Countries in the Arab world - from Saudi Arabia to Mauritania to Yemen - have made some significant health gains over the past two decades, including increases in life expectancy and swift reductions in child mortality. But the rise of chronic diseases, diet-related risk factors, and deaths from road injuries during the same period threatens that progress.
These are some of the findings published in "The State of Health in the Arab World, 1990-2010: An Analysis of the Burden of Diseases, Injuries, and Risk Factors." The paper was published in The Lancet as part of its series devoted to health in the Arab world. The study was led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
The data are drawn from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), a collaborative project of researchers worldwide led by IHME. The paper is the first to give a detailed look at changes in disease burden and the impact of risk factors and injuries between 1990 and 2010 in countries with predominately Arab populations.
The study examines trends in the region and also breaks down the 22 nations of the Arab League into low-income countries, middle-income countries, and high income countries, with challenges specific to each category.
"As a researcher, I see both the incredible progress being made in the health of people in the Arab world and the storm clouds on the horizon," said IHME Professor of Global Health Dr. Ali Mokdad, Director of Middle Eastern Initiatives and lead author of the study. "Health reforms with a focus on prevention are urgently needed in these countries. Our hope is that the Global Burden of Disease research will allow countries to better develop and implement programs to maximize their resources."
Dr. Mokdad will also present findings from the paper at the Arab Health Congress in Dubai on January 29th.
In the region as a whole, important changes occurred over those two decades. Burden attributable to noncommunicable disease, including ischemic heart disease, mental disorders such as depression and anxiety, and musculoskeletal disorders increased, while the premature death and disability from most newborn, nutritional, and maternal disorders decreased. Basically, there were tremendous improvements in what is killing the people but not in what is ailing them.
Of the 10 leading causes of health loss, combining both premature mortality and years lived with disability, between 1990 and 2010, lower respiratory infections remained the first, while ischemic heart disease rose to second. Major depressive disorder rose from eighth to fifth place, and low back pain, which was not among the top causes of health loss in 1990, was ranked seventh in 2010. The rise of noncommunicable disease in the Arab world mirrors similar changes in the US, Western Europe, and Canada.
By 2010, a transformation in leading risk factorsfor disease burden also took place, with dietary risks, high blood pressure, and high body mass index moving up in the rankings to become the top three. Poor diet and decreased physical activity reflect societal changes in the Arab world, where food is more abundant in wealthy Gulf states and people are spending more time indoors. Among non-dietary risk factors, smoking stands out for its toll on health in the Arab world. In many countries children can buy tobacco and smoke shisha, which is seen as a gateway to cigarette smoking.
But societal changes have had a positive impact in the last two decades as well. The Arab world has been impacted by several wars. Yet researchers point to strong family ties and social support that are part of Arab culture as some of the reasons for reductions in maternal and child mortality since 1990.
In dividing the region by income group, researchers found striking trends. The high-income group includes countries such as the United Arab Emirates and Qatar; the middle-income country group includes Lebanon and Jordan; and the low-income group includes Yemen and Djibouti.
As motor vehicle use grows in the Arab world, road injuries are an increasing cause of disease burden across all income groups. In high-income countries, road injuries were not only a leading cause of death but also a leading cause of premature mortality and disability. Dietary risks were the leading risk factors for death in all of the region's high-income countries with the exception of Saudi Arabia, where elevated blood pressure ranked higher.
Ischemic heart disease and stroke were the leading causes of death in middle-income countries, reflecting the region-wide transition toward chronic disease. Among men in these countries, in 2010 ischemic heart disease was the leading cause of health loss combining both premature mortality and years lived with disability. By the same measure, major depressive disorder was the top cause of poor health for women in 2010.
"The Arab countries are in transition from places where infectious diseases are the main cause of concern to places where heart disease, cancer, and diabetes are the main worries," said IHME Director Dr. Christopher Murray. "Right now, in the low-income countries, they are suffering from a double burden of non-communicable and infectious diseases. And that causes an incredible strain on their health systems."
Lower respiratory infections, diarrheal diseases, and malaria were the first, second, and third causes of death in low-income Arab countries. Pre-term birth complications, tuberculosis, stroke, and ischemic heart disease are also among the leading causes of death.
Despite the variety of health challenges seen in different income groups, almost all countries in the Arab world experienced increasesin life expectancy. For both men and women, Yemen and Sudan were among the countries with the greatest increases, while Kuwait and Iraq had the smallest increases.
Detailed findings on the Arab world and comparisons to other countries are available in online data visualization tools at http://www.ihmeuw.org/gbdcountryviz.
The Institute for Health Metrics and Evaluation (IHME)is an independent global health research center at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.