Obstacles to health in the Arab world

doi:10.1136/bmj.333.7573.859

BMJ 2006;333:859 (21 October), doi:10.1136/bmj.333.7573.859

Letter

Obstacles to health in the Arab world

EDITOR—Health indicators in the Arab world show starkdifferences between individual countries. But aggregate figuresprovide only a narrow perspective. They do not show variationaccording to socioeconomic group, sex, education, or politicalaffiliation. The scarcity of databases available to collectsuch detailed data reflects the fact that inadequate politicalsupport exists for rigorous intersectoral research of relevancefor health in the region. National development agendas and publicpolicies are focused on economic development. Funding for healthtends largely to be directed at providing curative medical servicesdesigned to emulate Western health systems.¹

Patriarchal and religious principles embedded in the state structuresof many Arab countries—such as Lebanon, Egypt, and SaudiArabia—are a further obstacle to unpicking and takingaction to tackle poor health and health inequity in the region.The conservative values of the Arab world render public debatesabout religion, politics, and sexuality unacceptable and placesocial stigma around drug users, commercial sex workers, andmentally ill people. As a result, health data on such groupsare limited and unreliable,² which presents an obstacle forthe development of appropriate services.

Although national cultural, social, and economic structuresare to blame for patchy and inequitable public health services,particularly in Egypt, Morocco, and Lebanon,³ regional and globalforces influence health provision too. The Arab-Israeli conflict,the wars in Iraq, the Gulf, Lebanon, Yemen, and Sudan have broughtabout hunger, epidemics, displacement, and death. These warshave been tacitly bolstered by multinational corporations, whichhave sold billions of dollars worth of weapons to Arab countriesin conflict. Governments' expenditures on defence in some Arabcountries are greater than their expenditure on health.⁴ Internationalpolitical action (and inaction), notably in Iraq and Lebanon,has played a part too. Similarly, global decisions have ledto fluctuations of funding for the United Nations Relief andWorks Agency (UNRWA), the leading health and social serviceprovider to Palestinian refugees.⁵

Multilateral and bilateral aid has also influenced public policymaking in many economies of the Arab world, owing to demandsfor reform and reduced public sector spending. These have hada disproportionate effect on low income groups. Although severalArab countries have banned tobacco advertisements, tobacco companiescontinue to reach Arab homes through satellite television stations,another global feature. Tobacco related mortality is expectedto reach 0.5 million deaths in the Arab world by 2020.

Further investigation of the ways that powerful regional andglobal agents effect health in the Arab world and beyond iscrucial for a clearer perspective on obstacles to health. Onlythen will the possibility of advocacy for lasting health seethe light.

J Makhoul, associate professor

Department of Health Behaviour and Education, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad el Solh 1107-2020, Beirut, Lebanon jm04{at}aub.edu.lb

F El-Barbir, public health practitioner

Department of Health Behaviour and Education, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad el Solh 1107-2020, Beirut, Lebanon

Competing interests: None declared.

References

United Nations Development Programme (UNDP), Arab Fund for Economic and Social Development, Arab Gulf Programme for United Nations Development Organizations. Arab human development report 2004 towards freedom in the Arab World. New York: UNDP, 2004.
Economic and Social Commission for Western Asia (ESCWA). Selected social trends in the ESCWA region. New York: United Nations, 1997.
Makhoul J, Harrison LJ. Intercessory wasta and village development in Lebanon. Arab Studies Quarterly 2004;26(3): 25-41.
Stork J. The Middle East arm bazaar after the cold war. Middle East Report 1995;197: 14-9.
Brynen R. Donor contributions to UNRWA. In: Babille M, Barney I, Brynen R, Jacobsen LB, Endersen L, Hasselknippe G, eds. Social service delivery to Palestinian refugees: UNRWA and other provider, UNRWA financial and donor environment. Vol 3 of Finding means UNRWA's financial crisis and refugee living conditions. [CD-ROM]. Fafo report. 2003: 157-178.