Health in times of uncertainty
Authors: Riyadh K Lafta
Journal: The Lancet Global Health (2016)

In The Lancet Global Health, Ali Mokdad and colleagues1Mokdad AH Forouzanfar MH Daoud F et al.Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet Glob Health. 2016; (published online Aug 24.)http://dx.doi.org/10.1016/S2214-109X(16)30168-1Google Scholar present the interesting subject of health in times of uncertainty, which sheds light on the burden of morbidity and mortality in the eastern Mediterranean region—a major setting for violence in the past decade. The security fluctuation in these countries draws attention to the need to analyse the health situation through translation of health status to a clear sketch about disease, death, and years of potential life lost in the region. The results revealed that the leading cause of death in the region was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17% since 1990. The leading cause of disability-adjusted life-years (DALYs) for men was ischaemic heart disease, and for women was lower respiratory infection. An increase of the burden of mental health problems and drug use was observed. The findings of this study are important because they provide baseline information about the health status in these countries, although more research, in-depth analysis, and ongoing surveillance are needed to complete the picture and to sustainably monitor the situation. These results could be a reliable and sensitive indicator of health status and impact of health services in those countries during this crucial health phase (due to ongoing wars) to allow governments to deal with the rapid changes that might negatively affect the health and wellbeing of people in the region. Most eastern Mediterranean countries are in a state of epidemiological transition, with some features of developing countries (eg, health problems related to sanitation and nutrition like infectious diseases, especially diarrhoea), and at the same time, people in these countries are also starting to have health problems more typical of developed countries (eg, ischaemic heart diseases, cancer, road-traffic accidents, and psychological problems). This transition has increased the burden of diseases on the community and exhausted the health system. It is well know that data collection (including vital and non-vital statistics) in countries with unrest is difficult and sometimes unreliable, especially if the sources of data are governmental institutions, where political interference is not uncommon. Nevertheless, the method of data collection in this study is the best choice available considering that widespread house-to-house surveys are costly, time and effort consuming, and not always feasible. The effect of violence on morbidity rates, mortality rates, and DALYs cannot be overlooked especially in the eastern Mediterranean region. War and other forms of armed conflict cause extensive morbidity (including disabling injuries and adverse effects on mental health) and mortality in military personnel and civilians. Populations suffer health problems during, and after, conflicts because of damage to the health-supporting infrastructure, safe food and water, sanitation, and medical care and public health services. Moreover, conflicts lead to internal displacement of large numbers of individuals and families, which increases the burden of diseases and injuries, and, consequently, leads to more violence.2Levy BS Sidel VW Documenting the effects of armed conflict on population health.Annu Rev Public Health. 2016; 37: 205-218Crossref PubMed Scopus (47) Google Scholar Injuries form a major component of the burden of disease worldwide, but little is known about civilian injuries, deaths, and disabilities during conflict.3Murray CJ Vos T Lozano R et al.Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2197-2223Summary Full Text Full Text PDF PubMed Scopus (6317) Google Scholar Between 1990 and 2010, road traffic accidents, falls, burns, violence, homicide, suicide, and war resulted in more than 5·1 million deaths annually.4Lozano R Naghavi M Foreman K et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128Summary Full Text Full Text PDF PubMed Scopus (9860) Google Scholar However, the highest proportion of people injured were left with substantial disabilities.5WHOThe injury pyramid. Violence and injury prevention: the facts.http://www.who.int/violence_injury_prevention/key_facts/VIP_key_fact_5.pdf?ua=1Google Scholar Although community-based injury data exist for stable low-income and middle-income countries, little is known about civilian injuries in conflict-affected regions.6Moshiro C Heuch I Astrøm AN Setel P Hemed Y Kvåle G Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey.BMC Public Health. 2005; 5: 11Crossref PubMed Scopus (121) Google Scholar, 7Tercero F Andersson R Peña R Rocha J Castro N The epidemiology of moderate and severe injuries in a Nicaraguan community: a household-based survey.Public Health. 2006; 120: 106-114Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 8Cardona M Joshi R Ivers RQ et al.The burden of fatal and non-fatal injury in rural India.Inj Prev. 2008; 14: 232-237Crossref PubMed Scopus (40) Google Scholar, 9Lafta R Al-Shatari S Cherewick M et al.Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq: a randomized household cluster survey.PLoS One. 2015; 10: e0131834Crossref Scopus (31) Google Scholar The key message that should be taken from this paper is that the eastern Mediterranean region is going through a crucial health phase that could result in deterioration in the health status of countries in the region for many years. We are facing common known and expected problems, but we should be more alert to emerging disasters that might result from the unfamiliar situation due to the continuous destruction of the infrastructures and the effect of the new sophisticated weaponry used in conflict. Addressing this growing burden requires sincere efforts, realistic plans, adoption of new approaches and skills to continuously evaluate and analyse the situation, proposal and implementation of plans for prevention and control measures, and improvement of health services to dilute the effect of the burden of conflict. I declare no competing interests. Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Full-Text PDF Open Access