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Time to take the train. Ammar Shaker

Heart disease and road accidents hit rich Arab nations

People in Arab countries are now living longer with less disability, but face a rise in problems related to chronic illness such as heart disease, according to a new paper in The Lancet. With the exception of HIV/AIDS, which has increased significantly, the likelihood of dying from communicable disease, poor nutrition and maternal health problems has fallen over the past 20 years.

According to data from the Global Burden of Diseases, Injuries and Risk Factors Study and published in the Lancet as part of a series on the state of health in the Arab world, heart disease was the biggest killer in 2010, replacing lower respiratory infection in 1990.

Biggest killers. Institute for Health Metrics and Evaluation

But a breakdown of the 22 countries in the Arab States into low, middle and high-income nations suggests the improvements in health were mainly in richer countries such as Bahrain, Saudi Arabia, Qatar and Oman. Middle-income countries included Algeria, Egypt, Morocco, Sudan and Syria, while those classed as low-income countries included Mauritania and Yemen. The difference in income between these countries is stark according to gross national income per person, ranging from US$523 per person in the poorest, US$3251 in the middle and US$39,688 in the richest.

Like many other countries including the US, Canada and western Europe, there was a rise in chronic illness such as heart disease, obesity and diabetes. Mental disorders such as depression and anxiety were also a major problem.

Dietary risks, high blood pressure, and high body mass index were among the top three risk factors to health in the Arab world, the authors said. Among non-dietary risk factors smoking had taken a toll on health. The Arab world has some of the highest smoking rates in the world.

Ali Mokdad, co-author of the paper, said: “The increase in chronic disease in the Arab world is due to behavioural changes. Arabs are consuming a poor diet low in fruits and vegetables and other important components such as fish and nuts. They are also living a more sedentary life with little or no physical activity.”

A high proportion of younger people, the so-called youth bulge, in a number of countries meant this could become an even bigger problem in the future, Mokdad said. In Saudi Arabia, for example around 60% of the population is younger than 30.

“Conditions such as diabetes and heart disease are increasing at the same time as risk factors including high blood pressure and obesity,” he said. “This increase in chronic diseases is alarming as it has a large population of young people and as they age, chronic disease will have an even larger and costlier impact.”

Of those living with a disability, major depressive disorder ranked first among women in richer countries compared to 9th place in low-income countries.

In the wealthiest countries, deaths from road traffic accidents also increased significantly and was the second biggest cause of death in 2010 and for men, the biggest source of disability. The authors attribute to the high number of people who migrated to those countries for job opportunities and the growth in traffic.

In the poorest countries, lower respiratory infections, diarrheal diseases, and malaria ranked first, second and third as the biggest causes of death.

HIV/AIDS across the region had “increased substantially” over the past 20 years, the report said, particularly in low and middle-income countries.

The impact of conflict in some countries had also taken a toll, the authors said. Although life expectancy in Iraq rose for both sexes, it only did so by one year, leading the authors to conclude this was largely due to prolonged war from 2003-2011. Women in Syria had the biggest increase in life expectancy from around 74 years to 80, but it remains to be seen what impact the current conflict will have on these figures.

“Each country in the Arab World is unique,” Mokdad said. “Even within countries there are variations in disease burden. Our country-specific estimates for the Arab world will enable each country to assess its disease burden and plan its health programmes and activities accordingly.”

“Hopefully Arab countries, especially the wealthy ones, will start producing local disease burden estimates similar to what China, England, and Mexico are now doing.”

A new category of intimate partner violence was introduced in 2010 though it is to early to analyse trends, the paper said.

The limitations on the study included a lack of data from some countries. The paper acknowledged that some countries were open to different risks (as in the case of the growth of road traffic in some countries) and improvements in diagnosis.

Commenting on health inequalities in the region, Hoda Rashad, Director of the Social Research Center at the American University in Cairo, said the Arab world had to embrace the idea of fairness and social justice.

“The available information base about health in Arab countries does not allow a full picture of the status and trend of health inequities. The little we know, however, does show wide health inequities that prevail within all Arab countries regardless of their economic status.”

The failure to collect information reinforced this, she said. “The Arab world is yet to embrace and to join this [health equity] movement. The appreciation of links between voiced aspirations and realisation of an equitable distribution of health has not filtered into the conscious minds of Arab people, and has not gained the prominence it deserves within the policy arena.”

“This is mainly a conceptual failure but is very much supported by the well known measurement trap, where neglect and absence of data are self-reinforcing.”

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