Health in Iran

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As for many developing countries, health issues in Iran stem from a variety of reasons: namely, water and sanitation, diet and fitness, various addictions, mental fitness, communicable diseases, hygiene and the environment.

Contents

The Human Rights Measurement Initiative [1] finds that Iran is fulfilling 88.6% of what it should be fulfilling for the right to health based on its level of income. [2] When looking at the right to health with respect to children, Iran achieves 96.5% of what is expected based on its current income. [2] In regards to the right to health amongst the adult population, the country achieves 98.8% of what is expected based on the nation's level of income. [2] Iran falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 70.6% of what the nation is expected to achieve based on the resources (income) it has available. [2]

Water and sanitation

Iran has one of the highest percentages of population in the Middle East with access to safe drinking water, with an estimate of 92% of its people enjoying such access (nearly 100% in urban areas and about 80% in rural areas as of 2007). [3] [4]

There is a considerable shortfall in sewage treatment; for example, in Tehran the majority of the population has no wastewater treatment, with raw sewage being injected directly into the groundwater. [5] As the water crisis deepens with an expanding population, this pollution of groundwater causes increasing health risks.

Nutrition and fitness

Percentage of national population suffering from malnutrition, according to United Nations statistics Percentage population undernourished world map.PNG
Percentage of national population suffering from malnutrition, according to United Nations statistics

Nutrition

Forty-five million Iranians face inadequate nutrition according to Iranian officials. [6] Kohgiloyeh and Boyerahmad, Sistan-Baluchistan, Hormozgan, Kerman and Khuzestan as provinces that face malnutrition or food insecurity. [6]

Diet, food ingredients and junk food

The soft drinks industry is valued at about $2 billion a year. As of 2008, Iran produces about 3 billion litres of different types of soft drinks to address consumption of 46 litres per capita, and they export more than 12% of its production. Increased awareness with regards to the damages of carbonated drinks and sugar, and high levels of diabetes has created a move towards healthier products. [7]

Food safety and packaging

The Codex Commission of Food Stuff, established in 2002 is in charge of setting and developing standards and quality and health regulations, related to the production of and trade in raw agricultural products and food stuffs, in accordance with the different global standards. Tainted meat has been imported according to Iranian authorities. [8] Uncontrolled use of pesticides is also a problem. Despite the potential health hazards caused by GM food and government restrictions on the production of biotech products, Iran imports $5 billion of genetically modified crops a year because of laxed laws (2015). [9]

Obesity

In 1988, Iran was one of the top seven countries with the highest rate of childhood obesity. In 2005, 33.7% of adults were at risk of developing metabolic syndrome. Eight million Iranians already live with this syndrome. [10] In 1995, 24.7% of boys and 26.8% of girls age 6 were overweight.

One of the major reasons for increased obesity is urbanization. In 2005, an average Iranian citizen consumed 42 liters of soda per year, as well as 40% more carbohydrates, 30% more fat, and 40% more food than the body needs. The greater availability of fast food and junk food in combination with a low activity lifestyle has contributed to the obesity trend. [10] Other factors include the impact of technology and a high consumption of rice and bread. Many families with a moderate income are limited in the foods they are able to afford, resulting in a higher incidence of obese children. However, childhood obesity is not a concern because it is believed that these children will outgrow their fatness as they age. The health impact of childhood obesity is unknown. The tendency of obesity is increasing among children. [11] The outbreak of obesity is increasing amid both girls and boys in civic area but sometimes it shows decrease in boys and girls in rustic area. Overweight should be observed as a preference and to be considered in relation with expansion of the different areas and districts. [12]

Physical fitness

As an additional measure of public health and inefficient food distribution, about thirteen percent of the young people are classified as obese, according to the United Nations FAO sources. According to the government of Iran, about 60 percent of Iranians are overweight and 35 percent of women and 15 percent of men suffer from obesity in Iran. [13] Despite the young age of many Iranians, only 20 percent of Iranians are physically active while the world average is 60 percent. [14] 30% of Iranian youths never play any sports. [15]

Communicable diseases & addictions

Immunization of children is accessible to most of the urban and rural population. [16]

Cholera

Cholera has been a persistent problem in Iran. In the 2005 epidemic which involved loss of lives, state television warned people not to eat vegetables or buy ice blocks on the streets. [17] Salads were also banned in some restaurants. The 1998 epidemic involved considerably more cases and loss of life.

HIV/AIDS

Increased drug use has driven up the incidence of human immunodeficiency virus (HIV). In 2005 two-thirds of the official total of 9,800 HIV cases were attributed to drug use. Iran has established a national HIV treatment system, including 150 testing sites and a free needle exchange program. [18]

According to the United Nations, AIDS has been increasing in Iran at a rapid rate. [19] The major factor fuelling the epidemic until now has been injecting drug use, while there is an increase in sexual transmission of the disease. An estimated 14% of people who inject drugs countrywide were living with HIV in 2007. [20] In 2009, men account for 93 percent of the HIV patients, and women comprise 7 percent of the infected population. [21]

The rate of the epidemic in Iran is however still very low compared to international standards. Iran has a low prevalence of HIV infections with a rate of about 0.16 percent of the adult population (18,000 cases, officially) compared with 0.8 percent in North America (2008). [22] But according to the WHO, as of the end of 2009, there are more than 100,000 AIDS sufferers in Iran (approximately 0.135% of the Iranian population).[ citation needed ]

Illegal drugs

Drug addiction constitutes a major health problem. Iran is situated along one of the main trafficking routes for cannabis, heroin, opium and morphine produced in Afghanistan, and designer drugs have also found their way into the local market in recent years. Iran ranks first worldwide in the prevalence of opiate addiction with 2.8% of its population addicted. [23] Initiation age for most Iranian addicts is their 20s. [24] Hundreds of drug production laboratories have been set up in Pakistan and Afghanistan. [25] Iran's police said in April 2009 that 7,700 tonnes of opium was produced in Afghanistan in 2008, of which 3000 tonnes entered Iran, adding that the force had managed to seize 1000 tonnes of the smuggled opium. [26] Iran spent over 600 million dollars in just the last two years to dig canals, build barriers and install barbed wire to seal off the country's crime-infested borders. [27]

Iran discovers 3 tons of drugs daily. [28] [29] In 2005, estimates of the number of drug addicts ranged from 2 to 4 million (1.2 million according to the Government). [30] Reasons for addiction include lack of economic prospects among the youth and lack of freedom. In a 2014 survey, 30.6% of the youth considered financial issues as their biggest concern, while 28.9% chose unemployment, 10.8% university acceptance, and 7.5% marriage issues as their biggest worries. [15]

Smoking

Iran has implemented a strict smoking ban in all public places. By 2007, smoking decreased to 11%. However, the rate of smokers in the general population increased again significantly in recent years. As of 2018, this rate stands at 14%. [31] According to the new law, smoking is prohibited in all public organizations, hotels, restaurants, tea houses and coffee shops. [32] Also forbidden is the offering and smoking of ghalyun , the traditional Persian waterpipe, which is a must in Iranian tea houses. A smoking ban for all car drivers nationwide was implemented since March 2006, and although offenders could face fines, the ban was widely ignored by the drivers. Also selling tobacco products to anyone under 18 would result in confiscation of the vendor's tobacco products and a cash fine. Repeated violations would lead to high cash fines.

About 20% of adult male and 4.5% of adult female population in the country smoke tobacco (12 million smokers according to some estimates). [33] [34] 60,000 Iranians die directly or indirectly due to smoking every year (2008). [35] Smoking is responsible for 25% of death in the country. [34] Approx. 54bn-60bn cigarettes are believed to be consumed annually in Iran. [36] Around 2.7bn cigarettes are smuggled into Iran annually, according to officials from the state-owned Iranian Tobacco Company (ITC), on top of another 26.7bn which are imported legally (2008). [16] Imports of cigarettes, tobacco, cigars, cigarette paper, cigarette tips are subject to government monopoly. [37] Iranians spend more than $1.8 billion a year on tobacco. [36] According to a 2010 law, smokers henceforth will not be appointed to senior government jobs. [36]

Air pollution

Some sources say Iran's air pollution is some of the worst in the world. [38] The prevalence of respiratory diseases and cancers in Iran is increasing at a significant rate, also because of air pollution in Tehran. [39] It is estimated that 5 million Iranian children suffer from asthma. [40] The World Bank estimates losses inflicted on Iran's economy as a result of deaths caused by air pollution at $640 million, which is equal to 5.1 trillion rials or 0.57 percent of GDP. [41] Substandard gasoline and imported car brakes are also a reported health hazard/air pollutant according to the authorities.

Alcohol consumption

Prohibited in Iran because of the Islamic law, except for non-Muslims who can legally consume alcoholic beverages in private. Alcohol smuggling into Iran was estimated at nearly $1 billion in 2010. [42] [43] More than 200,000 people in Iran are estimated to be involved in bootlegging. Many rely on what's made in people's basements or gardens in unsanitary conditions. [44]

COVID-19

Iran has been among the worst affected countries by the COVID-19 2019-pandemic claiming thousands of lives in the country (2020).

Family planning

The Islamic Republic of Iran has a comprehensive and effective program of family planning. While Iran's population grew at a rate of more than 3% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000. [45] Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN's Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran's 2005 to 2010 birth rate is fewer than two. [46] [47] As at 2012, more than half of Iran's population is under 35 years old. Authorities are now slashing its birth-control programs in an attempt to avoid an aging demographic similar to many Western countries that are struggling to keep up with state medical and social security costs. [47] One fifth of all couples are infertile. [48]

Leading causes of mortality

Historical development of life expectancy in Iran, discriminated by biological sex. (1960-2021) Life expectancy by WBG -Iran -diff.png
Historical development of life expectancy in Iran, discriminated by biological sex. (1960-2021)
Healthcare in Iran (Source: EIU) [16] 2005200620072008 est.2009 est.2010 est.
Life expectancy, average (years)70.070.370.670.971.171.4
Healthcare spending (% of GDP)4.24.24.24.24.24.2
Healthcare spending ($ per head)113132150191223261

In the early 2000s the main natural causes of death have been cardiovascular disease and cancer. Cancer Research Center of Iran says 41,000 Iranians die of cancer each year. [49] According to Iran's Health Ministry, the most fatal cancer for men across the country is stomach cancer and for women is breast cancer with 90,000 new cancer cases reported each year (2015). [50]

According to Ministry of Health and Medical Education, in 2003, 41% of total deaths were due to diseases of the circulatory system. Myocardial infarction as the cause of 25% of deaths was the leading cause of mortality among the population. [51]

Addiction is the fourth major cause of death in Iran following road accidents, heart disease and depression. [52]

From 2001 to 2010, over 438,000 Iranians have died from "unnatural deaths" such as electric shocks, gas poisoning, and drug intoxication. [53] 4,055 people committed suicide in 2013 and the number of suicides is on the rise. In 2013, the Association of Social Workers of Iran indicated that 61,000 people committed suicide in Iran from 2001 to 2011. [54]

According to Iran's parliamentary committee on health and treatment in 2015, 12 million Iranians suffer from mental illnesses (mostly stemming from economic reasons). [55] According to the ministry of health, mental issues among women is a major problem and it is the second cause of death and disabilities among men. [55]

Women's health in Iran

Similar to other countries, health of Iranian women plays a crucial role in well-being and economic growth of their society. Over the years, there has been significant progress in improving physical, mental and social health of women in this country. However, various obstacles have remained to be overcome to achieve the optimal well-being of Iranian women. Therefore, it is important to understand their challenges and the underlying explanations behind them.

Physical Health

Life Expectancy

According to WHO data published in 2018, life expectancy at birth in Iran is 76.9 years for women and 74.6 for men, which is above global average: 74 years for female and for 70 years for males. [56] The leading causes of death in Iranian women is non-communicable diseases, mainly cardiovascular diseases (179 per 100,000 death). [57] This can partly be due to their lack of physical activity. According to National Surveillance of Risk Factors of Non-Communicable Diseases in Iran (SuRFNCD -2007), 35% of the Iranian population of which 46% are women had a sedentary life style. In general, Iranian women have three times less physical activity than men. [58]

Maternal Health

In 1975, maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) in Iran was 274, however, by year 2015, it dropped to 25 by 2015, which is comparable with developed countries. Millennium Development Goal 5 (MDG5) suggested 5.5% reduction per year in MMR. Iran is one of the countries, which was able to achieve the goal of MDG5 with reduction of 75% by the year 2015. The main cause of maternal mortality among Iranian women is obstetric hemorrhage (30.7%) followed by hypertensive disorders in pregnancy, childbirth, and the puerperium (17%). Maternal mortality occurs more frequent in rural and nomadic areas of Iran. It is estimated that 90% of these mothers had poor economic status when compared to the middle or high-class groups. [59]

Sexual Health

Sexually transmitted infection (STIs)

Herpes simplex virus type 2 (HSV2) and chlamydia are two of the STIs with high prevalence among Iranian women. Two different studies on female sex workers showed the prevalence of HSV2 to be 9.7% and 18%.[ citation needed ] In some areas of Iran, the prevalence of chlamydia infection in Iran is higher than global and Eastern Mediterranean Region prevalence. The global estimate for chlamydia among women is reported to be 3.53% and for the Eastern Mediterranean Region is estimated to be 2.15%. [60]

HIV-1 prevalence among Iranian women

By 2018, of the 60,000 adults living with HIV in Iran, 15,000 (25%) are woman. [61] The proportion of women among those infected with HIV-1 has steadily increased from 6% in 2004 to 30% in 2013. [62] Sexual transmission is the main route of HIV-1 infection among Iranian women. It has been suggested that the number of HIV-1 infected individuals are much higher; however, social stigma and discrimination might prevent many Iranians, in particular women, from admitting they are infected. [63]

Summary of HIV/AIDS estimates among Iranian women and compared to national statistics [61]
Adult and children living with HIV61,000 (34,000 – 120,000)
Women living with HIV15,000 (8900 – 30,000)
Adult and children deaths due to AIDS2600 (1400 – 5100)
Death due to AIDS among women aged 15 and over<500
Adult and children newly infected with HIV4400 (1100 – 12,000)
Women newly infected with HIV1000 (<500 – 3000)
Coverage of adults and children receiving ART (%)20 (11 – 39)
Women aged 15 and over receiving ART (%)27 (16 – 53)
Coverage of pregnant women who receive ARV for PMTCT (%)81 (41 – >95)
Knowledge about HIV prevention among people aged 15–24 (%)18.27
Knowledge about HIV prevention among women aged 15–24 (%)16.21

Social health and women empowerment

In 2018, Iran was ranked 142 out of 149 for Global Gender Gap Index (GGI score: 0.589). As the women in many parts of the world, the gender gap in Iran is evident in all sub-indices including economic participation and opportunity (rank: 143; score: 0.376), political empowerment (rank: 141; score: 0.046), educational attempt (rank: 103; score: 0.969) and health and survival (rank: 127; score 0.966). [64]

Iran's Global Gender Gap index (GGI) between 2006-2018 [65]
YearGender gap rankingGGI
20181420.5890
20171400.5830
20161390.5875
20151410.5800
20141370.5811
20131300.5842
20121270.5927
20111250.5894
20101230.5933
20091280.5839
20081160.6021
20071180.5903
20061080.5803

Child marriage

It is estimated that 17% of Iranian girls under age of 18 are married. However, thousands of such marriages are not officially registered. Child marriage in Iran is mainly driven by gender inequality, religion, poverty and traditional costume. In line with target 5.3 of Sustainable Development Goals, Iran has made a commitment to eliminate child marriage by 2030. [66]

See also

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<span class="mw-page-title-main">Healthcare in Iran</span>

For health issues in Iran see Health in Iran.

<span class="mw-page-title-main">Healthcare in Pakistan</span>

The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through vertically managed disease-specific mechanisms. The different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (NGOs) and private sector. The country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was Rs 657.2 Billion, constituting 1.4% of the country's GDP. The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily responsibility of the provincial government, except in the federally administered areas. Health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Service delivery is being organized through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. Some government/ semi government organizations like the armed forces, Sui Gas, WAPDA, Railways, Fauji Foundation, Employees Social Security Institution and NUST provide health service to their employees and their dependants through their own system, however, these collectively cover about 10% of the population. The private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners.

The following are international rankings for Iran:

Health in the United Kingdom refers to the overall health of the population of the United Kingdom. This includes overall trends such as life expectancy and mortality rates, mental health of the population and the suicide rate, smoking rates, alcohol consumption, prevalence of diseases within the population and obesity in the United Kingdom. Three of these – smoking rates, alcohol consumption and obesity – were above the OECD average in 2015.

<span class="mw-page-title-main">Health in South Korea</span> Overview of health in South Korea

Life expectancy has been rising rapidly and South Korea ranked 3rd in the world for life expectancy. South Korea has among the lowest HIV/AIDS adult prevalence rate in the world, with just 0.1% of the population being infected, significantly lower than the U.S. at 0.6%, France's 0.4%, and the UK's 0.3% prevalence rate. South Korea has a good influenza vaccination rate, with a total of 43.5% of the population being vaccinated in 2019. A new measure of expected human capital calculated for 195 countries from 1920 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. South Korea had the sixth highest level of expected human capital with 26 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

<span class="mw-page-title-main">Health in Tajikistan</span>

The Tajikistan health system is influenced by the former Soviet legacy. It is ranked as the poorest country within the WHO European region, including the lowest total health expenditure per capita. Tajikistan is ranked 129th as Human Development Index of 188 countries, with an Index of 0.627 in 2016. In 2016, the SDG Index value was 56. In Tajikistan health indicators such as infant and maternal mortality rates are among the highest of the former Soviet republics. In the post-Soviet era, life expectancy has decreased because of poor nutrition, polluted water supplies, and increased incidence of cholera, malaria, tuberculosis, and typhoid. Because the health care system has deteriorated badly and receives insufficient funding and because sanitation and water supply systems are in declining condition, Tajikistan has a high risk of epidemic disease.

<span class="mw-page-title-main">Health in Thailand</span>

Thailand has had "a long and successful history of health development," according to the World Health Organization. Life expectancy is averaged at seventy years. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.

<span class="mw-page-title-main">Health in Turkey</span> Overview of health in Turkey

The healthcare system in Turkey has improved in terms of health status especially after implementing the Health Transformation Program (HP) in 2003. "Health for All" was the slogan for this transformation, and HP aimed to provide and finance health care efficiently, effectively, and equitably. By covering most of the population, the General Health Insurance Scheme is financed by employers, employees, and government contributions through the Social Security Institution. Even though HP aimed to be equitable, after 18 years of implementation, there are still disparities between the regions in Turkey. These discrepancies can be seen in terms of infant mortality between rural and urban areas and different parts of the country, although these have been declining over the years. While the under-5 mortality rate in Western Marmara is 7.9, the under-5 mortality rate in Southeastern Asia is two times higher than Western Marmara, with the rate of 16.3 in 2021.

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With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

The HIV/AIDS epidemic in Ukraine is one of the fastest-growing epidemics in the world. Ukraine has one of the highest rates of increase of HIV/AIDS cases in Eastern Europe and highest HIV prevalence outside Africa. Experts estimated in August 2010 that 1.3 percent of the adult population of Ukraine was infected with HIV, the highest in all of Europe. Late 2011 Ukraine numbered 360,000 HIV-positive persons. Between 1987 and late 2012 27,800 Ukrainians died of AIDS. In 2012 tests revealed 57 new cases of HIV positive Ukrainians each day and 11 daily AIDS-related deaths.

<span class="mw-page-title-main">Health in Ghana</span>

In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.

Health in Egypt refers to the overall health of the population of Egypt.

The health status of Namibia has increased steadily since independence, and the government does have focus on health in the country and seeks to make health service upgrades. As a guidance to achieve this goal, the Institute for Health Metrics and Evaluation (IHME) and World Health Organization (WHO) recently published the report "Namibia: State of the Nation's Health: Findings from the Global Burden of Disease." The report backs the fact that Namibia has made steady progress in the last decades when it comes to general health and communicable diseases, but despite this progress, HIV/AIDS still is the major reason for low life expectancy in the country.

<span class="mw-page-title-main">Health in Brunei</span>

Brunei's healthcare system is managed by the Brunei Ministry of Health and funded by the General Treasury. It consists of around 15 health centers, ten clinics and 22 maternal facilities, considered to be of reasonable standard. There are also two private hospitals. Cardiovascular disease, cancer, and diabetes are the leading cause of death in the country, with life expectancy around 75 years, a vast improvement from 1961. Brunei's human development index (HCI) improved from 0.81 in 2002 to 0.83 in 2021, expanding at an average annual rate of 0.14%. According to the UN's Human Development Report 2020, the HCI for girls in the country is greater than for boys, though aren't enough statistics in Brunei to break down HCI by socioeconomic classes. Brunei is the second country in Southeast Asia after Singapore to be rated 47th out of 189 nations on the UN HDI 2019 and has maintained its position in the Very High Human Development category. Being a culturally taboo subject, the rate of suicide has not been investigated.

Montenegro is a country with an area of 13,812 square kilometres and a population of 620,029, according to the 2011 census. The country is bordered by Croatia, the Adriatic Sea, Bosnia, Herzegovina, Serbia, Kosovo and Albania. The most common health issues faced are non-communicable diseases accounting for 95% of all deaths. This is followed by 4% of mortality due to injury, and 1% due to communicable, maternal, perinatal and nutritional conditions. Other health areas of interest are alcohol consumption, which is the most prevalent disease of addiction within Montenegro and smoking. Montenegro has one of the highest tobacco usage rates across Europe. Life expectancy for men is 74 years, and life expectancy for women is 79.

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  65. ↑ "The Global Gender Gap Index".
  66. ↑ "Child marriage".
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