As with many developing nations, the shift in the occupied Palestinian territory (OPT) towards urbanization and Western-style diet, along with decreasing physical activity, has left heart disease, cerebrovascular disease, diabetes, and cancer as leading causes of death. The response of the Palestinian National Authority to the chronic-disease challenge has been limited, as has been interest from international donors on whom the authority has depended for funding such programmes. Military occupation and its consequences are major impediments to improving the OPT's fragmented healthcare system. These issues are discussed in the third paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Dr Abdullatif Husseini, Birzeit University, OPT, and colleagues.
In 2005 (the latest year with data) heart disease caused 21% of all deaths in the OPT, followed by cerebrovascular disease (11%). Cancers were third with 10.3% of all deaths. Mortality from coronary heart disease was 2•8 times higher in Jerusalem Palestinian men than in Jewish men and 2•7 times higher for Palestinian women than for Jewish women. Although acute coronary care in the Israeli hospitals in which 84% of Palestinians from Jerusalem received their care was described as generally equally good, interventions were done less frequently on Palestinian patients than on Jewish patients.
Despite the absence of definitive evidence, diabetes mellitus and its complications are major health problems in the OPT according to all estimates. In 2000, the estimated prevalence rate of diabetes was 9•0% in adults aged 30 years and older. Reported age-adjusted cancer incidence for the occupied Palestinian territory for 1998 was lower than that in Jordan, Lebanon, and in Arabs living in Israel, probably because it was an underestimate since some patients use services outside the territory. In 2005, combined cancer mortality rate in the OPT was 27•8 per 100 000, which is not much different from that in 2000. Lung cancer, the most commonly diagnosed and most deadly cancer worldwide, is the most common type in Palestinian, Jordanian, Lebanese, and Palestinian Arab men living in Israel. Breast cancer is the most common type in Palestinian women. Smoking rates are high for men aged 10 years and older in the OPT (34.7%), but low for women in the same age group (2.1%). Obesity and being overweight is a big problem in the OPT and is particularly important in the adolescent population.
The authors say that primary prevention of chronic diseases should be urgently addressed by The Palestinian National Authority. The public health programmes required will need political will at the highest level. The Palestinian Ministry of Health's restricted budget encourages emphasis on primary prevention, while segregation and movement restriction encourages decentralisation. The authors encourage the use of community-based care and easily administered drugs to address the risk factors of chronic diseases. The OPT health-care system must become more integrated, and investment must be provided to train and develop the health-care workforce.
They conclude: "One of the major impediments to the improvement of the Palestinian health-care system is the continuing military occupation with all its consequences... Relevant to the challenge of chronic diseases is the effect of a state of perpetual limbo on the national economy, strategic planning, health-care policy formulation, and national priority setting. The geographic and administrative fragmentation of the occupied Palestinian territory, the military checkpoints and barriers to movement, and the separation wall and many other fences and barriers, all have detrimental effects on the ability to deliver good health care. The separation of Gaza Strip and the near impervious blockade of its population can only worsen health status and ability to deliver health care."
Dr Abdullatif Husseini, Birzeit University, OPT. T) +972 2298 8654 E) abdullatif@birzeit.edu
For full Article see: http://press.thelancet.com/opt3.pdf
Journal
The Lancet