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Original Article Health Status in the Islamic Republic of Iran, Middle East and North Af Iran J Public Health, Vol. 49, No.1, Jan 2020, pp.86-95 Original Article Health Status in the Islamic Republic of Iran, Middle East and North Af- rica Countries: Implications for Global Health Hossein MIRZAEI 1, Zhaleh ABDI 2, *Elham AHMADNEZHAD 2, Mahshad GOHRIMEHR 2, Elham ABDALMALEKI 2, Rezvaneh ALVANDI 2, Iraj HARIRCHI 3 1. HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 2. National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran 3. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran *Corresponding Author: Email: [email protected] (Received Mar 2019; accepted 11 May 2019) Abstract Background: The aim of this study was to evaluate the health status of the Iranians following the sustainable devel- opment goals’ (SDGs) introduction and the recent health reform implementation in Iran and to compare with those of the Middle East and North Africa region (MENA) and global average. Methods: This comparative study used secondary data to investigate socio-demographic and health status indicators. The sources included census, population-based surveys and death registries. Global and regional health status indicators were obtained from international databases including WHO, the World Bank and the Institute for Health Metric and Evaluation (IHME). Results: Life expectancy and human development index improved following the reform implementation. Among causes of death, 74.6% were attributed to non-communicable diseases (NCDs). There was an increasing trend in risk factors for NCDs in Iran, while at the same time neonatal, infant and under-5 mortality rates reduced. Compared to the MENA, Iran has a lower maternal mortality ratio, neonatal, infant, and under-5 mortality rates, and a higher life expectancy. NCDs and road traffic injuries accounted for a larger portion of disability-adjusted life years in Iran com- pared to the MENA and worldwide. Conclusion: Actions against communicable diseases and road traffic injuries are required together with continued efforts to address NCDs. Although based on the results, Iran has relatively high rankings, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs targets. Keywords: Health status; Non-communicable disease; Iran; Global health; Sustainable development goals Introduction The burden of infectious diseases has reduced main post-2015 agenda, will enable countries to globally through the strengthening of the health provide health for all (4). Health is placed centrally systems and development of primary health care within the SDGs (5, 6). (PHC) strategy (1, 2). However, health systems still The Alma-Ata Declaration was the first interna- face a number of challenges, which include demo- tional declaration that advocated PHC (7). Im- graphic and epidemiological transitions and shift- provements in health status following PHC imple- ing disease burden from communicable to non- mentation in Iran have changed disease patterns communicable diseases (3). SDGs, introduced as a (8). Forty years after the launch of PHC, universal 86 Available at: http://ijph.tums.ac.ir Mirzaei et al.: Health Status in the Islamic Republic of Iran … health coverage (UHC) as the central target of MENA and the world. Data for MENA and SGDs, has been given a prominent place in the global average was obtained from the World post-2015 global agenda. Countries have gradually Bank database and for Iran collected from put the program on their agenda since 2000 (9). As censuses conducted in 2006, 2011 and 2016. many other countries, Iran is committed to 2. Human Development Index (HDI) achieve UHC. Therefore, a health reform, called HDI is a summary measure of long and Health Transformation Plan (HTP), was initiated healthy life, being knowledgeable and have a in early 2014 with the prime intention to achieve decent standard of living. The health dimen- UHC. With a considerable increase in the Ministry sion is assessed by life expectancy at birth; the of Health and Medical Education (MoHME)’s education dimension is measured by mean of budget, insurance coverage was extended to ap- years of schooling for adults aged 25 yr and proximately 10 million people. A number of other more and expected years of schooling for chil- interventions were introduced to reduce Iranian dren of school entering age. The standard of out of pocket (OOP) payments to 20% or less of living dimension is measured by gross national the Total Health Expenditure (THE). A few income per capita (GNI) (based on 2011 Pur- months later, the next phase of the HTP started chasing Power Parity) (1, 5, 10). Data on HDI scaling up the primary health services coverage. were collected from the United Nations data- One of the main interventions implemented in base in 2015. Oct 2014 to reduce OOP payments was updating relative value units of health services to better re- Health status and risk factors flect the cost of services in both public and private 1. Life expectancy (LE) sectors (6). Health status indicators are employed LE at birth as benchmark to track progress towards achieving It is the average number of years that a new- broad health system objectives as well as evaluate born could expect to live if he or she were to the performance of health systems and the success pass through life exposed to the sex- and age- of health programs. Health indicators are also em- specific death rates prevailing at the time of ployed to examine the differences in health status birth, for a specific year, in a given country, within and between countries (9). territory or geographical area. LE at birth is de- In this study, health status indicators were used as rived from life tables and is based on sex- and benchmark to determine whether the stated goals age-specific death rates. United Nations (UNs) of health programs and UHC in Iran have been values for LE at birth correspond to mid-year achieved. Furthermore, the indicators of Iran were estimates, consistent with the corresponding compared with those of countries located in the UNs fertility medium-variant quinquennial MENA and the global average. population projections. The IHME database was used to compare LE in Iran to those of Methods MENA and global average in 2015 (5,10). 2. Main causes of death and disease burden This comparative study used secondary data anal- Main causes of deaths ysis. The indicators definitions and data collection Measuring how many people die each year and methods are as follows: why they have died, is one of the most im- portant means –along with gauging how vari- Socioeconomic indicators ous diseases and injuries are affecting the liv- 1. Demographic indicators ing– for assessing the effectiveness of a coun- The components are: i) Total population, ii) try’s health system. The indicators for Iran Average population growth rate, iii) Popula- were obtained from the World Health Organ- tion over 65 yr of age, iv) Urban population in ization (WHO) (10). The indicators for the Iran in 2016 were compared with those in the Available at: http://ijph.tums.ac.ir 87 Iran J Public Health, Vol. 49, No.1, Jan 2020, pp. 86-95 MENA and the world were extracted from WHO mortality database was the main source IHME database. for MMR. Years of healthy life lost to premature 5. Risk Factors death and disability (DALYs) Tobacco use DALYs are the sum of years of life lost (YLLs) The “prevalence of current tobacco use” was and years lived with disability (YLDs) (1, 10). estimated using two main indicators. Current Data sources were the same as those for main daily tobacco use for all ages in 2016 extracted causes of deaths. from IHME database. Trends of current daily 3. Neonatal, infant and under-5 mortality and non-daily tobacco use (18+ yr) were ex- rates tracted from NCDs Risk Factor Surveys Neonatal Mortality Rate (NMR) (STEPs) conducted in 2005, 2010 and 2016 in It is the number of deaths during the first 28 Iran. completed days of life per 1000 live births in a Prevalence of overweight in persons aged given year or period. The number of children 18+ yr who died during the first 28 days of life should It is the percentage of adults (18+ yr) who are be divided by the number of live births in 1000 overweight (having a BMI ≥ 25 kg/m²) and births (years of exposure) (1). Data from Iran's obese (having a BMI≥ 30 kg/m²) (3, 5). WHO Multiple-Indicator Demographic and Health database was used to estimate the prevalence Survey (IrMIDHS conducted in 2000, 2010), of overweight for Iran, MENA and global av- surveillance routine systems and death regis- erage in 2016. tries were used to capture the indicator infor- To investigate the trends of overweight and mation for Iran. The World Bank database was obesity (18+ yr) in Iran, data from STEPs con- used to check these indicators in the MENA ducted in 2005, 2010 and 2016 were used. and the world. Raised blood pressure (BP) and Blood Infant Mortality Rate (IMR) and Under-5 glucose mortality rates (U-5 MR) Prevalence of raised BP among persons aged It is the probability that a child born in a spe- 18+ yr is defined as systolic BP≥140mmHg cific year or period will die before reaching the and/or diastolic BP≥90mmHg. Number of age of 1 (for IMR) and 5 (for U-5MR) year, if respondents with systolic BP≥140mmHg or subject to age-specific mortality rates of that diastolic BP≥90mmHg was divided by all re- period, which is expressed as a rate per 1000 spondents of the survey aged 18+ yr used to live births.
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