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Health Status in the Islamic Republic of Iran, Middle East and North Africa Countries: Implications for Global Health

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Health Status in the Islamic Republic of Iran, Middle East and North Africa Countries: Implications for Global Health 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 Africa 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. Department of Biostatistics and Epidemiology, School of 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 Iranians following the sustainable de- velopment goals (SDGs) introduction and to compare with those of the Middle East and North Africa region (MENA) and global. Methods: This comparative study used secondary data analysis to investigate socio-demographic and health status indicator. The sources included census, population-based surveys and death registries. The indicators in MENA were obtained from international databases including WHO, the World Bank and the Institute for Health Assessment and Evaluation (IHME). Results: Life expectancy and human development index increased following the HTP 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 injuries accounted for a larger portion of disability-adjusted life years in Iran compared to the MENA and worldwide. Conclusion: Actions against communicable diseases and road traffic injuries are required together with con- tinued efforts to address NCDs. Although Iran does not have a low global SDGs Index ranking, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs implementation. Keywords: Health status; Non-communicable disease; Iran; MENA region; Global health; Sustainable devel- opment goals Introduction The burden of infectious diseases has reduced agenda, will enable countries to provide health globally through the strengthening of the health for all (4). Health is centrally placed in the SDGs systems and development of primary health care (5, 6). (PHC) strategy (1, 2). However, health systems The Alma-Ata Declaration was the first interna- still face a number of challenges, which include tional declaration that advocated PHC (7). Im- demographic and epidemiological transitions and provements in health status with PHC implemen- shifting of the burden of non-communicable dis- tation in Iran have changed disease patterns (8). eases (3). SDGS, introduced as a main post-2015 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 Population over 65 yr of age, iv) Urban SGDs has been given a prominent place in the population in Iran in 2016 were compared post-2015 global agenda. Countries have gradual- with those in the MENA and the world. Data ly put the program on their agenda since 2000 for MENA obtained from the World Bank (9). Iran made a commitment to make UHC a database and Data for Iran collected from priority. Iran initiated a health reform, called censuses conducted in 2006, 2011 and 2016. Health Transformation Plan (HTP), in early 2014 2. Human Development Index (HDI): with the prime intention to achieve UHC. The HDI including long and healthy life, being HTP aimed at reducing the shortage and control- knowledgeable and have a decent standard of ling the price of essential medicines. living. The health dimension is assessed by With a considerable increase in the Ministry of life expectancy at birth; the education dimen- Health and Medical Education (MoHME)’s sion is measured by mean of years of school- budget, insurance coverage was extended to ap- ing for adults aged 25 yr and more and ex- proximately 10 million people. A number of oth- pected years of schooling for children of er interventions were introduced to reduce Irani- school entering age. The standard of living an OOP payments to 20% or less of the Total dimension is measured by gross national in- Health Expenditure (THE. A few months later, come per capita (GNI) per capita (based on the next phase of the HTP started scaling up the 2011 Purchasing Power Parity- $) (1, 5, 10). primary health services coverage. One of the Data on HDI for MENA and Iran were col- main interventions implemented in Oct 2014 to lected from the United Nations database in reduce OOP payments was updating relative val- 2015. ue units of health services to better reflect the cost of services in both public and private sectors Health status and risk factors (6). Health indicators are employed as benchmark 1. Life expectancy (LE): to track progress towards achieving broad health LE at birth: system objectives as well as evaluate the perfor- The average number of years that a newborn mance of health systems and the success of could expect to live if he or she were to pass health programs. Health indicators are also em- through life exposed to the sex- and age- ployed to examine the differences in health status specific death rates prevailing at the time of within and between countries (9). birth, for a specific year, in a given country, In this study, health indicators were used as territory or geographical area. LE at birth is benchmark to determine whether the stated goals derived from life tables and is based on sex- of health programs and UHC in Iran have been and age-specific death rates. United Nations achieved. Furthermore, health status indicators of (UNs) values for LE at birth correspond to Iran were compared with those of countries lo- mid-year estimates, consistent with the corre- cated in the MENA and the global average. sponding NUs fertility medium-variant quin- quennial population projections. The IHME Methods database was used to compare LE in Iran to MENA and global average in 2015 (5,10). This comparative study used secondary data anal- Healthy LE (HALE): ysis. The indicators definitions and data collec- Average number of years that a person can tion methods are as follows: expect to live in "full health" by taking into account years lived in less than full health due Socioeconomic indicators to disease and/or injury (5, 10). The source 1. Demographic indicators: of information is the same source of LE at The components are: i) Total population, ii) birth. Average population growth rate (GR), iii) Available at: http://ijph.tums.ac.ir 87 Iran J Public Health, Vol. 49, No.1, Jan 2020, pp. 86-95 2. Main causes of death and disease burden: yr (0–59 months of age divided by number of Main causes of deaths: live births (person-years of exposure) used Measuring how many people die each year for calculation. Source of information is the and why they have died is one of the most same source of NMR. important means –along with gauging how 4. Maternal Mortality Ratio (MMR): various diseases and injuries are affecting the MMR (per 100,000 live births): Number of living– for assessing the effectiveness of a maternal deaths per 100,000 live births during country’s health system. These indicators for a specified time, usually one year. Number of Iran were obtained from Iran’s Health Profile maternal deaths divided by number of live Reports (10). These indicators in the MENA births used for calculation (5). Information and the world were extracted from IHME on this indicator was collected from the global burden of disease database. MoHME reports. The WHO mortality data- DALYs)\ base was the main source for MMR in the Years of healthy life lost to premature death MENA and the world. and disability. DALYs are the sum of years of 5. Risk Factors: life lost (YLLs) and years lived with disability Tobacco use: (YLDs) (1, 10). The source of information is Prevalence of current tobacco use among the same source of main cause of deaths. persons aged 18+ yr “smoked tobacco prod- 3. Neonatal, infant and under-5 mortality ucts”. “Current users” include both daily and rates (per 1000 live births): non-daily users of smoked or smokeless to- Neonatal mortality rate (NMR) bacco divided by number of current tobacco Number of deaths during the first 28 com- users aged 18+ yr used for calculation (3, 5). pleted days of life per 1000 live births in a Data were extracted from NCDs Risk Factor given year or period. Number of children Surveys (STEPs) conducted in 2000, 2010 who died during the first 28 d of life divided and 2016. WHO database was used to obtain by number of live births (years of exposure) these indicators for MENA and the global. used for calculation (1). Data from Iran's Prevalence of overweight in persons aged Multiple-Indicator Demographic and Health 18+ yr: Surveys (IrMIDHS conducted in 2000, 2010), Percentage of adults (18+ yr) who are over- surveillance routine systems and death regis- weight (defined as having a BMI ≥ 25 kg/m²) tries were used to capture these indicators for and obese (defined as having a BMI ≥ 30 Iran. The World Bank database was used to kg/m²). Number of respondents aged 18+ yr check these indicators in the MENA and the overweight divided by all respondents of the world. survey aged 18+ yr used for calculation (3, 5).
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