Health in the Arab world

The Series is a collaborative project between the Faculty of Health Sciences (FHS) at the American University of Beirut (AUB) in Lebanon, the Institute of Community and Public Health (ICPH) of Birzeit University (BU), and The Lancet, and will be launched in London on January 20, 2014, and in Beirut on January 23, 2014. For more details on the launch events, please contact Daisy Barton, media relations manager, The Lancet journals, London, UK, T) +44 (0) 207 424 4949 E) daisy.barton@lancet.com.

The State of Health in the Arab World by Ali Mokdad et al

• The Arab World has made dramatic progress in reducing mortality and prolonging life. Over the past 20 years, the Arab World succeeded in decreasing premature death and disability for most communicable, newborn, nutritional, and maternal causes of death, with the exception of HIV/AIDS.

• Despite improvements, substantial burdens of communicable, newborn, nutritional, and maternal causes of disease persist in the low-income countries of the Arab World.

• Depression and anxiety were major causes of disease burden, and affected women more than men.

• The Arab World is experiencing a major epidemiological transition. Between 1990 and 2010, disease burden from many non-communicable causes has increased, especially ischaemic heart disease, mental disorders (such as depression and anxiety), musculoskeletal disorders (including low back pain and neck pain), diabetes, and chronic kidney disease.

• The impact of demographic change in age and sex structure and population growth was large on the burden of disease, as measured by DALYs. About 11% of the change in NCDs was due to population ageing and 54•6% was due to population growth.

• The changes to the pattern and burden of disease in the Arab World will challenge already stretched human and financial resources since many Arab countries are now dealing with a double burden of non-communicable and infectious diseases. A road map for health in the Arab World is urgently needed.

• Ischaemic heart disease (IHD) is the number one cause of death in the Arab World in 2005 and 2010 (13•32% and 14•30% of deaths, respectively).

• Deaths from road traffic injuries increased significantly between 1990 and 2010.

• Deaths due to suboptimal breastfeeding and childhood underweight declined from ranks 6 and 5 in 1990 to 10 and 11, respectively, in 2010.

Governance and Health in the Arab World by Rajai Batniji et al

• The Arab world is characterised by weak political institutions, shaped by legacies of colonialism and patronage. These institutions exclude large segments of the population from political representation and government services.

• Despite weak political institutions, the Arab World has seen sharp reductions in mortality and increases in life expectancy over the past 30 years.

• There does not appear to be any association between democracy and improved health indicators in the Arab World. However, there is a suggested association between more effective governments and reductions in mortality from 1980-2010.

• Efforts to reduce corruption and improve government effectiveness may be more plausibly linked to population health improvements than efforts to democratise.

• Lost in the aggregate statistics on population health are sharp inequalities, leaving minorities, refugees, political opponents of entrenched regimes, immigrants, women, and the poor often excluded from healthcare and social protection. Their exclusion is likely to be amplified in countries undergoing political transformation.

Non-Communicable Diseases in the Arab World by Hanan Abdul Rahim et al

• Noncommunicable diseases (cardiovascular disease, cancer, chronic lung diseases, and diabetes) pose an enormous human and financial burden in the countries of the Arab World. In addition to population ageing, risk factors—including tobacco use, physical inactivity, and unhealthy diets—fuel the epidemic.

• Across the Arab world, there are variations in resources, health system capacity, and policy responses to the non-communicable disease crisis. In general, however, the efforts have not been proportionate to the magnitude of the problem, and there is substantial room for improvement.

• Cost-effective and feasible interventions have already been identified for prevention and treatment, including stricter tobacco control measures and immediate action on salt reduction. Implementation of these and other important measures requires strengthened health systems, multisectoral action, and continuous monitoring and assessment of progress.

• Most importantly, political commitment at the highest level is essential for success, and Arab governments should be held accountable for their national and international commitments. Engaging in the global framework for NCDs should promote accountability for effective action.

• Addressing the epidemic is a development imperative. Inaction is not an option.

The Path towards Universal Health Coverage by Shadi Saleh et al

• The constitutions of many countries in the Arab World clearly highlight the role of governments in guaranteeing the provision of health as a right for all citizens. Yet citizens of these countries still suffer from inequitable health-care systems.

• One component of such inequity relates to the limited financial access to health care services.

• The recent uprisings in the Arab World, commonly referred to as the "Arab Spring", created a sociopolitical momentum that should be used to pave a path towards realising universal health coverage (UHC).

• The authors present a brief overview of the evolution of health-care systems in the Arab World, with a focus on Tunisia, Egypt, Libya, and Yemen. The authors offer a roadmap for action to address the challenges and opportunities for progressing towards UHC.

• The path towards UHC will require compromises at each stage to move the process forward. One issue should not be part of any compromise; that is each individual's right to the highest attainable standard of health.

Changing therapeutic geographies of the Iraq and Syrian Wars by Omar Al-Dewachi et al

• There is a need to explore the long-term and transnational structural health care challenges that accompany the chronicity of conflicts in the Arab World.

• The global war on terror has blurred the boundaries between warfare and healthcare.

• Two main phenomena have accompanied large-scale conflicts in Iraq and Syria: the militarisation and regionalisation of health care. Healthcare has become a tactic of war and the massive displacement of national populations is changing health priorities in the region.

• It is central to pay attention to the dismantlement of state-health care systems and the emerging survival strategies of national populations.

• Framing therapeutic geographies of healthcare is crucial to understanding the global health challenges of ongoing conflicts, since they speak to the mobility, politics, value, and dynamics of healthcare access and transformation.

Health and Ecological Sustainability in the Arab World by Abbas El-Zein et al

• Problems associated with water scarcity, food insecurity, and informal urban settlements in parts of the Arab World are critical and worsening, exacerbated by climate change and a quasi-permanent state of violent conflict.

• Mutually-reinforcing dynamics around ecological degradation, past and present development policies, and demographic change have combined to create an ecological crisis that calls into question the survival of communities and institutions.

• The ecological crisis is occurring in a context characterised by autocratic systems of government, lack of accountability and poor governance, retrenchment of the welfare state, large social and geographic inequalities, heavy militarisation, and squandering of revenues from fossil fuels.

• "Survival" can be used as a criterion for identifying critical thresholds and differential threats to communities and individuals, towards better understanding of the crisis, as well as short- and long-term responses and emergency preparedness.

• Regional collaboration is key to tackling the ecological crisis. The authors call on health professionals to play a central part in informing, networking, lobbying, and developing evidence-based responses, within and beyond the health sphere.

NOTES TO EDITORS:

The Lancet Series on "Health in the Arab World: a view from within" is a collaborative project that began in July, 2011, between the Faculty of Health Sciences (FHS) at the American University of Beirut (AUB) in Lebanon, the Institute of Community and Public Health (ICPH) of Birzeit University (BU) in the occupied Palestinian territory, and The Lancet. The objective of the project was to focus on priority health issues in the Arab world based on evidence interpreted mainly by scholars from the region, while adopting a multidisciplinary approach that included medical, public health, social, and political perspectives. The Series, consisting of six multi-authored papers, as well as viewpoints, essays, and comments, will be published by The Lancet on January 20, 2014, the date of the launch of the Series in London. The Lancet Series will also be launched in Beirut on January 23, 2014, by FHS in collaboration with ICPH and The Lancet. The launch will be one of the first events celebrating the 60th anniversary of FHS.