In the Eastern Mediterranean Region [1] health inequalities have long been pervasive.
Whether it is in differences in life expectancy, mortality in children under the age of five, health status, or health care, they all result from the enormous disparity in the economic and social conditions in which people are born, raised, lived, worked and advanced in age.
These disparities are evident from the start of life.
Conflicts are not a new phenomenon in the Eastern Mediterranean Region, but their current scale has reached an exceptional level.
Our region has 10 out of 36 countries and territories on the World Bank's 2019 Harmonized List of Fragile Situations.
More than half of the countries in the Eastern Mediterranean Region are affected by conflict, which is causing large-scale migration and an increase in the number of refugees and internally displaced persons.
The WHO Eastern Mediterranean Region suffers from many huge disparities in the area of health.
Here is the report "Rebuilding More Fairly: Achieving Health Equity in the Eastern Mediterranean Region" [2], prepared by global and regional experts at the World Health Organization, which sheds light on the stark differences in life chances in our region.
These differences are not due to biological reasons. Rather, the keyword lies in "disparities".
The report shows that conflict and fragility lead to greater inequalities.
The damage caused by Covid-19 is also expected to increase in the most vulnerable groups, which are the poorest and most vulnerable groups.
In all cases, people's health remains the biggest loser from the prevailing inequalities.
It is worth noting that this region witnessed a significant decrease in the mortality of children under the age of five from 68.8 to 23.7 per 1000 live births between the 1990s and 2018. The rate of premature death and disability caused by communicable, maternal, nutritional and other diseases decreased by three. Quarters since 1990. However, deaths from conflict are on the rise, and obesity, undernutrition and food insecurity remain major challenges.
Also, food security is increasingly affected by the containment of COVID-19 and the effects of conflict.
Conflicts are not a new phenomenon in the Eastern Mediterranean Region, but their current scale has reached an exceptional level.
Our region has 10 out of 36 countries and territories on the World Bank's 2019 Harmonized List of Fragile Situations.
More than half of the countries in the Eastern Mediterranean Region are affected by conflict, which is causing large-scale migration and an increase in the number of refugees and internally displaced persons.
The consequences of conflicts not only affect the safety of people, but also have direct and long-term effects on health and its social determinants.
Therefore, health equity should be a priority in peace and reconstruction efforts, as well as in international responses in the region.
Although there is already evidence that the scale of social and economic prejudices is expanding in the region due to COVID-19 infection and measures to contain it, there are also concerns that the pandemic will exploit those who do not value peace.
There is no doubt that increased violence and insecurity will exacerbate already existing health and social injustices.
Development is nothing but real improvements in the quality and satisfaction of people's lives.
In the past decades, several attempts have been made to set economic and social goals.
Most of them are summarized in 17 sustainable development goals, such as ending poverty, protecting the planet, and ensuring peace and prosperity for all.
However, the institutions and policies in our region are not yet fully prepared to achieve the goals of development, prosperity and equality.
The aspiration to "rebuild in a more equitable way", as stated in the commission's report, affirms that economic decisions must take into account the implications for health and health equity.
Awareness of the effects of economic decisions on health equity should be raised, to hold governments accountable for the effects of these decisions.
Demands for social justice arise from massive wealth inequalities.
Inequalities in wealth impede development and deepen poverty in the Eastern Mediterranean Region, and the same is the case in other regions of the world.
The share of private wealth is increasing, and public wealth is declining.
The effects of the Covid-19 pandemic are likely to exacerbate these trends, as governments spend public money to support economies, and will therefore further engage in health inequities.
Poverty can also be prevented if effective policies are put in place to ensure real job creation.
And we have seen, in many cases, countries that are not benefiting from economic growth, and are not using the wealth of wealth to increase employment opportunities.
This may be attributed to conflicts, large numbers of refugees and migrants, the high concentration of wealth in the hands of a small group of people, and low levels of wages and social protection, all of which have been amplified by the Covid-19 pandemic.
Increasing employment rates - especially since the Eastern Mediterranean Region has the highest rates of youth unemployment - and improving the quality of work remain essential to achieving healthy, social and economic development.
And societies with high rates of child or informal labor face catastrophic consequences for long-term health and wellness.
Child labor rates are relatively high in some countries of the Region, primarily due to conflict and high levels of poverty and ill health.
In other countries, rates of informal employment are high, which is devoid of guaranteed employment, and carries multiple risks related to poor health.
Poor health is a double burden for women and girls in the Region.
Also, the Eastern Mediterranean Region is one of the regions most affected by gender inequality (0.4), according to the Gender Inequality Index.
Gender inequalities also have a critical impact on inequalities in health, education, employment, income, vulnerability to harm from conflict and violence, and the ability to lead a dignified and healthy life.
The report, Building Back More Fairly, also recognizes the paramount importance of providing a dignified and healthy life for the elderly.
Fortunately, many elderly people in the Region are able to live relatively good health and wellness.
Family traditions and religious practices remain a safe haven for the elderly.
Yet sharp disparities in health and life expectancy between and within countries persist.
Although all regions of the world have disparities in the health and well-being of the elderly in later life, levels of social protection for the elderly, especially women and migrants, are very low in the Eastern Mediterranean Region.
Given the relatively high percentage of young people in the region, it is expected that the proportion of the elderly will increase significantly over the next 50 years.
This means that traditional forms of support for the elderly will not suffice.
Likewise, rapid urban growth in the Region is insufficient to ensure human living conditions and health opportunities.
Uncontrolled urban growth and the rapid growth of informal refugee settlements lead to inequities in accessing basic services, such as sanitation, clean water, electricity, internet, transportation and healthcare services.
The Region also faces the challenge of climate change and its impact on health equity.
Urgent changes must be made to protect the existing population and reduce severe risks in the future.
The only way before us is to rebuild in a fairer way.
What we need is to achieve equity in people's living conditions.
National plans on social determinants and health equity need to be developed in all countries of the Region, with a special focus on humanitarian response to conflicts and emergencies.
Improving health care is directly related to improving health systems.
As the report, Building Back More Fairly, shows, effective health systems should support more equitable social determinants.
It should also work to strengthen relationships with partners in other sectors to achieve this.
Countries of the Region also need to mitigate the disproportionate impacts of measures to contain COVID-19 on unemployment, income, hunger and gender equality.
Progress must be made in eliminating youth unemployment, providing education for all, equitable health care for mothers and children, and providing care for the elderly with public funding.
Universal health coverage should be promoted throughout the Region in a way that ensures access to equitable and affordable health care.
The path to health equity begins, and becomes sustainable, with rebuilding in a more equitable way.
Let us work together to achieve this in the Eastern Mediterranean Region.
[1] Director of the World Health Organization for the Eastern Mediterranean Region.
[2] The WHO Eastern Mediterranean Region includes 22 countries and territories: Afghanistan, Bahrain, Djibouti, Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, the Occupied Palestinian Territory, Oman, Pakistan, Qatar and the Arab Kingdom. Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic, Tunisia, the United Arab Emirates, and Yemen.
[3] Building More Equitable: Achieving Health Equity in the Eastern Mediterranean Region, Report of the Commission on Social Determinants of Health in the Eastern Mediterranean Region.