Health and ecological sustainability in the Arab world: a matter of survival

Abstract

Discussions leading to the Rio+20 UN conference have emphasised the importance of sustainable development and the protection of the environment for future generations. The Arab world faces large-scale threats to its sustainable development and, most of all, to the viability and existence of the ecological systems for its human settlements. The dynamics of population change, ecological degradation, and resource scarcity, and development policies and practices, all occurring in complex and highly unstable geopolitical and economic environments, are fostering the poor prospects. In this report, we discuss the most pertinent population-environment-development dynamics in the Arab world, and the two-way interactions between these dynamics and health, on the basis of current data. We draw attention to trends that are relevant to health professionals and researchers, but emphasise that the dynamics generating these trends have implications that go well beyond health. We argue that the current discourse on health, population, and development in the Arab world has largely failed to convey a sense of urgency, when the survival of whole communities is at stake. The dismal ecological and development records of Arab countries over the past two decades call for new directions. We suggest that regional ecological integration around exchange of water, energy, food, and labour, though politically difficult to achieve, offers the best hope to improve the adaptive capacity of individual Arab nations. The transformative political changes taking place in the Arab world offer promise, indeed an imperative, for such renewal. We call on policy makers, researchers, practitioners, and international agencies to emphasise the urgency and take action.

Figure 1. Worldwide spatial distribution of biocapacity in 2008 and trends in ecological footprint and biocapacity in the Arab world, 1961–2008

Ecological footprint and biocapacity represent, respectively, demand for and supply of resources, converted into units of global hectares. (A) Worldwide spatial distribution of biocapacity debtors and creditors in 2008. (B) Mean ecological footprint and biocapacity per person in the Arab world, 1961–2008; green shaded area shows excess in biocapacity relative to footprint until 1979, and red shaded area shows deficit in biocapacity relative to footprint since 1979. Reproduced from the 2012 report of the Arab Forum on Environment and Development, jointly prepared with Global Footprint Network, by permission of N Saab.

Figure 2. Current state and future trends of urbanisation in the Arab world

(A) Urban population and informal settlements in Arab countries for which data were available; data for urban populations are for 2010 and are from the UN Department of Economic and Social Affairs′ report on world urbanisation prospects and data for informal settlements are for 2005, from the UN Human Settlements Programme′s report on the state of Arab cities. (B) Urban population as a percentage of the total population by subregion, 1950–2030; data are from the UN Department of Economic and Social Affairs.^, GCC=Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). LDAC=least developed Arab countries (Comoros, Djibouti, Somalia, Sudan, Yemen). Maghreb=Algeria, Libya, Morocco, Tunisia, Mauritania. Mashreq=Egypt, Iraq, Jordan, Lebanon, occupied Palestinian territory, Syria.

Figure 3. Change in water resources, 2011–50, and water scarcity and water demand by sector in the Arab world

(A) Current and projected total renewable water resources per person in 2011, 2030, and 2050 per Arab country, and total renewable water resources per person in 2011 in the Arab world, Asia, Africa, and worldwide. The horizontal dashed line shows the absolute water poverty limit (500 m³ per person per year). Data for 2011 are from AQUASTAT and data for 2030 and 2050 are from the authors′ own calculations using AQUASTAT and data from the UN Department of Economic and Social Affairs. (B) Current and projected water supply, and demand by sector, for 2000–09, 2020–30, and 2040–50 in the Arab world; percentages show the water demand per sector as a proportion of total demand. Data are from Assaf and colleagues. oPt=occupied Palestinian territory.

Figure 4. Aridity and food security in the Arab world

(A) Aridity, calculated by precipitation divided by reference evapotranspiration, in selected countries of the Arab world, 2007 Adapted from Bucknall, with permission of the World Bank. (B) Land use in Arab countries for which data were available and for the Arab world overall, 2008; data are from Kassas. (C) Demand for, and availability of, cereals (including feed) in the Arab world, 2000–30; reproduced from the International Food Policy Research Institute′s Middle East and north Africa strategy report, by permission of the International Food Policy Research Institute.

Figure 5. Change in population sizes in the subregions of the Arab world, 1950–2050

Data are from the UN Department of Economic and Social Affairs′ report on world population prospects, 2010. GCC=Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates) LDAC=least developed Arab countries (Comoros, Djibouti, Somalia, Sudan, Yemen). Maghreb=Algeria, Libya, Morocco, Tunisia, Mauritania. Mashreq=Egypt, Iraq, Jordan, Lebanon, occupied Palestinian territory, Syria.

Figure 6. Projected change in total yearly household income in Yemen, 2010–50

Change as a result of local and global effects of climate change (eg, flooding, loss of yields, and global rise in food prices), according to one model. Reproduced from Wiebelt and colleagues, by permission of the International Food Policy Research Institute.

Figure 7. Prevalence of moderate and severe child undernourishment and adult obesity in the Arab world

(A) Latest national estimates of moderate and severe child undernourishment according to height-to-age ratio in children younger than 5 years in Arab countries for which data were available, and in the USA and worldwide; data are from UNICEF.^– (B) Latest national estimates of age-standardised adult obesity for men and women in Arab countries for which data were available, and in the USA and worldwide; data are from the WHO global status report on non-communicable diseases 2010. oPt=occupied Palestinian territory.

Figure 8. Health and military expenditure as percentage of GDP in world regions and Arab countries

(A) 11-year mean (2001–11) of total health and military expenditure as a proportion of GDP (left-hand axis) and ratio of total health to military expenditure (right-hand axis), by world region and overall. (B) 11-year average mean (2001–11) of total health, public health, and military expenditure as a proportion of GDP for Arab countries for which data were available, and for Turkey, Iran, Israel (three non-Arab military powers in the Middle East), and the world for comparison. Data are from the World Bank WorldData database. GDP=gross domestic product. OECD=Organisation for Economic Cooperation and Development.