It is no secret that the Middle East and North Africa (MENA) is a region of current turmoil and upheaval. Recent conflicts, most notably the Syrian civil war and resulting rise of terrorist organizations such as ISIS, have added a newfound literality to the geographic epithet--with all nations watching and/or involved in the violence being played out, it seems that the Middle East has truly become the center of the world. The result on public health in the MENA nations is two-pronged, both explicit and implicit. It is explicit in that attacks on physical health institutions discourage patients from seeking care and professionals from working to provide that care; it is implicit in that the perception of said conflicts results in notions of a hidebound and stagnant region, notions that impact the type of care people in the area receive. While both aspects present considerable challenges, I argue that the latter is more easily remedied, and that special care should be given to do so.
Daily media broadcasts relay horrific scenes of graphic violence and bloodshed perpetrated by countless militant groups, both sectarian and secular, demonstrating how stagnantly undeveloped the MENA region is, as a whole. Or so one would think.
In fact, the MENA area has been making remarkable progress in terms of development and growth, especially in the public health field. One metric of this development is the ratio of communicable to non-communicable disease deaths in the area. Public health professionals maintain that public health progress can be usefully gauged by analyzing what illnesses are causing the most deaths in the region. And, in recent years, MENA nations have shifted towards a higher prevalence of non-communicable diseases, otherwise known as “chronic illnesses” [1].
In the Middle East, the incidence of diseases associated with poverty and underdevelopment, such as tuberculosis and lower respiratory infections, has decreased significantly over the past decade. In contrast, the prevalence of diseases viewed as more “Western” ailments, including diabetes and lower back pain, has skyrocketed. Between 1990 and 2010, there was a 69% decrease in the prevalence of diarrheal diseases while the incidence of major depressive disorder increased over the same period by 58% [2].
Along with chronic diseases, high body mass index (high BMI) is among the top ten causes of premature death and disability in the area. High BMI is frequently observed across nations in the MENA region [3]. A 2011 study found that the percentage of obese men in the region ranged from 5.7% in Morocco to 39% in Kuwait; among women, the range was between 7.1% in Libya and 53% in Kuwait [4]. The obesity prevalence is higher than in the United States, where rates of obesity among American adults over the age of 20 is estimated to be 34.9% for both sexes [5].
These data point to a startling reality: the Middle East is following the disease trends of developed nations. In light of conspicuous political and military turmoil in the region, however, it must be asked whether the recent trends in public health development will continue. Regional militancy introduces challenges to addressing public health in general in the area, not only the chronic illnesses it has come to face. Conflict in Syria has caused more than half of the physicians in the nation to flee and seek refugee status in other nations [6]. Reports of damage to hospitals, both intentionally inflicted and collateral, commonly appear in the news [7]. Such damage to public health institutions begs the question of whether or not the recent trend in the region towards “Westernized illness” will persist.
That said, while infrastructural damage is devastating, more pressing is the implicit perception that Western nations have of the Middle East. Dan Schueftan, Director of the National Security Studies Center at the University of Haifa, asserts that American policies tend to focus on “taking care of the symptoms rather than the problem,” an attitude precipitated by misunderstanding, and misconceptions, of regional politics [8]. Misinformation can result in policies that more enduringly hinder development in the region than infrastructural damage caused by militant groups.
Such misinformation stems from American separation from the region, both geographically and in media. While based in fact, media tends to paint the Middle East with a broad brush; an internet search for “development Middle East” returns a 2012 CNN article entitled “Why the Middle East is a Mess,” even though the piece focuses entirely on only four sub-regions of the Middle East [9]. Beyond this singular news publication, constant reports of conflict in Syria and Yemen, among other nations, are taken by western audiences to be confirmation that the entire region is in chaos.
The severity of these misperceptions presents itself in the form of public opinion and subsequent public policy formation. Unfortunately, monetary health aid to MENA nations fails to address the actual concerns of the region. The U.S. global health aid to the country of Jordan for the year 2013 was $49 million; between 2000 and 2011, zero dollars were granted to deal with non-communicable diseases [10]. Similarly, over $11.5 million were given to the Republic of Yemen for health aid in 2013, while zero dollars were granted for addressing non-communicable diseases between 2000 and 2011 [11].
These figures demonstrate that, historically, aid to the Middle East has been unfocused on the true issues plaguing the region. Because there exists a perception of the area as being underdeveloped and antiquated, there is an accompanying idea that the region suffers exclusively from “diseases of poverty,” and not the chronic illnesses that actually present the most concern. Moving forward, it is unlikely that this (mis)funding trend will change, particularly given current media coverage of the region. And while immediate infrastructural damage inflicted by militant groups presents a major obstacle to health, the impact of mis- or non-funding is more enduring and dangerous, threatening to keep public health from ever progressing in the region.
To address the inadequacies of current health funding allocation, I argue that media institutions should strive to present news developments in the region holistically, noting any possibly misconstrued generalizations and the consequences of such on public perception and policy. This is not an imploration to censor conflict; accurate reporting is imperative in appropriately informing the public. My claim is, however, a call for more thoughtful presentation of news so as to prevent the formation of stereotypes about entire world regions. As has been demonstrated, these stereotypes are more dangerous than bruised emotions; misconceptions can hinder the appropriate and informed allocation of health resources and care in the regions that most desperately need them.
References
[1] Francisca Ayodeji Akala and Sameh El-Saharty, “Public-health challenges in the Middle East and North Africa,” The World Bank, Middle East and North Africa Region, Human Development Sector, March 25, 2006, accessed July 5, 2016, http://web.worldbank.org/archive/website01055/WEB/0__CO-24.HTM
[2] “In Middle East and North Africa, Health Challenges are Becoming Similar to Those in Western Countries,” The World Bank, September 4, 2013, accessed July 5, 2016, http://www.worldbank.org/en/news/press-release/2013/09/04/middle-east-north-Africa-health-challenges-similar-western-countries
[3] “In Middle East and North Africa,” The World Bank
[4] Abdulrahman O. Musaiger, “Overweight and Obesity in Eastern Mediterranean Region: Prevalence and Possible Causes,” Journal of Obesity, September 18, 2011, accessed July 5, 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175401/
[5] “Adult Obesity Facts,” The Centers for Disease Control and Prevention, last updated September 21, 2015, accessed July 5, 2016, https://www.cdc.gov/obesity/data/adult.html
[6] Aryn Baker, “Syria’s Health Crisis Spirals As Doctors Flee,” TIME, February 4, 2014, accessed July 6, 2016, http://time.com/3968/syrias-health-crisis-spirals-as-doctors-flee/
[7] “WHO condemns attacks on health facilities in Benghazi,” Middle East Monitor, June 28, 2016, accessed July 5, 2016, https://www.middleeastmonitor.com/20160628-who-condemns-attacks-on-health-facilities-in-benghazi/
[8] Afarin Dadkhah, “Getting it Wrong: American Misperceptions of the Middle East,” Wilson Center Middle East Program, June 6, 2013, accessed July 6, 2016, https://www.wilsoncenter.org/event/getting-it-wrong-american-misperceptions-the-middle-east
[9] Frida Ghitis, “Why the Middle East is a mess,” CNN, November 30, 2012, accessed July 6, 2016, http://www.cnn.com/2012/11/30/opinion/ghitis-middle-east/
[10] “The Emerging Crisis: Noncommunicable Diseases,” Council on Foreign Relations, 2014, accessed July 6, 2016, http://www.cfr.org/diseases-noncommunicable/NCDs-interactive/p33802?cid=otr-marketing_use-NCDs_interactive/#!/
[11] “The Emerging Crisis,” Council on Foreign Relations