Patterns of Disease Are Changing in the Arab World
BEIRUT—As the Arab world has become more prosperous in recent decades, the number of people dying from contagious diseases has fallen. But the death rate from non-infectious diseases, such as diabetes and cancer, has risen sharply.
Al-Fanar Media reviewed regional data on disease patterns to find out how those patterns diverge from what is happening globally. We want to guide both our own editorial efforts and the focus of our readers to those medical issues that are the most important. Some of those are obvious, but others, like the effect of gender or income, are hidden within the numbers.
Investments in vaccination and better sanitation have paid off in many Arab countries, but this also means people are living long enough to die from non-infectious diseases that are heavily influenced by lifestyle and environmental factors like diet, exercise and pollution.
Non-communicable diseases kill 2.2 million people every year in the Eastern Mediterranean region, which consists of North Africa and the Middle East along with Afghanistan, Cyprus and Pakistan, according to the World Health Organization. Most of those deaths – 1.7 million – are caused by just four conditions: heart disease, diabetes, cancer and chronic respiratory disease. More than half of the deaths occur before the age of 70, and are thus considered premature.
But the data also show that this trend does not hold true across all income levels in Arab societies, and some neglected infectious diseases are still either rising sharply or declining sluggishly.
Public-health experts warn that poorer countries, like Yemen, get the worst of both worlds.
“In parts of the Arab world, we are seeing a double burden of disease,” says Hanan Abdul Rahim, head of the public-health department at Qatar University. “There are high levels of obesity and diabetes typically associated with affluence and modernization, but there are also diseases of underdevelopment, including micronutrient deficiencies,” such as anemia.
According to other regional statistics collected by the World Health Organization, the number of deaths from infectious diseases in the Eastern Mediterranean fell by 23 percent between 2000 and 2015. That is slightly below the global rate of decline, which was 26 percent in the same time frame.
Diarrheal diseases, such as cholera, have been falling at a faster rate—by about 37 percent in the Eastern Mediterranean between 2000 and 2015, in line with the global rate of decline.
But some infectious diseases buck this trend, not the least of which are diseases associated with HIV, the virus that causes AIDS. The region’s AIDS death rate is rapidly increasing. Between 2000 and 2015, it rose by 274 percent despite a global decrease in the number of AIDS deaths by 27 percent in the same period. (See a related article, “AIDS Deaths Soar in the Arab Region.”)
Navid Madani, a senior scientist in the department of health and social medicine at Harvard Medical School, says that Arab countries must not be complacent and assume that all infectious diseases will decrease as living standards improve. She studies HIV transmission in the Middle East and warns that governments need to start taking AIDS seriously.
Stigma, a lack of education and poor access to treatment have allowed HIV infections to increase against a backdrop of declining rates of infectious diseases in general, says Madani.
“The whole thing has been festering—just waiting to happen,” she says.
Meanwhile the number of deaths from non-infectious disease in the region rose by 38 percent between 2000 and 2015, compared to a global increase of 25.5 percent over the same period, according to World Health Organization statistics.
“Like many parts of the world, Arab countries are suffering from the burden of non-communicable diseases and their risk factors, including high levels of obesity, smoking, and physical inactivity. Obesity is particularly problematic in high-income Arab countries,” says Abdul Rahim, of Qatar University.
Other data indicate that the public-health equivalent of a train wreck is on its way. A report published by the World Bank and the Institute for Health Metrics and Evaluation, an independent research center based at the University of Washington in Seattle, shows the risk factors for non-communicable diseases are fast accumulating. For example, in the Middle East and North Africa, the incidence of high blood pressure increased by 59 percent between 1990 and 2010, and obesity increased by 138 percent. Smoking increased by 10 percent from an already high level. Smokers pick up the habit at a very young age.
In most Arab countries, at least 20 percent of males ages 13 to 15 use tobacco products, most commonly cigarettes. The rate among females of the same age is typically half of that proportion, according to a report from the Population Reference Bureau, an independent research center based in Washington, D.C.
Abdul Rahim says risky behaviors are also on the rise in the rest of the world. A paper from the National Health Service in England reported that obesity prevalence almost doubled from 15 percent of the population in 1993 to 27 percent in 2015.
According to the World Health Organization, most non-communicable disease deaths in the region are linked to these risk factors. “Non-communicable diseases are essentially lifestyle diseases, which means they can be averted by changing behaviors such as physical inactivity, smoking and unhealthy diets,” says Abdul Rahim. “However, this seems like a deceptively easy recipe.”
Convincing people to improve their diet, exercise more and quit smoking is tough and realistically requires governments to take concerted action, she warns.
“Such changes would include legislation like anti-tobacco laws, policies on food prices and on the advertising of unhealthy products to children,” says Abdul Rahim, adding that investments to promote active lifestyles, like advertising campaigns and using exercise facilities, would also help. “However, structural changes are very difficult to implement because there are powerful vested political and financial interests at stake,” she says.
It is however true that non-communicable diseases are not entirely caused by lifestyle or choice. Some people are genetically predisposed to developing a disease such as diabetes.
There are also environmental factors beyond an individual’s control that increase the risk of non-communicable diseases, such as second-hand smoke and air pollution — both of which are common problems in Arab cities. In Cairo, the concentration of toxic compounds in the air is 7.6 times higher than the WHO’s safe level and in Beirut the air is 3.2 times more toxic than recommended. Low-income housing is more likely to be found close to the sources of this air pollution, such as highways and factories.
While the wealthy often escape the impact of infectious disease, the poor in many Arab countries are still carrying that disease burden.
None of top three causes of early death and disability for high-income individuals in the Arab world were infectious diseases in 2010, according to the Institute for Health Metrics and Evaluation. But for low-income individuals, the top three causes of early death and disability were all infectious diseases: lung infections, diarrheal diseases and malaria.
Low-income men and women have similar causes of early death and disability. But for the wealthy, the causes diverge by gender.
For rich men, early death or disability is most likely to be caused by motor-vehicle accidents or heart disease, but for wealthy women it’s depression or diabetes. Road injury is ninth on the list of causes for early death or disability for high-income women, and depression is number four for high-income men.
Hard numbers on mental health in the Arab world are scarce and occasionally seem contradictory. Regional data from the World Health Organization indicate that depressive disorders did not cause any deaths or suicides between 2000 and 2015. But the Institute for Health Metrics and Evaluation lists it as the top cause for early death and disability among high-income Arab women in 2010.
The erratic nature of the data makes it hard to address the problem, says Fadi Maalouf, chief of the division of child and adolescent psychiatry at the American University of Beirut Medical Center. Maalouf studies the mental health needs of young people in Lebanon. He says that as many as 94 percent of young people with a mental-health problem do not get help. “The treatment gap is much higher than in the developed world,” he says. (See a related article, “Anxiety and Depression Often Shadow Arab Youth.”)
Studying disease trends highlights where healthcare and research investments are needed most. Missing data indicate where better tracking is needed so governments and researchers can improve their focus.