Majdi Ashour (ex-participant courses of Health Policy and QMM at ITM; New Voice in Global Health at the World Health Summit in Berlin in 2013)
More than one month ago, The Lancet published the series “Health in the Arab World : a view from within”. On the eve of the launch of the Lancet series, a bomb exploded in a southern suburb of Beirut, echoing the horror in Syria. This explosion is not an isolated incident in a region where violence has – sadly – become commonplace. Instead, it symbolizes the scene of health issues in the region. The Lancet Series used the appropriate lens, in other words. It is not surprising at all that the majority of the articles and viewpoints in the Series tackle the major political determinants of health in the region.
The Series starts by analyzing data from the Global Burden of Diseases, offering the first research of its kind to assess the state of health, including changes in disease burden between 1990 and 2010 in the region and the impact of risk factors and injuries. Then, five review articles discuss Governance and health, Non-Communicable Diseases, the path towards Universal Health Coverage in four of the “Arab Spring” countries, changing therapeutic geographies of the Iraqi and Syrian wars, and health and environmental sustainability. A viewpoint, essays, and a number of comments complement the series.
Although coordinators of the series indicated that they had decided not to go for the theme “health and the Arab spring”, the series cannot escape from the shadows of the Arab Spring, which some consider an Arab version of the European revolutions in 1848. The review article on “ Governance and Health” presents an account of the multiple threats to health during the Arab uprisings; the review article on the path towards UHC selected four countries which went through their own “Arab Spring”; and the introduction of the concept of therapeutic geographies – i.e. the geographic reorganisation of health care within and across borders under conditions of war- uses, among others, the Syrian experience, which was initially considered a slow-motion version of the “ Arab Spring”, but eventually turned out to be a devastating civil war.
For some reason, the word “Arab” was expunged when dealing with countries and populations of this region, intentionally or unintentionally. Arab countries are usually categorized as countries of the Middle East, Near East, the Crescent, Eastern Mediterranean region, West Asia, or even the Middle East and North Africa – according to the regional classifications used by the international agencies they belong to or according to the interests of Western funding agencies. The Lancet Series, however, introduced them in the way they are engraved in the minds and hearts of millions of Arabs, considering them, rightly, as a unit of analysis. The 22 Arab countries belonging to the League of Arab States indeed share the same language, cultural heritage and turbulent history. Most of them ( except Somalia, Djibouti, and Comoros ) are geographically connected, and importantly in many cases they also share similar challenges, including the predominance of authoritarian regimes and the often harsh interference by colonial, ex-colonial and neocolonial powers, who try to protect their own interests in the region.
A clear asset of this series is thus that it makes the Arab world, as a whole and as separate countries part of the Arab world, more visible in global health, where they are usually overlooked or even erased, including by themselves. Moreover, the series certainly contributes to increasing the footprint of health research in the Arab world, which clearly has a rather low research productivity till now.
However, the added value of the series goes beyond the introduction of the Arab World as a unit of analysis, increasing the visibility of the Arab countries ( and the Arab World) in global health, and contributing to more Arab research productivity. Even before September 11, 2001, the Arabs and the Arab world were stereotyped as terrorists and opponents to western civilization by certain scholars and in some media. In 1992, Samuel Huntington introduced his thesis on The Clash of Civilizations, a phrase which had been used earlier by other scholars during the colonial period to rationalize colonialism. The Lancet series could be a crucial vehicle to shed light on the complex realities of life and health in the Arab world, in order to contribute to a better understanding of the diversity of this heterogeneous region, which includes Muslims, Christians as well as other religious groups, rich and poor, and even Arabs and non-Arabs, and to confront the Clash of Ignorance (see Edward Said in the Nation’s issue of 22 October 2001) as this ignorance is one of the fundamental causes of the purported antagonism between the so called “West” and “Islam”. Cheap labels and generalizations like the “Islam” and “the West” serve only to confuse us about a disorderly reality, Edward Said contended, and he’s right, even more so more than 10 years later, now that the interdependence of our world is becoming ever clearer.
The Arab world, with a population of more than 354 million, should get the place it deserves in global health, acknowledging however that there exist no “sealed-off” entities in our global community. Instead, different entities, peoples and regions should be open for and exposed to exchange and cross-fertilization.
So let’s applaud the Lancet Series for finding the right balance between zooming in on health in the “Arab world” while avoid cheap labels and cultural generalizations.