Health is a regional objective for sustainable development in Arab countries

Health as a regional goal for sustainable development is the subject of the sixth installment of the series on health and environment in Arab countries. This article is based on the chapter on the relationship between health and development in the recent report of the Arab Forum for Environment and Development (AFED). Dr Rima Habib, head of the Department of Environmental Health at the College of Health Sciences at the American University of Beirut, co-authored the chapter with researchers Natalie Al-Haddad and Shelby Sordick.

Health systems in most Arab countries face a number of challenges including: lack of doctors, limited data on health facilities, lack of emergency preparedness, in addition to low budgets allocated to the sector. The fragility of these systems has become apparent with the epidemic of the coronavirus (Covid-19), which is expected to have serious – and potentially catastrophic – systemic effects on the Arab world.

The “Health and Environment” report published by the Arab Forum for Environment and Development (AFED) examines the main environmental factors that have a major impact on various aspects of human health and examines the progress made by Arab countries in the achievement of the third objective of the Sustainable Development Goals, which include “ensuring the enjoyment of all”. Healthy and well-being lifestyles for people of all ages.

The report also summarizes the challenges that Arab countries face in reaching these goals, proposes an integrated framework for health and sustainable development, and recommends new horizons for local and regional action, as well as a health coverage approach. universal approach to achieve health for all.

How is “health for all” ensured

The third goal of the Sustainable Development Goals includes nine targets for a number of indicators which include: maternal health, child health, communicable and non-communicable diseases, drug abuse, traffic accidents and deaths, sexual and reproductive health, universal health coverage, and environmental health. It describes four means of implementation with specific objectives, related to the adoption of frameworks for tobacco control, innovation in medicine and immunization, capacity building and financial support for health, as well as preparation and response to health risks.

Health in Arab countries is affected by the social and political situation in each country. Social and economic inequalities, the lack of political stability, the tyranny of armed conflicts and the scarcity of resources are all urgent factors affecting public health.

Mental disorders such as depression and anxiety, as well as lower respiratory tract infections, lead to an increase in the years of life lost due to poor health in the Eastern Mediterranean region. Diabetes is also recorded, among other noncommunicable diseases, an increase in the Arab world, requiring intervention to control this disease, which has reached the stage of an “epidemic”.

And cancers of the lung, bladder, prostate, breast, colon, rectum and liver are widespread in various Arab countries. There are still disparities in incidence and death rates between countries, with Lebanon having one of the highest rates of all types of cancer in the Eastern Mediterranean region.

According to 2017 data released by the Institute for Health Metrics and Evaluation at the University of Washington, there is a set of main causes and risk factors that affect the healthy years of life lost in the Arab world, including the most important are cardiac. ischemia, neonatal disorders, lower respiratory tract infections and diarrheal diseases, substance use disorders, birth defects, road traffic accidents, stroke, headache, lower back pain, diabetes and HIV (AIDS).

Noncommunicable diseases, traffic accidents and mental health rank first in high-income countries, while infectious and neonatal diseases are more serious in low-income countries. The main risk factors for poor health in low-income countries are malnutrition, water, sanitation and hygiene, and air pollution. In high-income countries, these effects are offset by a high body mass index (obesity), high blood pressure, drug use, high fasting blood sugar and smoking.

Concerns about the health of the population in the Arab world are increasing with the outbreak of emerging infectious diseases, such as the Middle East respiratory syndrome (MERS) and the coronavirus pandemic (Covid-19), which is disrupting measures aimed at improve health and achieve the third goal of the Sustainable Development Goals.

Corona’s impact on healthcare systems

Weeks after the emergence of the renewed Corona virus, the World Health Organization declared its transformation into a pandemic that constitutes a public health emergency, raises international concerns and poses an existential threat to countries with weak health systems . The virus has spread to all Arab countries and the number of cases continues to rise. And recently, the number of infections and deaths caused by the Corona virus has increased dramatically in most Arab countries, so that the accumulated figures in the Arab world approached 4 million in mid-February, in addition to ‘approximately 70,000 deaths. The Johns Hopkins University Center for Systems Science and Engineering continued to record between 12 and 26,000 injuries per day for 4 months in Arab countries. Some Arab countries have recorded record figures with the number of daily injuries, such as the United Arab Emirates and Lebanon, sometimes exceeding 3,000 injured per day, and surpassing 6,000 in Lebanon, which is one of the highest in the world in relation to the population. . As for the mortality rate, it exceeds 2% in 45% of Arab countries. Notable differences appear between countries, with Yemen having the highest death rate (29%), followed by Syria, Sudan and Egypt with 5-6%, while Qatar, the Emirates, Bahrain , the other Gulf states and Lebanon recorded the lowest death rates (less than 1 percent). This difference in mortality is not surprising, given the significant difference between low-income and high-income countries in the resources, health infrastructure and health services available to care for and support injured patients. In contrast, the decrease in the number of reported cases in Yemen, compared to the higher figures reported in neighboring countries, indicates the big difference in the ability to perform diagnostic tests.

The “AFED” report indicates that the epidemic of the new Corona virus has revealed the disastrous consequences of fragile health systems, the lack of emergency preparedness in most Arab countries, as well as the weak capacity to mobilize resources for health. public and patient care in middle- and middle-income Arab countries is approaching low.

The relationship between health and the economy

The disease burden is increasing in Arab countries whose incomes tend to be low, as opposed to those with higher incomes, despite the common history and culture of some countries. Contrary to estimates presented in WHO statistics for the year 2016, death rates from noncommunicable diseases and air pollution have increased over time in all Arab countries. In contrast, the death rate from road traffic crashes has fallen in high- and middle-income countries, and suicide rates have fallen in low-income countries.

In a 25-year study, maternal mortality showed a remarkable decline in most Arab countries, but rates are still relatively high in countries whose incomes tend to be low. Between 2016 and 2019, some countries experienced declines in under-five mortality rates and neonatal mortality rates.

Death rates from poor water, sanitation and hygiene vary among Arab countries and are highest in Somalia. It is relatively common to smoke tobacco among Arab citizens, and Lebanon has the highest percentage of smokers, at 33.8%.

The AFED report warns of the significant increase in death rates due to air pollution in the Arab world between 2016 and 2019. Out of 100,000 people, deaths have increased from 32.2 to 50 , 9 in Iraq, from 29.7 to 51.4 in Lebanon and from 13.5 to 53.9 in Oman., And from 9 to 47.4 in Qatar. The alarming increase in the death rate from air pollution underscores the importance of environmental protection, a key aspect of improving health in the region.

Despite the positive development of a number of indicators, including the decline in malaria infection rates and child under-five mortality and birth rates, other indicators have remained relatively unchanged. such as the incidence of tuberculosis, the exacerbation of a few, and death rates from air pollution. This indicates that health in the Arab world is improving slightly, but there are some areas that need to be addressed to be successful in achieving the third goal of the Sustainable Development Goals.

Arab countries face various challenges that hamper their ability to achieve sustainable development goals and achieve “health for all”. These challenges include political and economic conditions, in particular armed conflicts in a number of countries which have had a significant regional impact.

Besides the high rates of injuries and deaths, armed conflicts in the Arab world lead to destruction of ecosystems and infrastructure, deterioration of health systems, disruption of health services, emergence of diseases previously eliminated or increased rates of certain diseases, such as in the new emergence of polio, the increase in leishmaniasis in Syria and the spread of famine and cholera in Yemen. These conflicts go beyond their geographic scope to affect neighboring countries due to their regional economic impacts and the large number of refugees crossing borders in search of safe refuge.

Environmental crises are obstacles to progress in the Arab world, where air pollution is one of the most common problems in the region. Inadequate management of wastewater and solid waste also creates an environmental burden in some countries. It is estimated that by 2030, 70 percent of Arab citizens will reside in cities, leading to increased overcrowding.

While AFED report says coronavirus pandemic will negatively affect progress towards achieving sustainable development goals in Arab countries, increasing morbidity and mortality rates and straining systems and infrastructure health care, he concludes that the success of the Arab world in achieving the goal The third of the Sustainable Development Goals depends on adopting a better approach at the local and regional levels to create an appropriate environment that guarantees health. and the well-being of all. This requires cooperation among Arab countries in exchanging capacities and resources, and preparing for emergencies that affect health.