ArticlesThe state of health in the Arab world, 1990–2010: an analysis of the burden of diseases, injuries, and risk factors
Introduction
Geographically, the Arab world comprises 22 countries from north Africa to western Asia—ie, Algeria, Egypt, Bahrain, Comoros, Djibouti, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, occupied Palestinian territory, Qatar, Yemen, Somalia, Sudan (including South Sudan), Syria, Tunisia, and the United Arab Emirates. These countries are the members of the League of Arab States.1 Each country has a unique set of historical, geopolitical, social, cultural, and economic characteristics,2 which determine its public health systems and the burden of disease and injury.
Countries bordering the Persian Gulf—eg, Saudi Arabia and the United Arab Emirates—have a rising burden of occupational and road injuries because of the high number of expatriates who migrate for job opportunities.3, 4 Non-communicable diseases have increased substantially in the Arab world, with varying prevalence between different populations.5, 6 Therefore, conclusions about the Arab world cannot be drawn from simple generalisations because they are likely to be misleading.2
The status of the health-care system in the Arab world has been reported previously.7 Public health systems are perceived as being non-productive and are low priority in national spending plans.8, 9 Despite the resources in some Arab countries, the development and performance of their public health systems are lower than expected, with a continued focus on treatment rather than prevention.9, 10 Progress in health care in the Arab world has been reported; however, it has been slow in some countries compared with others.7
In this study, we assess the burden of disease and injuries in the 22 Arab countries in 1990, 2005, and 2010 using data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010).11, 12, 13, 14, 15, 16, 17, 18
Section snippets
Overview
GBD 2010 was a comprehensive assessment of the burden of 291 diseases and injuries, 1060 disease sequelae, and 67 risk factors. Estimates of these were provided by age group, sex, and country for 1990, 2005, and 2010.11, 12, 13, 14, 15, 16, 17, 18 Health loss was assessed with a systemic analysis of all the available data, with the following metrics: mortality, causes of death, years of life lost due to premature mortality (YLLs), years of life lived with disability (YLDs), and
Results
In 2010, ischaemic heart disease was the leading cause of death in the Arab world (contributing to 14·3% of deaths; appendix p 1), whereas in 1990 it was ranked second (figure 1). From 1990 to 2010, the ranking of lower respiratory infections, diarrhoeal diseases, preterm birth complications, malaria, protein–energy malnutrition, tuberculosis, neonatal encephalopathy, meningitis, maternal disorders, and measles declined, whereas that for HIV/AIDS and neonatal sepsis increased (figure 1).
Discussion
The Arab world has made great progress in reducing the number of deaths from diseases and injuries and prolonging life. Over the past 20 years, it has succeeded in decreasing premature death and disability from most communicable, newborn, nutritional, and maternal causes with the exception of HIV/AIDS. Despite improvements, substantial burden of communicable, newborn, nutritional, and maternal causes persist in the Arab LICs. As far as we know, this study is the first in which the changes in
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