Health in Lebanon

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Life expectancy in Lebanon Life expectancy by WBG -Lebanon.png
Life expectancy in Lebanon

Lebanon is a small middle-income country on the Eastern Mediterranean shore with a population of around 4 million Lebanese citizens, 1.2 million Syrian refugees, and half a million Palestinian refugees. It is at the third stage of its demographic transition characterized by a decline in both fertility and mortality rates. [1] Moreover, Lebanon, like many countries in the Middle East is experiencing an epidemiological transition with an increasingly ageing population suffering from chronic and non-communicable diseases. [2] Mortality related to non-communicable diseases is 404.4 deaths per 100,000 individuals, with an estimate of 45% due to cardiovascular diseases, making them the leading cause of death in Lebanon. [3] Lebanon has health indices that are close to those of more developed countries, with a reported life expectancy at birth of 80.1 years (81.4 years for women and 78.8 years for men) and an under-five mortality rate of 9.5 per 1,000 live births in 2016. [4] Since the end of the 15-year Lebanese Civil War in 1990, Lebanon’s health indicators have significantly improved.

Contents

The Human Rights Measurement Initiative [5] finds that Lebanon is fulfilling 85.1% of what it should be fulfilling for the right to health based on its level of income. [6] When looking at the right to health with respect to children, Lebanon achieves 99.1% of what is expected based on its current income. [6] In regards to the right to health amongst the adult population, the country achieves 98.9% of what is expected based on the nation's level of income. [6] Overall, Lebanon falls between the "bad" and "fair" categories for the right to health because when evaluating the right to reproductive health, the nation is fulfilling only 57.2% of what the nation is expected to achieve based on the resources (income) it has available. [6]

Background

Change in Lebanon’s Health Indicators between 1974 and 2016
IndicatorValue in 1974 (before the Lebanese civil war)Value in 1976 (during the Lebanese civil war)Value in 2016
Life expectancy at birth (years)67.934.980.1
Under-five mortality rate (by 1,000 live births)58.956.89.5
Fertility rate4.534.361.71
Maternal mortality ratio (by 100,000 live births)No data104 (1984 value)16 (2013 value)
Income (gross domestic product per capita)15,0004,37013,000

Cardiovascular diseases

Cardiovascular diseases represent the leading cause of morbidity and mortality in Lebanon and are also the primary cause of hospital admission. [7] In 2012, it was estimated that 31% of all deaths in Lebanon were due to ischemic heart disease. [8] This high cardiovascular disease incidence can be attributed to several risk factors. For example, 42% of the Lebanese people are smokers, 29.4% are obese, 22.8% are diabetic, and 29.8% suffer from hypertension. [9]

Lebanon's major causes of death in 2014 Lebanon's Major Causes of Death in 2014.png
Lebanon’s major causes of death in 2014

Cancers

Data from World Health Organization (WHO) Globocan 2012 have shown that in the Arab world, Lebanon has the highest lung cancer incidence in females and the third highest in males, with an age-standardized incidence rate among the world population (ASR(w)) per 100,000 person-years of 30.2% in men and 11% in women. Similarly, it has been reported that Lebanon has one of the highest ASR(w) of bladder cancer worldwide, with 29.1 as estimated ASR(w) of bladder cancer among males, thus falling second after Belgium (31.0). [10] Trends in high lung and bladder cancer incidence are largely the product of changing smoking prevalence and patterns of tobacco consumption. Smoking is very prevalent and culturally ingrained into Lebanese society, with the most common forms of tobacco smoking in Lebanon being cigarettes or waterpipe smoking, which is gaining popularity, particularly among females. [11] Relative to a single cigarette, a single waterpipe use episode is associated with similar peak plasma nicotine levels and three times greater peak levels of blood carboxyhemoglobin. The first five minutes of waterpipe smoking produce more than four times the increase in blood carboxyhemoglobin as smoking an entire cigarette. [12] Adult smoking in Lebanon is estimated at 46% for males and 31% for females. Smoking prevalence among the youth is estimated to be among the highest worldwide (65.8% for boys and 54.1% for girls), with waterpipe smoking the major form of smoking (33.9%) followed by cigarette smoking (8.6%). [13] In addition to smoking, urban air pollution measured by concentrations of particulate matter <10 mm in size exceeds the levels set by the WHO (20 mg/m3) in most urban Lebanese cities. [14]

Example of smoking culture in Lebanon around 1800s. A) Prince of Lebanon, Moslem of Damascus.jpg
Example of smoking culture in Lebanon around 1800s.

Refugees

In 2015, there were 452,669 registered Palestinian refugees in the country; more than half live in 12 Palestinian refugee camps. They are ineligible for state social services, including health care. Further adding to the issue is the amount of Syrian refugees, totalling almost one for every four Lebanese. These people are often forced to live in squalid conditions due to a lack of government resources. More often than not, these people are also subject to discrimination in certain aspects of life. This includes medical treatment, to which they have no legal right to according to Lebanese law. [15]

Mental health

Lebanon, a society of people generally wrought by war and loss, is currently plagued with mental health issues where a staggering 17% of citizens suffer from some form of non-war related mental illness. Having only three dedicated psychiatric facilities, but frequent access to psychiatrists and therapy, means that Lebanese has somewhat lacking access to psychiatric treatment by Western standards, but still better access than the rest of the Middle East and the Levant. Cultural stigma, however, often prevents sufferers from receiving the proper care they require and more often than not ends badly. [16] [17]

The WHO indicated that 49% of Lebanese are afflicted with some form of war-related trauma.[ when? ] This often includes former combatants, as well as many victims of the combat, suffering from PTSD. Furthermore, many victims of rape are subject to fear of stigma and do not report their victimization, thus preventing them proper medical and psychiatric treatment, and more importantly, justice. [16] [17]

It has also been estimated[ by whom? ] that on average, every 2.5 days, someone dies by suicide and every 6 hours, someone attempts suicide in Lebanon. “Embrace Lifeline”, Lebanon’s first suicide prevention hotline was established in 2016. This is part of the “Mental Health and Substance Use-Prevention, Promotion and Treatment-Strategy for Lebanon 2015–2020", launched by the Lebanese Ministry of Public Health to create a more effective and comprehensive mental health treatment infrastructure in Lebanon. [18]

History

The Asfouriyeh Hospital, founded in 1896 in Lebanon, is considered the first modern mental health hospital in the Middle East. The impact of the Lebanese Civil War led to the hospital's closure in 1982. [19]

"Embrace Lifeline", Lebanon's first suicide hotline "Embrace Lifeline", Lebanon's First Suicide Hotline.png
“Embrace Lifeline”, Lebanon’s first suicide hotline

Women's health

Women have adequate access to gynecological and other female health facilities in Lebanon, excluding contraceptives. [20] Abortion is illegal except in cases where the woman's life is at risk, under Lebanon's Penal Code of 1943. [21]

The Lebanese view on unborn children is that they are equivalent to an infant, thus making it difficult for legalization of abortion. However, abortion is widespread among women and frequently performed by the same doctors who call for its prohibition. Underage pregnancies as well as extramarital pregnancies are the most commonly terminated, often in decent conditions but occasionally not. The general consensus of the Lebanese indicates that most do not support abortion, however a significant urban population is currently vying for its legalization. Most Lebanese prefer the concept of birth then adoption by a sterile family, and this is a frequent occurrence. However, more often than not abortions are forced upon young mothers by family members attempting to preserve family honour. [20]

Related Research Articles

<span class="mw-page-title-main">Tobacco smoking</span> Practice of burning tobacco and breathing the resulting smoke

Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America. Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.

<span class="mw-page-title-main">Hookah</span> Type of water pipe

A hookah, IPA: ; also see other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco, flavored tobacco, or sometimes cannabis, hashish and opium. The smoke is passed through a water basin—often glass-based—before inhalation.

<span class="mw-page-title-main">Oral cancer</span> Cancer of the lining of the lips, mouth, or upper throat

Oral cancer, also known as oral cavity cancer, tongue cancer or mouth cancer, is a cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless red or white patch, that thickens, gets ulcerated and continues to grow. When on the lips, it commonly looks like a persistent crusting ulcer that does not heal, and slowly grows. Other symptoms may include difficult or painful swallowing, new lumps or bumps in the neck, a swelling in the mouth, or a feeling of numbness in the mouth or lips.

Women's health differs from that of men's health in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization (WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

<span class="mw-page-title-main">Diseases of affluence</span> Health conditions thought to be a result of increasing wealth in society

Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.

<span class="mw-page-title-main">Health effects of tobacco</span> Circumstances, mechanisms, and factors of tobacco consumption on human health

Tobacco products, especially when smoked or used orally, have serious negative effects on human health. Smoking and smokeless tobacco use are the single greatest causes of preventable death globally. Half of tobacco users die from complications related to such use. Current smokers are estimated to die an average of 10 years earlier than non-smokers. The World Health Organization estimates that, in total, about 8 million people die from tobacco-related causes, including 1.3 million non-smokers due to secondhand smoke. It is further estimated to have caused 100 million deaths in the 20th century.

<span class="mw-page-title-main">Non-communicable disease</span> Medical conditions that cannot transmit from one individual to another

A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others. NCDs may be chronic or acute. Most are non-infectious, although there are some non-communicable infectious diseases, such as parasitic diseases in which the parasite's life cycle does not include direct host-to-host transmission.

<span class="mw-page-title-main">Prevalence of tobacco use</span> Percentage of population smoking tobacco

Prevalence of tobacco use is reported by the World Health Organization (WHO), which focuses on cigarette smoking due to reported data limitations. Smoking has therefore been studied more extensively than any other form of consumption.

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

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

Health in Israel is generally considered good.

Chronic, non-communicable diseases account for an estimated 80% of total deaths and 70% of disability-adjusted life years (DALYs) lost in China. Cardiovascular diseases, chronic respiratory disease, and cancer are the leading causes of both death and of the burden of disease, and exposure to risk factors is high: more than 300 million men smoke cigarettes and 160 million adults are hypertensive, most of whom are not being treated. An obesity epidemic is imminent, with more than 20% of children aged 7–17 years in big cities now overweight or obese. Rates of death from chronic disease in middle-aged people are higher in China than in some high-income countries.

<span class="mw-page-title-main">Muʽassel</span> Syrupy tobacco mixture used in hookahs

Muʽassel, or maassel, is a tobacco mix containing molasses, vegetable glycerol and various flavourings which is smoked in a hookah, a type of waterpipe. It is also known as "shisha".

Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia.

About a quarter of adults in Turkey smoke. Smoking in Turkey is banned in government offices, workplaces, bars, restaurants, cafés, shopping malls, schools, hospitals, and all forms of public transport, including trains, taxis and ferries. Turkey's smoking ban includes provisions for violators, where anyone caught smoking in a designated smoke-free area faces a fine of 188 Turkish lira (~€9.29/$9.90/£8.22) and bar owners who fail to enforce the ban could be fined from 560 liras for a first offence up to 5,600 liras. The laws are enforced by the Ministry of Agriculture and Forestry of Turkey.

<span class="mw-page-title-main">Smoking in Egypt</span>

The use of tobacco products in Egypt is widespread. It is estimated that approximately twenty percent of the population uses tobacco products daily. Cigarettes are the most common form of tobacco consumption in Egypt, with an estimated twenty billion cigarettes smoked annually in the country. After cigarettes, shisha water-pipes are the most common form of tobacco consumption.

Smoking in South Korea has decreased overall for both men and women in the past decades. However, a high prevalence of tobacco use is still observed, especially with the rise of novel tobacco products such as e-cigarettes and heat-not-burn tobacco products. There are socioeconomic inequalities in smoking prevalence according to gender, income, education, and occupational class. Advocates call for measures to reduce the smoking rates and address smoking inequalities using a combination of monitoring and tobacco control policies. These measures include significant price hikes, mandatory warning photos on cigarette packs, advertising bans, financial incentives, medical help for quitting, and complete smoking bans in public places.

Health in Malta has seen improvements in recent years, with one of the highest life expectancies in Europe. Malta has a good overall quality of health and has seen rapid growth and improvement in key health indicators. Malta has seen significant development in the practice of mental health which has been supported by new infrastructure and increased government health spending. The introduction of health-focused government initiatives, particularly around nutrition, alcohol, smoking, and health will likely contribute to the further improvement of overall health nationwide.

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

Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low under five mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.

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.

References

  1. ↑ Sibai AM, Sen K, Baydoun M, Saxena P. Population ageing in Lebanon: current status, future prospects and implications for policy. Bull World Health Organ 2004;82:219-25.
  2. ↑ Pierre-Louis AM, Ayodeji Akala F, Samaha Karam H. Public Health in the Middle East and North Africa: Meeting the Challenges of the Twenty-first Century. Washington D.C: World Bank Institute; 2004.
  3. ↑ World Health Organization (WHO). Lebanon. 2014. Available from: . [Accessed on September 8, 2018].
  4. ↑ Institute for Health Metrics and Evaluation (IHME). Lebanon. 2016. Available from: . [Accessed on September 8, 2018].
  5. ↑ "Human Rights Measurement Initiative". humanrightsmeasurement.org. Retrieved 5 May 2023.
  6. 1 2 3 4 "Lebanon - Rights Tracker". rightstracker.org. Retrieved 7 May 2023.
  7. ↑ Deek H, Newton P, Inglis S, et al. Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease. Collegian 2015;22:333-9.
  8. ↑ World Health Organization (WHO). Lebanon: WHO statistical profile. 2015. Available from: .[Accessed on September 8, 2018].
  9. ↑ Fahs I, Khalife Z, Malaeb D, Iskandarani M, Salameh P. The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations. Cardiol Res Pract 2017;2017:3530902.
  10. ↑ Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Estimated Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer. 2013. Available from: .[Accessed on September 8, 2018].
  11. ↑ Salameh P, Khayat G, Waked M. Lower prevalence of cigarette and waterpipe smoking, but a higher risk of waterpipe dependence in Lebanese adult women than in men. Women Health 2012;52:135-50.
  12. ↑ Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med 2009;37:518-23.
  13. ↑ Saade G, Warren CW, Jones NR, Asma S, Mokdad A. Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC):the case for Lebanon. Prev Med 2008;47(Suppl 1):S15-9.
  14. ↑ Saliba NA, El Jam F, El Tayar G, Obeid W, Roumie M. Origin and variability of particulate matter (PM10 and PM2.5) mass concentrations over an Eastern Mediterranean city. Atmos Res 2010;97:106-14.
  15. ↑ "Health in Lebanon". UNWRA. Retrieved 22 December 2015.
  16. 1 2 "Addressing mental health needs in Lebanon". Humanitarian Practice Network. Archived from the original on 2018-09-08. Retrieved 2021-02-01.
  17. 1 2 "Mental Health System in Lebanon" (PDF). WHO. 2010. Archived (PDF) from the original on October 7, 2013.
  18. ↑ Embrace. Embrace LifeLine - Lebanon's First National Emotional Support and Suicide Prevention Helpline. 2018. Available from: Archived 2019-02-17 at the Wayback Machine . [Accessed on September 8, 2018].
  19. ↑ Reader, The MIT Press (January 19, 2023). "The Tragic Downfall of ʿAṣfūriyyeh (The Lebanon Hospital for the Insane)". The MIT Press Reader. Retrieved August 28, 2024.
  20. 1 2 "Bound by taboos, Lebanese women seek abortions". DW. 4 February 2014.
  21. ↑ "Moral Work and the Construction of Abortion Networks: Women's Access to Safe Abortion in Lebanon". Health and Human Rights Journal. 2019-12-09. Retrieved 2023-04-08.
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