Arab Health Research Should Keep Pace With Changing Demands
As countries get richer, their citizens suffer from different diseases.
This well-documented trend comes after governments have more money to spend on immunizations and sanitation, ending historical causes of mortality. As countries get wealthier, their citizens are subject to different sorts of stress and spend more money on red meat, cigarettes and alcohol—even in countries where the latter is illegal.
Experts say this change is now underway in the Arab world with a move away from communicable diseases like measles and toward non-infectious diseases like high blood pressure. But some experts believe that Arab research remains focused on the diseases of the past, rather than the chronic illnesses of the future.
Arab disease patterns depend on the country, says the WHO Regional Advisor, Ahmed Mandil in Cairo. He divides the region into three groups: the rich ones like Saudi Arabia and Qatar; the poor like Yemen; and those in between such as Morocco. The wealthier countries are already experiencing significant rates of high blood pressure and diabetes, says Mandil. “The middle-of-the-road countries have also started to follow suit,” he adds. “It’s a matter of time before they all catch up.”
Data collected by the WHO illustrate the discrepancy. Cholera infected just 11 people in the United Arab Emirates from 1999 to 2011, but there were 12,000 cases in Somalia in 2011 alone.
Measles has also been steadily declining in middle-income countries. Morocco reported 10,723 cases in 1999, a number which has since declined to 291 in 2012. Poorer countries like Yemen have yet to catch up.
The steady decline of contagious diseases is coupled by a rise in ailments that usually develop slowly. Twenty six percent of Jordanians and almost 40 percent of Bahrainis suffer from high blood pressure, according to 2007 estimates from the WHO. By comparison, the British Heart Foundation says about 30 percent of people in England have high blood pressure.
Mandil says the rise of such ailments shouldn’t necessarily be seen as bad thing. “It’s almost a good sign, it shows we’re living longer.”
Alaa Badawi, a program director with the Public Health Agency of Canada and a consultant on public health for Qatar’s Ministry of Health says infectious diseases can be squelched, but conditions like high blood pressure and diabetes can afflict people for the rest of their lives.
Nevertheless, research remains stubbornly focused on the diseases that are on their way out, says Mandil. “Lots of money goes into the prevention, control and research of communicable diseases.”
Within the next 40 years, non-communicable diseases will entirely outnumber communicable ones, says Badawi.
He adds that it’s not as simple as estimating that diabetes will be a problem in 10 years, followed by high blood pressure in the next decade and finally cancer. “The issue is more complicated than predicting a timeline,” he says, “the problems will come in clusters.”
Lessons can be learned from other countries around the world that have already gone through this demographic change, says Mandil. “There is evidence of ‘best buys’ from other regions: Don’t drink alcohol and don’t smoke—that’s obvious,” he says.
Badawi says that the Arab world should be doing its own research on behaviorally induced diseases and not rely solely on Western academia’s findings. “We need an Arab solution to this problem because we have many unique cultural and religious traits that would impact the success of policies.”
Designing locally effective campaigns to encourage people not to smoke, for example, is a goal of some public health researchers. According to data compiled by the World Lung Foundation and the American Cancer Society, Serbia is the country that smokes the most, with an average of 2,861 cigarettes per person per year. Ethiopia smokes the least, at just 42 cigarettes per person. Most Arab countries sit in the middle of this spectrum. Tunisians are the heaviest of smokers in the Arab world (1,628) and residents of the United Arab Emirates are the lightest smokers (583).
One other example that Badawi points to is poor mental health among Arab women. He believes that “Women here are more likely to suffer from depression from a lack of vitamin D because they’re [sometimes] more covered up.” Sexual health also assumes a different tone in the region compared to European and American cultures, “Contraceptives here are extremely expensive and they’re also perceived as highly embarrassing,” says Badawi.
Metabolic diseases such as diabetes and high blood pressure are the result of interactions between the environment and a person’s genetics. Badawi says it would be extremely valuable for scientists and universities in the Arab world to focus on the genetics of Arab populations.
“Genetic public health initiatives are going on in North America and we need to be doing the same,” he said. Researchers should explore genetic biomarkers that would indicate whether a person is inherently predisposed to a disease. If more such markers were known, testing would allow individuals at risk for a disease to take steps to prevent them or to get treatment.
One condition that may have a strong genetic component is osteoporosis. Last month, a study published in the SpringerPlus journal concluded that osteoporosis research is neglected in the region. The author said that neglect is shortsighted because more people will suffer from it as lifespans continue to rise. “Arab countries should care about osteoporosis because it is a common disorder of increased age,” says Dr. Mustafa Ghanim from An-Najah National University Hospital in Palestine. “Its complications can be avoided or reduced if it is treated.” Women over the age of 50 should consume 1,200 milligrams of calcium a day to prevent the onset of osteoporosis—regular exercise is also important.
Ghanim thinks one of the biggest barriers to the effective of management of the disorder is a lack of understanding of the condition among ordinary people in the Arab world. “There are few research and awareness programs about it,” he says. He believes this may be due to the fact that osteoporosis is more widespread among women: “Should it affect males, it would be discovered and recognized earlier.”
While Arab countries may share some health problems, they don’t share research budgets. Government support of research is uneven at best. It will be left to the scientists to try to work together individually and catch up as best they can with the region’s evolving public-health patterns.