Non-communicable diseases in the Arab world

Summary

According to the results of the Global Burden of Disease Study 2010, the burden of non-communicable diseases (cardiovascular disease, cancer, chronic lung diseases, and diabetes) in the Arab world has increased, with variations between countries of different income levels. Behavioural risk factors, including tobacco use, unhealthy diets, and physical inactivity are prevalent, and obesity in adults and children has reached an alarming level. Despite epidemiological evidence, the policy response to non-communicable diseases has been weak. So far, Arab governments have not placed a sufficiently high priority on addressing the high prevalence of non-communicable diseases, with variations in policies between countries and overall weak implementation. Cost-effective and evidence-based prevention and treatment interventions have already been identified. The implementation of these interventions, beginning with immediate action on salt reduction and stricter implementation of tobacco control measures, will address the rise in major risk factors. Implementation of an effective response to the non-communicable-disease crisis will need political commitment, multisectoral action, strengthened health systems, and continuous monitoring and assessment of progress. Arab governments should be held accountable for their UN commitments to address the crisis. Engagement in the global monitoring framework for non-communicable diseases should promote accountability for effective action. The human and economic burden leaves no room for inaction.

Introduction

The Global Burden of Disease Study (GBD) 2010 identified a clear shift between 1990 and 2010 in the number of deaths from communicable, maternal, neonatal, and nutritional causes to deaths caused by non-communicable diseases.¹ Two-thirds of the 52·8 million deaths worldwide in 2010 were caused by non-communicable diseases, with ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes ranking among the top ten causes.¹ This trend is also true for the Arab world, particularly in middle-income and high-income countries where ischaemic heart disease is the number one cause of death.² Risk factors have increased substantially for the major non-communicable diseases (cardiovascular disease, cancer, chronic lung diseases, and diabetes). In nine Arab countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Libya, occupied Palestinian territory, Tunisia, and Syria), the prevalence of daily tobacco smoking now exceeds 30% in men, and that of obesity, particularly in women, is alarmingly high.3, 4, 5, 6 The region has six of the ten countries in the world with the highest diabetes prevalence.⁷

Internationally, action against non-communicable diseases is gaining momentum, most notably with the political declaration of the UN General Assembly on the prevention and control of non-communicable diseases in 2011, and the subsequent monitoring framework.8, 9 Cost-effective and evidence-based prevention and treatment measures to address non-communicable diseases—called best buys by WHO—have been identified.10, 11 Arab governments need to engage with this international momentum and should be held accountable for their management of the non-communicable disease crisis, which threatens to derail an already fragile social and economic development trajectory. The response of Arab countries to the crisis has so far been inadequate. The gap between epidemiological burden and policy response is surprising, given that a Global Burden of Disease Study, published in 1997, identified non-communicable diseases—notably cardiovascular disorders—as the leading causes of deaths in the Middle Eastern crescent (which included north Africa, the Middle East, Pakistan, and the central Asian republics of the former Soviet Union).¹² Subsequent evidence suggested that the greatest increase in non-communicable disease mortality rate between 2006 and 2015 was expected in Africa (27%) and the eastern Mediterranean region (25%), which includes most Arab countries.¹³ The discrepancy between epidemiological data and policy response is partly caused by the weaknesses in the public systems (of which health systems are a part) and in the complex political, social, and economic environments in which these public systems operate.¹⁴ Poverty, conflict, sex inequality, corruption, and lack of accountability have affected health in the Arab world to varying degrees, and Arab countries have substantial variation in the availability of resources for spending on health.15, 16, 17

This report will focus on current actions and future needs for an effective response to the non-communicable disease crisis. First, we briefly review the burden of non-communicable diseases and their risk factors in Arab countries. We summarise current actions to address non-communicable diseases and discuss the gaps between what needs to be done and what is being done. Following the proposed stepwise approach for national action to meet UN commitments on non-communicable diseases, we show where the focus of future actions must be shifted.¹⁸ We will also draw attention to the challenges for effective action against non-communicable diseases.