Countries in the Eastern Mediterranean Region are in a “crucial health phase,” as deteriorating health conditions are expected in the years to come, according to research published by the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington.
Bringing together research and data from 176 researchers, an article in The Lancet medical journal highlights emergent trends and coincidental findings, while the institute has published data for each country on its website.
Since the IMHE released the similar report titled the Global Burden of Disease Study 2010 (GBD 2010), parts of the region have been engulfed in conflict, violence and unrest as a result of revolutions, wars, and so-called Arab uprisings. The objective of the new study was to present an updated account of diseases, injuries and risk factors in the Eastern Mediterranean Region as of 2013.
While the report does look at the drop in life expectancy in the region, linked primarily to civil wars in Libya and Syria, it focuses principally on the effects of disease and the need to develop a better approach to future health crises in the region.
Mada Masr spoke with Ali Mokdad, director of Middle Eastern Initiatives at the institute and the coauthor of the paper along with the institute’s director Christopher J. L. Murray, about what the findings mean for Egypt.
Mokdad argues that Egypt has historically been an active population reliant on farming. However, innovations during the past century have changed people’s behavior, resulting in a less active lifestyle while increasing access to food.
“Egyptians have become very sedentary when working,” Mokdad says. “And, as a result, this change in their behavior has led to an increase in diseases we didn’t see before.”
Mokdad argues that the region is dealing with an epidemiological shift – or a shift in the spread and incidence of disease. Egypt now suffers from diseases that for a long time were considered specific to developed countries, including obesity, diabetes and high blood pressure, according to Mokdad.
Heart disease was found to be the leading cause of death in most countries in the region, as it is globally. Coronary heart disease encompasses a group of diseases often caused by obesity, diabetes, poor diet, lack of exercise, high blood pressure and smoking.
In 1990, cardiovascular diseases were responsible for a third of all deaths in Egypt, while common infectious diseases such as diarrhea and lower respiratory diseases accounted for 22.8 percent of fatalities. However, statistics provided by the IMHE show that cardiovascular diseases have steadily increased to account for 41.63 percent of all deaths in Egypt in 2013, while cirrhosis was the second most deadly disease at 11.54 percent.
The Disability-Adjusted Life Years (DALY) is a common metric used to determine the impact of disease by measuring the potential years of “healthy” life lost due to disease, disability and adverse mental health conditions. While cardiovascular disease, at 21.62 percent in 2013, remains the single largest contributor to the DALY metric, diabetes and other endocrine diseases have increased from 5.37 percent in 1990 to 8.7 percent in 2013.
The leading contributors to DALYs in Egypt are primarily metabolic and behavioral, meaning the largest risks are associated with unhealthy diets, smoking and a lack of physical activity. High body-mass index was the leading cause of DALYs in Egypt in 2013, at 4,291 per 100,000 people, followed by high systolic blood pressure (3,616) and smoking (1,655).
As the region’s population is young, Mokdad predicts that there will be problems ahead. “Across the region we have a very large youth population, and the younger population doesn’t put pressure on the health system but that does not mean they are healthy. As the population ages, the burden will increase, and medical services won’t be equipped to deal with it,” Mokdad warns. “They will not have the financial resources or the manpower to deal with the burden of disease. Egypt must work on prevention or it will be very costly, and they cannot afford that.”
In order to improve public health in Egypt, Mokdad proscribes a combination of preventive measures and prompt treatment that must, in part, be preceded by a shift in rooted social practices. “People often don’t go to the doctor unless they are severely sick, and, in Egypt, people don’t go see a primary physician, but rather wait until they need a hospital, and it is too late for prevention,” he says.
One of the solutions the report calls for is increased investment in health. Article 18 of the Egyptian Constitution mandates that the government must allocate at least three percent of gross domestic product to healthcare.
The Health Ministry, he argues, should encourage Egyptians to regularly visit primary physicians to detect potential risks early on, and, in that way, increase the management of risk factors, such as high-blood pressure and obesity, before developing diabetes or cardiovascular diseases. “Someone who is borderline diabetic will be more motivated to change their habits, and they should not wait until they become diabetic or have a full-on heart attack.” People with a family history of diabetes may have a genetic predisposition to the disease, making them even more susceptible, Mokdad explains.
However, Mokdad argues that it would be a mistake to think that the Health Ministry alone can address the issue, contending that only a multiagency approach supported by proper investment and planning can make significant changes.
To this end, Mokdad says that the Agriculture Ministry should promote healthier diets by providing vegetables at affordable prices and introduce education programs to promote better diets, and the Education Ministry should place greater emphasis on physical activity in schools. Within this broad approach, Mokdad also argues that the Planning Ministry must work to improve pavements to make it easier for people to walk more often and that police should better enforce restrictions on smoking in public area. Policies that prohibit smoking in public places should also be more rigorously enforced by the police, and parents must be better role models for their children, he argued.
“People must be encouraged to eat better, smoke less, and exercise more,” he said. People suffering from mental health issues are also more likely to engage in habits such as smoking or unhealthy diets, Mokdad added, and, as such, they are particularly vulnerable to potential health risks unless the state or their communities provide help.
One of the report’s key findings was a rise in the burden mental health problems will place on societies and public health infrastructures. With few exceptions, mental health is not on the agenda of national health ministries and international agencies, according to the report.