June 21, 2023
Chronic diseases pose a significant health challenge in the Middle East and North Africa (MENA) region. As the region experiences rapid socioeconomic transitions, the burden of non-communicable diseases (NCDs) has steadily increased. This article explores the prevalence, risk factors, and potential solutions to combat chronic diseases in the MENA region.
The social, economic, and political impacts of chronic diseases are now recognized as some of the greatest challenges countries face to deliver Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). Whilst the public policy dialogue has focused on infectious diseases, research into NCDs has received little attention.
The recent Health Systems Reform series in the MENA region provided evidence of the heterogeneous patterns of health outcomes across this region. The population at risk of chronic diseases, i.e., those over 60, currently ranges from 0.8% in the UAE to 10.6% in Turkey. These percentages are expected to increase significantly in the coming years as a result of the demographic transition due to continuing improvements in life expectancy Over the years child and adult mortality rates have declined across the MENA region, especially in Saudi Arabia, Iran, Qatar, the United Arab Emirates, Oman, and Turkey.
2. Prevalence of Chronic Diseases in the MENA Region
The MENA region is witnessing a concerning rise in chronic diseases. Cardiovascular diseases, diabetes, cancer, and respiratory diseases account for a significant portion of the region’s disease burden. According to the World Health Organization (WHO), NCDs account for approximately 70% of deaths in the region. Urbanization, sedentary lifestyles, unhealthy diets, tobacco use, and obesity contribute to the high prevalence of these diseases.
Cardiovascular Diseases, including heart disease and stroke, are the leading cause of death in the MENA region. According to the Global Burden of Disease Study, in 2019, ischemic heart disease caused over 810,000 deaths in the region, while stroke caused over 370,000 deaths. Cancer is a growing concern in the MENA region. In 2020, around 461,000 new cancer cases and over 274,000 cancer-related deaths in the region were predicted. Breast, lung, colorectal, and prostate cancers were the most common types. Respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, are prevalent in MENA. COPD alone accounted for approximately 3.2 million disability-adjusted life years (DALYs) lost in 2019.
In Bahrain, Egypt, Jordan, Kuwait, Saudi Arabia, and the United Arab Emirates, adult obesity (BMI ≥ 30) is becoming a major issue in both men and women, and almost 25% of the MENA population suffers from hypertension. Estimates from the Global Burden of Disease (GBD) study show that the highest prevalence of obesity among adults 20 years or older in 2015 was observed in Qatar, with 42.5% among males and 52.4% among females, and in the younger population of children 2–19 years in Kuwait with 22.1% among males and 19.2% among females (GBD 2015). While tobacco use is declining worldwide, according to the World Health Organization (WHO) Global Report on Trends in Tobacco Smoking 2000–2025, the prevalence of tobacco smoking in the MENA region is projected to increase between 2010 and 2025.
Fig: Percentage of 13–15 years Secondary School Students who are Overweight or Obese; by Sex
Source: World Health Organization and Centers for Disease Control and Prevention, Global School-Based Student Health Survey
3. Risk Factors Contributing to the Rising Burden
Several risk factors contribute to the rising burden of chronic diseases in the MENA region. One prominent factor is the adoption of Westernized lifestyles, characterized by poor dietary choices, decreased physical activity, and higher stress levels. Smoking rates remain alarmingly high in some countries, further exacerbating the risk of chronic diseases. Socioeconomic disparities, inadequate healthcare infrastructure, and limited access to essential medications and treatments are also factors that hinder the effective management and prevention of chronic diseases. Some of the major risk factors are discussed below.
- Unhealthy lifestyles
Adoption of sedentary lifestyles, poor dietary choices, and increased consumption of processed foods contribute to the rising prevalence of chronic diseases. Insufficient physical activity leads to obesity, a major risk factor for various NCDs, including diabetes and CVDs.
- Tobacco use
Smoking rates in the MENA region are among the highest globally. In 2019, the WHO reported that approximately 24.3% of adults in the region smoked tobacco. Smoking is a significant risk factor for CVDs, respiratory diseases, and cancer.
Obesity rates have surged in the MENA region, primarily driven by changes in dietary patterns and reduced physical activity. According to the Global Burden of Disease Study, in 2019, the prevalence of obesity among adults aged 20 years and older was 30.9% for men and 45.9% for women in the region.
- Socioeconomic factors
Socioeconomic factors, including income inequality, limited access to education, and healthcare disparities, contribute to the burden of chronic diseases. Individuals with lower socioeconomic status often face barriers to preventive care, timely diagnosis, and disease management.
Despite the rising risk factor exposure and chronic disease mortality, regional public health policy responses have been slow. Historical and future R&D activity in NCD is foundationally dependent on the knowledge economy of these countries; however, in many places, this is still lagging behind. In the face of the significant public health threat from chronic diseases and the drive to improve health systems research and address the knowledge gap in the MENA region, there is a need for evidence-based inter-sectoral measures for NCD prevention and care in the MENA region and for an understanding of how to improve the NCD research capacity and capability across the region. To achieve this, it is important to understand from a public policy perspective how, why, and which particular NCD research domains have evolved.
4. Challenges Faced in Tackling Chronic Diseases
Tackling chronic diseases in the MENA region poses several challenges. Limited awareness about healthy lifestyle choices, insufficient preventive care measures, and a lack of integrated healthcare systems contribute to delayed diagnoses and poor disease management. Furthermore, the region faces challenges in terms of healthcare financing, capacity building, and the availability of healthcare professionals skilled in chronic disease management. These challenges highlight the urgent need for comprehensive strategies and policies to address the growing burden of chronic diseases.
According to the WHO, MENA countries will have to address several weak aspects of their health systems, including weak policy analysis, formulation, coordination and regulation, limited cooperation among sectors, poor community participation in planning and provision, and inadequate health information systems, human resource policies and management of health services at all levels. Poor planning has resulted in inefficient and misuse of resources, leading to the growth of unregulated markets, decreased productivity, and increased pressure on limited financial and human resources.
The MENA countries face challenges related to the financing needed for the provision of pharmaceuticals and medical equipment. Lack of properly functioning pharmaceutical regulations, inappropriate medication prescribing, and self-medication practices contribute to a high percentage of total health expenditure on pharmaceuticals. These countries largely depend on passive purchasing of health products instead of adopting active purchasing provider payment mechanisms, which can enhance quality, productivity, and equity. Expenditure on medical equipment and technology is also inefficient and excessive in view of the predominance of the curative care approach in the health systems in the MENA region. Many MENA countries adopt curative approaches, especially for chronic disease management, rather than preventive approaches, leading to increased healthcare costs.
5. Promising Approaches and Interventions
Efforts to combat chronic diseases in the MENA region are gaining momentum. Governments and healthcare organizations increasingly prioritize public health campaigns and awareness programs to promote healthy behaviors. This includes initiatives to encourage physical activity, improve nutrition, and reduce tobacco consumption. Strengthening primary healthcare systems and promoting early detection and screening programs are vital for timely intervention and improved outcomes. Telemedicine and digital health solutions can potentially enhance access to healthcare services, particularly in remote areas.
Available evidence indicates significant improvements in key health indicators, including a rise in life expectancy, a decline in infant and maternal mortality, and an expansion in health coverage, albeit to variable degrees in all the countries of the MENA region. The MENA region is taking various approaches and implementing interventions to address the growing burden of chronic diseases. Here are some promising strategies:
- Health Promotion and Awareness
Governments and healthcare organizations are increasingly prioritizing health promotion and awareness programs. These initiatives aim to educate the public about healthy lifestyles, the importance of physical activity, and the risks associated with tobacco use, obesity, and poor dietary habits. Seventy-three million adults (20–79) are living with diabetes in the IDF MENA Region in 2021, and USD 33 billion was spent on healthcare for people with diabetes in 2021 in the MENA region in terms of awareness and promotion of better treatment and diagnosis.
- Strengthening Primary Healthcare
Enhancing primary healthcare systems is crucial for early detection, management, and prevention of chronic diseases. This includes strengthening primary care infrastructure, training healthcare professionals, and improving access to affordable medications and treatments. As of January 2021, UNICEF has supported 343 primary health centers in Egypt to maintain essential maternal, newborn, and child health services. It is estimated that 1,306,700 women and children, including 141,692 persons during the reporting period, received essential maternal and child health services in the health facilities supported by UNICEF.
- Screening and Early Detection
Implementing population-based screening programs for high-risk individuals can facilitate the early detection of chronic diseases. Regular screenings for diabetes, hypertension, and certain cancers enable timely intervention and improved outcomes. The UAE Diabetes Society follows the American Diabetes Association (ADA) recommendations on testing, which focuses on people with risk factors for type 2 diabetes, such as BMI, ethnicity, polycystic ovary syndrome, and hypertension, to detect and screen the disease early. They only differ from the ADA in starting screening at 30, rather than 35, for those at risk.
- Telemedicine and Digital Health
Telemedicine and digital health solutions promise to improve access to healthcare services, particularly in remote and underserved areas. These technologies enable remote consultations, patient monitoring, and health education, improving disease management. Healthtech in the MENA region is the vertical that has grown the most by combined enterprise value since 2016. The Healthtech startup ecosystem in the MENA region is now worth over USD 1.5B, a 22× increase since 2016. Since 2020, telemedicine service providers in medical centers and hospitals in the UAE have started to offer a 360° solution using the help of a regulation-compliant health information system, supporting patients living in remotely built areas.
6. Government Initiatives
Listed below are some noteworthy government healthcare initiatives in the MENA region:
- National Health Insurance Programs
Several countries in the MENA region have introduced National Health Insurance (NHI) programs to enhance access to healthcare services and ensure financial protection for their populations. These programs aim to provide comprehensive coverage, including preventive care, diagnostics, treatment, and medications. Here are some examples:
- Saudi Arabia
Saudi Arabia implemented the Unified Health Insurance Scheme (UHIS) in 2005. It provides coverage to Saudi nationals and expatriates working in the private sector. As of 2020, UHIS covered more than 13 million individuals, ensuring access to a wide range of healthcare services.
Qatar’s National Health Insurance Scheme (Seha) was launched in 2013. It offers comprehensive coverage to Qatari nationals, residents, and expatriates. By the end of 2020, Seha covered around 1.8 million individuals.
- United Arab Emirates (UAE)
The UAE introduced mandatory health insurance through the Dubai Health Insurance Law in 2014. The law requires all residents to have health insurance coverage. As of 2021, health insurance coverage in Dubai reached 99% of the population.
- Public Health Campaigns and Awareness Programs
Governments in the MENA region have implemented public health campaigns and awareness programs to educate the public about healthy behaviors, risk factors, and disease prevention. These initiatives aim to promote behavioral changes and empower individuals to take control of their health. Here are notable examples:
The Ministry of Health in Kuwait launched the “Live Your Life” campaign in 2017 to raise awareness about chronic diseases and encourage healthy lifestyles. The campaign focused on physical activity, healthy eating, and tobacco control. It reached over 60,000 individuals through various activities and initiatives.
Oman’s Ministry of Health launched the “Live Healthy” campaign 2012 to combat obesity and promote healthy living. The campaign emphasized the importance of physical activity, healthy eating, and regular health check-ups. It targeted schools, workplaces, and communities, reaching over 400,000 individuals.
- Diabetes Prevention and Management Programs
Given the high prevalence of diabetes in the MENA region, governments have implemented targeted programs to prevent and manage this chronic disease. These initiatives aim to raise awareness, improve access to care, and enhance diabetes management. Here are examples:
Bahrain’s Ministry of Health launched the National Diabetes Register in 2011 to monitor and manage diabetes cases effectively. The register helps track diabetes prevalence, assess risk factors, and implement preventive strategies. By 2020, the register covered over 120,000 individuals.
Egypt implemented the National Diabetes Prevention and Control Program in 2015, focusing on diabetes prevention, early detection, and comprehensive management. It includes health education, regular screening campaigns, and training healthcare professionals. The program has reached millions of Egyptians across various governorates.
- Technology-driven Healthcare Solutions
Governments in the MENA region are leveraging technology to improve healthcare services and enhance disease management. Digital health solutions, telemedicine, and health information systems are being implemented to improve access, efficiency, and quality of care. Here are notable examples:
- United Arab Emirates (UAE)
The UAE launched the “Dubai Health Strategy 2021” in 2016, which emphasizes the use of technology and innovation in healthcare. Initiatives include the Dubai Health Authority’s “Smart Health” app, which provides teleconsultations, medication delivery, and health records access. The UAE has been at the forefront of digital health adoption in the region.
Jordan’s Ministry of Health introduced the Electronic Health Solutions (EHS) program in 2009 to digitize healthcare records and enhance healthcare delivery. EHS enables electronic medical records, telemedicine consultations, e-prescriptions, and health information exchange. As of 2020, EHS covered over 15 million individuals.
Additionally, the rising prevalence of noncommunicable diseases and high expenditure on the healthcare sector in the MENA region is creating opportunities for several pharma companies. Currently, the pharma goliaths that are operating in the region include Novo Nordisk, AstraZeneca, Sanofi, Merck Sharp & Dohme LLC, Pfizer, Eli Lilly and Company, Janssen-Cilag International NV, Janssen Research & Development, LLC, Takeda, Regeneron Pharmaceuticals, Bayer, Roche, Freenome Holdings, Bristol-Myers Squibb, Novartis, Boehringer Ingelheim, Sorrento Therapeutics, and others.
Similarly, several local pharmaceutical companies such as Otida, Julphar, Ciba Health, and others are also trying to strengthen their position in their respective domain. Only a few companies are presently active in clinical research and development activities. Companies are looking to seize opportunities to collaborate with the big giants in the market.
7. The Role of Partnerships and Research
Collaborations between governments, healthcare providers, researchers, and non-governmental organizations are crucial for combating chronic diseases in the MENA region. Sharing best practices, conducting research on regional health determinants, and implementing evidence-based interventions are essential steps toward effective prevention and management. Robust data collection and surveillance systems can help monitor the prevalence and trends of chronic diseases, enabling policymakers to make informed decisions and allocate resources more efficiently.
The MENA region is confronted with an escalating burden of chronic diseases, threatening the well-being and economic stability of its populations. Addressing this challenge requires a multifaceted approach encompassing health promotion, improved access to healthcare services, and enhanced research and surveillance systems. By prioritizing prevention, early detection, and comprehensive disease management, countries in the MENA region can pave the way for healthier populations, reduced healthcare costs, and a more prosperous future.
The increasing burden of chronic diseases in the MENA region demands immediate attention and comprehensive strategies. By addressing risk factors, promoting healthy lifestyles, strengthening healthcare systems, and investing in research and surveillance, countries in the MENA region can alleviate the impact of chronic diseases and improve public health outcomes. A concerted effort from governments, healthcare organizations, and communities is essential to overcome this growing epidemic and ensure a healthier future for the region.
Government healthcare initiatives in the MENA region are crucial in addressing the burden of chronic diseases. National health insurance programs, public health campaigns, diabetes prevention programs, and technology-driven solutions are improving access to care, raising awareness, and enhancing disease management. These initiatives, supported by statistical data, highlight the commitment of MENA governments to prioritize public health and create sustainable healthcare systems. Continued efforts, collaboration, and monitoring of outcomes will be vital to ensure the effectiveness and sustainability of these initiatives, ultimately leading to improved health outcomes and reduced burden of chronic diseases in the region.
Source: Delveinsight http://www.delveinsight.com/