Non-Communicable Diseases in North Africa, the Eastern Mediterranean and Turkey

mount.jpgNon-communicable diseases (NCDs), particularly cardiovascular diseases (CVD), diabetes, and cancers, are increasing dramatically in low and middle income countries (LMICs), including in southern and eastern Mediterranean countries. International reports have identified the East Mediterranean Region as a hot spot for NCDs, where projections of its burden exceed those of other regions (WHO, 1999, Murray and Lopez, 1996; Alwan 1993).

In 2005, 25 million died from NCDs in the East Mediterranean Region, more than half due to CVD (WHO, 2005). The rising trends in urbanization and ageing of societies represent the driving force behind the continuing rise of the burden of NCDs in developing countries.

On a more proximal level, the main reasons for the increase in these chronic diseases lie in the increase in major risk factors that are closely linked to socio-economic and environmental causes, which impact differentially across the population. These include:

  1. The increase in obesity as a result of changes in nutrition and decreased physical activity associated with urbanisation and changing lifestyles.
  2. Still increasing tobacco use; and in many contexts.
  3. Increased exposure to urban and industrial pollution (from traffic, domestic fuel consumption, and industrial production).

In addition to these factors which are external to the health system are those which are significant within it – notably the wide differentials in availability and access to good health services. Health services, developed to tackle acute infectious diseases, are often not ideally organised to promote effective care and prevention for NCDs. The vast majority of resources that are available for health related projects in LMICs, both for research and development, are for areas that are strongly associated with extreme poverty. Health problems include tuberculosis, malaria, and maternal and child health. Addressing these areas is rightly seen as essential for the promotion of economic and social development, hence their inclusion in the millennium development goals.

market250w.jpgThe WHO Global InfoBase (a databank of chronic disease prevalence and risk factors) reveals that most developing countries of the Mediterranean region have no population-level information or disease surveillance system for major NCD and risk factors ( In 2003, only 3 out of 21 countries of the WHO East Mediterranean Region were deemed to have complete data about causes of death, and more than a half of these countries (12) had no recent mortality data (Mathers et al., 2005).

Most countries in the region have only limited experience with integrated approaches to dealing with chronic diseases, whereby health systems are better at providing acute care than promoting healthy lifestyles. Fewer than half of the 22 countries in this region have national policies on chronic disease, and only a minority have implemented tobacco control legislations (Nishtar S, 2006).

Automatic application of NCD prevention models conceived and tested in developed countries, can be counterproductive (Ebrahim & Davey Smith, 2001; McLaren et al, 2007), as knowledge of the role of local factors (cultural, socioeconomic) and specificities of the health care systems is essential to tailor effective intervention to the local environment and health care system in LMICs.

spices.jpgLooking into the nuances of local NCD patterns in LMICs requires local capacity that is trained in a multidisciplinary tradition of approaching NCD, and at the same time native, or familiar with, the local culture and environment, in order to be able to generate appropriate and reliable data about this burden. Analysis and policy evaluation require an approach similarly attuned to local economic and cultural circumstances and political feasibility.

Most LMICs still lack local research capacity, which is mirrored by the lack of capacity in population-based health promotion and translation of health knowledge into effective policies and intervention strategies (Maziak, 2006, 2009). The mismatch between the increased NCD burden in the LMICs and the availability of qualified human and technical resources necessary to manage these diseases and their consequences is globally recognized. The RESCAP-MED project will assist in correcting such a mismatch by capacity building in two key ways: namely, the capacity to produce vital knowledge, and the capacity to use and apply it through effective engagement in the policy process.

Read more about the RESCAP-MED project here.