time in Sierra Leone would probably not survive beyond 36, the report found.
"A world marked by such inequities is in very serious trouble," wrote Mr Lee.
The report said AIDS was the leading cause of death in the 15-59 age range, reducing the life expectancy of adults in Botswana, Lesotho, Swaziland and Zimbabwe by 20 years.
Deaths from the virus and the complications it brings were almost twice those from the next top killer - heart disease.
The WHO said diseases related to tobacco were responsible for some five million deaths a year.
It said that in 2002, over 1.2 million people died of lung cancer - largely caused by smoking - which was a 30 per cent increase on 1990. Three out of four of these deaths were among men, the WHO said.