An Arab man
Cultural changes and conflict are helping displace infectious disease as a main cause of death in Arab countries

Diseases related to unhealthy lifestyle and psychological stress are overtaking infectious diseases as the main cause of death in the Arab world, according to a series of papers published in The Lancet.

Health in the Arab World: a View from Within” shows that between 1990 and 2010, cardiovascular diseases, mental disorders and diabetes replaced infectious diseases as the region’s main killers.

Ischaemic heart disease has supplanted lower respiratory infections as the biggest cause of death for Arab men and moved from sixth to third place for women. Other diseases climbing up the list include major depressive disorder, which was the second highest killer of women in 2010.

This epidemiological shift is occurring partly because of a decline in infectious diseases, which lead author Ali Mokdad of the University of Washington attributes to three factors. “When women are educated they make better health decisions for themselves and their families, increased vaccination helps give lifelong protection against infectious disease, and better medical care allows people to manage the impact of infectious diseases on their health,” he says.

But cultural changes are having the opposite effect. “Some countries in the Arab world are adopting western habits with respect to poor diet and less physical activity, and stress plays a significant role in the rise of psychological disorders,” says Mokdad. “Arab families used to live together and support each other financially, raising children together and dealing with day-to-day problems as a group. Now many people live away from their support network.”

Rita Giacaman, a professor of public health at the Birzeit University near Ramallah, says that although wealthy Gulf countries are experiencing the greatest increase in lifestyle-related diseases, low- to middle-income and politically unstable states, such as Egypt, are facing the greatest challenge. For them, little has changed in the quality of their healthcare.

Instability brought about by warfare should also be taken into consideration for the rise in mental health disorders. “The most important factor associated with mental health is conflict and war,” adds Giacaman.

According to Mokdad, the solution lies in prevention rather than treatment. “Improved diet and increased physical activity will go a long way toward reducing some of the biggest risk factors to health in the region,” he says.

But Hanan Abdul Rahim of Qatar University believes that a change must occur at the political level. “The Arab world needs policies and legislation that support prevention of non-communicable diseases, including policies related to tobacco control, building environments that support an active lifestyle,” she says.


The long-term cost of brain injury

The human brain

Traumatic Brain Injury (TBI), which affects 1-2 per cent of the population, causes a threefold increase in the risk of premature death for at least five years after the initial incident, according to research by scientists at a group of UK universities.

The study, published in JAMA Psychiatry, compared the mortality rate of 218,300 Swedish TBI sufferers to the general population from 1969 to 2009. The main causes of death in the former were external events such as suicide, assault and substance abuse – attributable to the loss of brain function caused by TBI.

Damaged connectivity in the brain’s neural networks can have very detrimental effects on the victim’s personal life, with symptoms such as inability to pay attention, memory loss and impulsive behaviour.

Unfortunately, lack of monitoring after discharge means that TBI often goes untreated, leading to an increase in crime, says Huw Williams, a clinical neuropsychologist at the University of Exeter. “While 7 per cent of the general population has suffered some form of head injury, this figure stands at 60 per cent for prisoners,” he says.

To control the disease and reduce preventable deaths, close monitoring of patients would be required. But Williams believes that the first step should be primary prevention, particularly for young people. “We must ensure that people take sufficient care of their heads.”

People already suffering from TBI must be helped to come to terms with it, says Richard Greenwood, consultant neurologist at Homerton hospital in London. “We need to teach people how to deal with having TBI, and how to adapt their life to it by understanding new limitations. The stage after that will be looking at how pharmacology and restorative treatments can add to this.”

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