Abdullatif Husseini

Non-communicable diseases in the Arab world

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.

Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory

Heart disease, cerebrovascular disease, and cancer are the major causes of morbidity and mortality in the occupied Palestinian territory, resulting in a high direct cost of care, high indirect cost in loss of production, and much societal stress. The rates of the classic risk factors for atherosclerotic disease-namely, hypertension, diabetes mellitus, tobacco smoking, and dyslipidaemia-are high and similar to those in neighbouring countries. The urbanisation and continuing nutritional change from a healthy Mediterranean diet to an increasingly western-style diet is associated with reduced activity, obesity, and a loss of the protective effect of the traditional diet. Rates of cancer seem to be lower than those in neighbouring countries, with the leading causes of death being lung cancer in Palestinian men and breast cancer in women. The response of society and the health-care system to this epidemic is inadequate. A large proportion of health-care expenditure is on expensive curative care outside the area. Effective comprehensive prevention programmes should be implemented, and the health-care system should be redesigned to address these diseases.

Tobacco in the Arab world: old and new epidemics amidst policy paralysis

The Arab world is comprised of 22 countries with a combined population of ∼360 million. The region is still at the initial stages of the tobacco epidemic, where it is expected to witness an increase in smoking levels and mounting tobacco-related morbidity and mortality in the future. Still, the bleak outlook of the tobacco epidemic in the Arab world continues to be faced with complacency in the form of underutilization of surveillance systems to monitor the tobacco epidemic and prioritize action, and failure to implement and enforce effective policies to curb the tobacco epidemic. Understandably, the focus on the Arab world carries the risk of trying to generalize to such a diverse group of countries at different level of economic and political development. Yet, tobacco control in the Arab world faces some shared patterns and common challenges that need to be addressed to advance its cause in this region. In addition, forces that promote tobacco use, such as the tobacco industry, and trends in tobacco use, such as the emerging waterpipe epidemic tend to coalesce around some shared cultural and socio-political features of this region. Generally, available data from Arab countries point at three major trends in the tobacco epidemic: (1) high prevalence of cigarette smoking among Arab men compared with women; (2) the re-emergence of waterpipe (also known as hookah, narghile, shisha, arghile) smoking as a major tobacco use method, especially among youth and (3) the failure of policy to provide an adequate response to the tobacco epidemic. In this review, we will discuss these trends, factors contributing to them, and the way forward for tobacco control in this unstable region.

Obesity in a rural and an urban Palestinian West Bank population

OBJECTIVE: To compare the prevalence of obesity, household food consumption patterns, physical activity patterns and smoking between a rural and an urban community in the Palestinian West Bank and to describe the associations of the latter factors with body mass index (BMI).DESIGN: A population-based cross-sectional survey in a rural and an urban Palestinian West Bank community.SUBJECTS: A total of 549 women and 387 men aged 30–65 y, excluding pregnant women.MEASUREMENTS: Obesity was defined as BMI ≥30 kg/m2.RESULTS: The prevalence of obesity was 36.8 and 18.1% in rural women and men, respectively, compared with 49.1 and 30.6% in urban women and men, respectively. The mean difference (s.e) in BMI levels was 1.6 (0.52) kg/m2 between urban and rural women and 0.9 (0.46) kg/m2 in men. At the household level, the mean energy consumption from 25 selected food items was 13.8 MJ (3310 kcal)/consumption unit/day in the rural community compared to 14.5 MJ (3474 kcal)/consumption unit/day in the urban community (P=0.021). BMI was positively associated with age in both men and women and with urban residence in women. BMI was negatively associated with smoking and physical activity in men and with educational level in women.CONCLUSION: BMI was associated with urban residence in women after adjusting for age, smoking, education, physical activity and nutrition-related variables, suggesting that the differences in the conventional determinants of obesity could not fully explain the difference in the prevalence of obesity between the two communities. Among men, the measured determinants explained the rural–urban differences in BMI.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of

Obesity and selected co-morbidities in an urban Palestinian population

235,000,000 and 6455 LYG in Tunisia;

Food consumption patterns in a Palestinian West Bank population.

39,000,000 and 31674 LYG in Syria;

Type 2 diabetes mellitus, impaired glucose tolerance and associated factors in a rural Palestinian village

6,000,000 and 2682 LYG in Palestine and

Mediterranean studies of cardiovascular disease and hyperglycemia: analytical modeling of population socio-economic transitions (MedCHAMPS)—rationale and methods

1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

Preventing type 2 diabetes among Palestinians: comparing five future policy scenarios

OBJECTIVE: To assess the prevalence of obesity and central obesity in an urban Palestinian population and their associations with selected co-morbidities, including diabetes, hypertension and dyslipidaemia.DESIGN: A population-based cross-sectional survey in an urban Palestinian community.SUBJECTS: Men and women aged 30–65 y residing in the urban community, excluding pregnant women.MEASUREMENTS: According to WHO guidelines, obesity for men and women was defined as BMI≥30 kg m−2, while pre-obesity was defined as BMI 25–29.9 kg m−2. Central obesity was defined as a waist-to-hip ratio (WHR) of >0.90 in men and >0.85 in women.RESULTS: The prevalence of obesity in this population was high at 41% (49% and 30% in women and men, respectively). Central obesity was more prevalent among men (59% compared to 25% in women). After adjusting for the effects of age, sex, smoking and each other, obesity and central obesity were found to be significantly associated with diabetes, low HDL-cholesterol and elevated triglycerides in separate logistic regression analyses. Central obesity was also significantly associated with hypertension (OR 2.26, 95% CI 1.30–3.91).CONCLUSION: Obesity and central obesity are prevalent in the urban Palestinian population. Their associations with diabetes, hypertension, and dyslipidaemia point to a potential rise in cardiovascular disease (CVD). An understanding of the reasons behind the high prevalence of obesity is essential for its prevention as well as for the prevention of the morbidities to which it may lead.