People have been asking me lately, as I’ve bounced from place to place, why I find the Middle East an interesting place to pursue global health work. There are about fifty different answers to this, but in short: I think inequality within countries makes for more challenging distribution of resources than inequality between countries, I’m interested in how healthcare can be used as a political tool, and I expect the challenges much of the region faces now to be similar to those some areas of Africa will face in twenty-thirty years. But the easiest explanation is quick and visual.
The Institute of Health Metrics and Evaluation at the University of Washington has some wonderful data visualization tools highlighting the burden of different diseases in different countries. Here, for a read on what an high-income Western country might look like, is Denmark:
The red rectangles, outlined in red, signify burden from infectious diseases, such as malaria and HIV. Blue is what most people we know die from here in the U.S. – cancer, heart disease. And green signifies forms of accident and violence.
For comparison, here’s India – a less developed country with a health burden more representative of those where the majority of global health work takes place:
In my experience, people in the U.S. expect countries in the Middle East to look more like Denmark and less like India – perhaps with a larger green percentage to account for violence. But that isn’t always the case. Below, I’ve included the 2010 burden of disease charts for a variety of MENA countries that span the scale, with Denmark and India at the bottom for comparative reference. Feel free to click for larger versions. Many of these countries don’t receive international support for their health challenges – Yemen in particular is incredibly burdened in terms of health but is often either granted column space for Other Reasons, neglected by traditional global health contractors, or outright ignored.
There’s one quick lesson from this: when it comes to health metrics, the Middle East is not some ignorable monolith. It’s home to extreme variety in terms of development, health access, and disease burden, and it’s a place where inequality – be it derived from refugee or migrant status, or from religious or ethnic tension – makes the gaps between blue, red, and green more challenging and more interesting to surmount.