Public health challenges in the Middle East

Important gains in the health status of the population have been achieved in the Middle East, thanks to improvements in technology, health service delivery and public health programs, but the region still faces big public health challenges.

Although the region shows decreasing rates of communicable disease, it has increasing rates of noncommunicable disease (NCDs), also known as chronic diseases, which tend to be generally slow in progression. The four main types are cardiovascular disease (heart attacks and stroke), cancers, chronic respiratory disease (such as chronic obstructed pulmonary disease and asthma) and diabetes.

These diseases are driven by factors that include aging, rapid unplanned urbanization and the globalization of unhealthy lifestyles, including unhealthy diets, tobacco use, lack of physical activity and obesity. They may increase blood pressure as well as blood glucose blood lipid levels. The economic costs of these diseases can be considerable. In low-resource households, health care costs for cardiovascular disease, cancer, respiratory disease or diabetes may quickly drain families’ finances and drive them into further poverty, thus hindering their countries economic development.

Some relatively new diseases are emerging, such as HIV/AIDS, and in some areas, old diseases like tuberculosis are re-emerging. Though HIV prevalence rates are low in Mideast countries, the spread of further infections could have significant social and economic impacts.

Communicable diseases spread from one person to another or from animal to person. They spread usually via airborne viruses or bacteria, but also through blood or other body fluids. Among this group of diseases are malaria, tuberculosis, measles, HIV/AIDS, Ebola, influenza, hepatitis and poliomyelitis. Malaria, tuberculosis and measles are responsible for a significant proportion of the region’s morbidity.

The conflicts afflicting the Mideast region have provoked an increase in the incidence of communicable diseases. This is the case in Gaza, where the recent conflict led to outbreaks of water- and food-borne diseases from drinking water contaminated with raw sewage.

Wars in some countries such as Syria and Iraq have prompted a substantial emigration of doctors, adding to existing problems of too few qualified health care personnel. In Iraq, the amount of physicians has been decimated by continuing conflict, and the conflicts have led to the destruction of much of the health infrastructure in the country.

Although progress has been made in the health status of mothers and children in most countries in the region, disparities persist, as UNICEF has reported.

“The health and well-being of mothers and children is often determined by their income and where they live,” said Shashia Azfar, UNICEF regional director for the Middle East and North Africa.

Most health services in the region are still based on a curative model, which is expensive to maintain and inefficient in addressing new health challenges. That is why health care services will have to increasingly include the provision of preventive services and improve primary health care to address immediate needs.

Although some countries have the economic resources to face this challenge, they have to be redirected in a way to make them more effective. Because the Middle East region is composed of a diverse mix of countries ranging from very poor ones to wealthy oil-exporting countries, there are no solutions that uniformly apply to all. A thorough evaluation of the situation in each country can provide the information to apply the best approach to solving health problems.

Cesar Chelala, M.D. and Ph.D., is an international public health consultant, and a winner of the Overseas Press Club of American award and a national journalism award from Argentina.

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