Health Determinants in Egypt

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Introduction

Healthcare in Egypt is confronted with numerous challenges; the government, parastatal, and private providers are struggling to meet the growing demand in the country whose population undergoes rapid growth. Although the institutions responsible for funding or providing medical services are exerting a considerable effort, now widening the outreach, the system has yet to overcome fragmentation and find ways to increase health expenditure. A question that is to be answered to elaborate a viable strategy is how health determinants affect the situation in the country. This paper deals with eight of such determinants explains the link between them and health outcomes and discusses government initiatives to address the issues.

Age

Some diseases are linked to old age; the older a person becomes, the more likely they are to suffer from them. For instance, cardiovascular diseases (CVD) are usually associated with aging. Demographically, Egypt is undergoing changes, with the cohort older than 55 years increasing up to 10.12% in 2017 (Central Intelligence Agency, 2017). It is projected that by 2050, elderly citizens will make up 20.8% of the country’s population (Sweed, 2016). At the same time, it has been noticed that between 1990 and 2015, the number of CVD occurrences has risen from 153,214 to 226,457 respectively (Tehrani-Banihashemi et al., 2018, p. 140). Therefore, in Egypt, more and more people are likely to experience age-related diseases, and in order to provide them with timely treatment, the health institutions will need to make health care more accessible.

Education

An educated person is more likely to reject dangerous lifestyles and make conscious, well-informed decisions about their health. It is known that pregnancy in adolescents may lead to numerous complications such as preeclampsia, preterm labor, premature rupture of membranes, and oligohydramnios (Abdelsattar, 2016, p. 39). In Egypt, despite an apparent decline in teenage pregnancy rate between 1960 and 2015, still, 50 per 1,000 women give birth between the age of 15 and 19 (The World Bank, 2015a). It is important to notice that the rate is higher in rural Upper Egypt as opposed to urban Lower Egypt (Abdelsattar, 2016, p. 35). What may account for such a discrepancy is a high school dropout rate in rural regions due to poverty. Hence, adolescents, who do not have access to education, are more likely to be unaware of family planning and expose themselves to health risks.

Gender

One of the most pressing gender-specific issues in the Eastern Mediterranean Region (EMR) is sexual violence that may lead to physical injuries as well as mental traumas. In a 2013 study, UN Women found that 25% of Egyptian women experienced sexual or physical intimate partner violence at least once in their lives (Ministry of Health and Population Cairo, Egypt, El-Zanaty and Associates Cairo, Egypt, & The DHS Program ICF International Rockville, Maryland USA, 2014, p. 229). It has been proven that violence has long-lasting physiological and mental consequences, e.g., PTSD, anxiety, and depression (Oshodi, Y., et al., 2016). Thus, in Egypt, gender violence is a grave issue, occurrences of which are detrimental for female health.

As for the impact that sex has on health outcomes, for women, pregnancy and birth are especially risky. Throughout the last 25 years, the maternal mortality rate in Egypt decreased significantly from 106 deaths down to 33 per 100,000 live births (WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group, 2015, p. 1). However, medical training and medication availability still appear to be insufficient; more women than ever prefer Caesarean section to vaginal birth due to inefficient painkillers or lack thereof (Al Rifai, 2017, p. 12). Despite certain improvements, the Egyptian government should take measures to assist labor better.

Access to Healthcare

A prime characteristic of a well-functioning health care system is its accessibility for an ordinary citizen. Unfortunately, a number of issues such as great distances to nearest facilities and the lack of appropriately trained specialists may hinder access to medical services. To illustrate how geographic location affects access to health care and thus, life expectancy, one may point out the vast difference between the child mortality rates in rural upper Egypt and urban lower Egypt. According to the Ministry of Health and Population, the number of deaths is 38 and 20 per 100,000 births respectively (2014, p. 20). Another example is the prevalence of stunting in children aged 0-4 in the Red Sea governorate (85%) as opposed to Suez (12%) (El-Kogali & Krafft, 2015, p. 18). One may assume that in the first region, parents experience difficulties addressing the health condition early, which results in aggravation. Therefore, health care quality varies across the country, and the insufficient medical infrastructure at times results in developmental delays and premature death.

Socioeconomic Status

Low-income, impoverished, and otherwise disadvantaged social groups are at higher risk of poor physical and psychological health than their wealthier counterparts. As for Egypt, the pressing issues are soaring poverty rates, health care pluralism, and providers’ self-agency that entitles them to demand out-of-pocket fees. According to recent statistics, out-of-pocket health payment amounts to 58% of total health expenditure (Rizk & Abou-Ali, 2016, p. 2). What makes the situation complicated is that even government providers are allowed to charge fees. One may readily see how such pricing policies may cut off access to health care for a considerable population share, which is especially unsettling for a country with the poverty rate at an all-time high (28%) (The World Bank, 2015c). Thus, the lack of insurance plans with sufficient coverage and low income are two factors that lead to pessimistic health outcomes.

Burden of Disease

In a country, it is imperative to establish how many people carry a specific disease to help the carriers find treatment and prevent others from contracting in case the disease is communicable. Recent data on the burden of disease in Egypt showed that the tuberculosis mortality rate is at 0.42 per 100,000 people (World Health Organization, 2017). According to a 2014 WHO report on EMR, the country is considered a low burden for malaria (World Health Organization, 2014a, p. 7); HIV prevalence is also low at 0.1% among citizens between the ages of 15 and 49 (World Health Organization, 2018). Despite current positive statistics, the country needs to do further research on the burden of disease and improve surveillance quality.

An example of introducing viable policies in Egypt is the country’s collaboration with WHO and the US Centers for Disease Control and Prevention to address the prevention and treatment of Hepatitis C. The partnership resulted in a steady decline in the number of disease carriers from 9.8% in 2008 to 7% in 2014 in the demographic cohort aged 15-59 (World Health Organization, 2015, p. 10). All in all, to improve the health care system, public health practitioners and policy-makers should be able to see a larger picture of diseases and disabilities on a country scale. At that, one of the workable strategies may be joint international health programs.

Environment

Environmental issues are affecting people in a variety of ways; some of them may trigger an acute health reaction whereas some have mild symptoms but an accumulative effect that in perspective may decrease the quality of life. As for Egypt, the country experiences the issues common for all developing countries: water scarcity and pollution, poor air quality, and increased use of herbicides and pesticides. Throughout recent years, the government introduced an array of environmental initiatives to tackle the issues. According to the 2018 Environmental Performance Index, Egypt ranks 66th on the list comprised of 190 countries. Among the countries in the Eastern Mediterranean region, Egypt ranks 7th (Yale Center for Environmental Law & Policy, 2018, p. 3). It attests to the government’s genuine concerns about environmental health.

Unfortunately, recent studies show that persistent issues have yet to cease negatively affecting the citizens. For instance, Soliman, Nasr, and Okba (2015) state that heavy metals in sediments in proximity to the Mediterranean coast pose a potential ecological and health risk (p. 10). Heavy metals are dangerous pollutants as in case they enter the human body, they are never fully metabolized and reside in soft tissues (Soliman et al. 2015, p. 1). Therefore, environmental policies are still a work in progress, and at that, the health of the nation should be one of the top priorities.

Economy

It is only logical that increased demand for medical services calls for a greater health budget. For a country with a rapidly growing population, a decrease in health expenditure from 5.18% to 4.17% between 2000 and 2015 seems unreasonable (The World Bank, 2015b). Furthermore, Egyptian health experts among policy-makers with the leverage to start a dialogue and give an impetus to positive changes prefer to protect the interests of the private healthcare sector moguls. In consequence, the healthcare system maintains the status quo where public-sector medical professionals remain underpaid.

In search of higher salaries and standards of living, many health specialists decide to leave the country and work elsewhere. For instance, The World Health Organization’s Mental Health Atlas showed a decline in the number of psychiatrists per 100,000 of the population between 2011 and 2014 (2014b, p. 34). Inarguably, sufficient health expenditures and adequate working conditions for medical staff will account for a better healthcare system.

Conclusion

The complexity of finding viable solutions for the Egyptian health care system is calling for a comprehensive intersectional analysis of all the contributing factors. A multidimensional approach to the problem will help reveal numerous links between health determinants and their impact. Insufficient health expenditure is discouraging doctors from staying in the domestic labor force, which results in understaffed medical facilities. In turn, the lack of medical professionals is compromising healthcare accessibility, especially for disadvantaged population groups. The shortage of appropriately trained professionals in Egypt is hindering surveillance of the country’s burden of disease. Healthcare also needs to adjust to the aging tendencies to address age-related issues more efficiently.

The performance of other sectors also affects national health; available nationwide educational programs will help raise awareness and encourage citizens to make better decisions. As for raising awareness, it is vital that the government makes an effort to stop sexual harassment. Apart from gender violence, women’s health is also often endangered by inadequate labor assistance. Lastly, Egypt needs to tackle the issues of environmental pollution as it gives rise to various health conditions among the population.

References

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