Visualizing health in the Arab world

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

In Tunisia in December 2010, a poor, unemployed college graduate named Mohamed Bouazizi, set himself aflame after the contents of his fruit stand were confiscated by police because he was operating without a license. Bouazizi’s frustration about his inability to earn a living struck a chord with many other young people in the country, prompting mass protests against a government many viewed as guilty of keeping people in poverty.

Thus began the so-called Arab Spring, a revolutionary wave of anti-government protests that spread from Tunisia to neighboring countries such as Egypt, Libya, Syria, and Yemen. Most of the protesters were similarly motivated by frustration with oppressive governments perceived as indifferent to the suffering and inequity experienced by most citizens.

The protests continue, having in many cases exploded into deadly clashes and outright civil war. Many of those in the conflict are unemployed young people like Bouazizi who have taken to the streets – or even taken up arms – to demand a better life. It’s worth noting that 77% of the Arab world is under age 40.

What did the health landscape look like in these countries leading up to the uprisings? To answer this question, we’ll use data from the Global Burden of Disease Study 2010 and a recently-published study on health in the Arab world.

Prior to Bouazizi’s suicide and the start of the Arab Spring, all of these countries had succeeded in increasing their life expectancy, as shown in the chart below for increases in female life expectancy. Syria, Egypt, and Yemen made the largest gains, but the increases in Tunisia and Libya were not as large.

Here is a link to a similar graph showing increases in male life expectancy.

In 2010, Syria, Tunisia, and Libya had the highest life expectancies for females at 80.2 years, 78.9 years, and 76.5 years, respectively. In Egypt and Yemen, life expectancy was 73.4 years and 66.3 in 2010, respectively. In terms of changes in life expectancy, Syria, Egypt, and Yemen made the largest gains, but the increases in Tunisia and Libya were not as big.

Nearly all countries worldwide have seen increases in life expectancy, though this is neither universal or uniform around the world (or even within countries). The video below compares levels and changes in female life expectancy in these Arab countries between 1990 and 2010.

Here is a link to another view of the data visualization tool showing increases in male life expectancy in these countries between 1990 and 2010.

Delving deeper into changes in disease patterns over time reveals how many of these countries achieved gains in life expectancy. The screen grab below shows the top 20 causes of premature death and disability, also known as healthy years lost, in Syria in 1990 and 2010. (Click on it to get better resolution)

In 1990, five of the top 10 causes were conditions that primarily kill and disable children (see red shading). By 2010, only two red causes appear in the top 10 causes of early death and disability. Healthy years lost from lower respiratory infections, which were the third-leading cause in 1990, declined by 64% to 15^th place in 2010. Seven of the top 10 causes were non-communicable diseases, shown in blue, and road injuries rose from the 12^th-leading cause in 1990 to the eighth-leading cause in 2010.

Egypt also lowered the number of healthy years lost from lower respiratory infections by 71% between 1990 and 2010. The country also successfully reduced early death and disability from prematurity and diarrheal diseases by 39% and 85%, respectively. Similar to Syria, the importance of non-communicable diseases and road injuries increased over this 20-year period.

Another way to measure progress is to look at how rates of early death and disability from communicable, newborn, and nutritional disorders in children have changed over time. The following screen grab shows the progress made in Yemen from 1990 to 2010 in children under 5 years.

Note: The vertical lines surrounding each data point represent the uncertainty intervals for a specific estimate.

It’s also important to note that Yemen was a poorer country in terms of both wealth and health than Libya, Syria, Tunisia, and Egypt in 2010. That year, Yemen was a low-income country, while the other four were middle-income countries. To put this in perspective from a health standpoint, here is a screen grab showing rates of healthy years lost from communicable, maternal, newborn, and nutritional disorders in Yemen, Egypt, Libya, Tunisia, and Syria compared to other countries in Africa and Latin America in 2010. Yemen’s disease profile was more similar to Ethiopia, Kenya, Senegal, and Madagascar. At the same time, the disease profiles of Egypt, Libya, Tunisia, and Syria more closely resembled those of Brazil and Mexico.

What drove the progress in health seen in these Arab countries?

Professor Ali Mokdad, IHME’s Director of Middle Eastern Initiatives, said: “Education among women increased a lot in in the Arab world. Much of this progress we are seeing is due to maternal education.”

In Egypt, for example, IHME researchers estimate that the average number of years of education among women increased from 3 years in 1990 to 5 years in 2009.

However, with ongoing conflict in Syria, many fear setbacks in health progress. The UN estimated previously that 100,000 had died in the conflict in Syria but recently announced that it could not verify the accuracy of the figure given its inability to gauge the quality of the data. The conflict could change estimates of life expectancy in Syria in future updates of the Global Burden of Disease study. In November, the World Health Organization confirmed that polio has broken out in the country for the first time since 1999.

The Global Burden of Disease (GBD) Study 2013, scheduled to be published later this year, will provide a clearer picture of health in the Arab world following revolts in many countries. As the GBD research is updated in years to come, it will also help policymakers, international organizations, civil society, and donors monitor health outcomes in countries such as Yemen and Tunisia as they make progress towards democracy.