Effect of Social Factors on Health in Iraq
•
3 likes•276 views
Added some slides to the existing presentation. Presented at the University of Utah, department of sociology, Global health class Fall 2015
Recommended
More Related Content
What's hot
What's hot (19)
Similar to Effect of Social Factors on Health in Iraq
Similar to Effect of Social Factors on Health in Iraq (20)
Recently uploaded
Recently uploaded (20)
Effect of Social Factors on Health in Iraq
- 1. Effect of social life on Health in Iraq Sarah Al-Obaydi, M.B.Ch.B, MPH
- 2. preface • All data presented here are taken from international non-profit organizations since Iraq lacks local agencies with creditable statistical data.
- 3. Iraq in a glance:
- 4. • Population: ≈36 million • Composition: Arabs (3/4), Kurds (1/5), Turkmen, Assyrians, Chaldeans, Armenians and many others. • Language: Arabic • Religion: Islam (75-80%), Christianity (mainly Catholic), Yazidis, Mandais, Jews.
- 5. Health indicators: Indicator Iraq USA Life expectancy at birth m/f in Years 62/70 76/81 Infant mortality rate 31 7 Under-five mortality rate per 1000 live births 39 8 Adult mortality rate per 1000 population 222 106 Maternal mortality ratio - Interagency estimates is /100,000 live births 63 21
- 6. Children’s health in Iraq
- 7. Important numbers • Vaccination rate is ~ 80% • malnutrition ~ 27%
- 9. Health system in Iraq
- 10. Health system in Iraq • Healthcare access in Iraq is a Right granted by the Iraqi constitution. • Generally all types of health care are provided. • No insurance system.
- 11. Healthcare sectors: • Public sector (governmental) • Private sector
- 12. Healthcare expenditure & workforce • Iraq spends 5.2% of its GDP on healthcare. • Healthcare workforce: Iraq U.S Physicians per 10,000 population 6.9 24.2 Nurses and midwives per 10,000 population 13.8 98.2
- 13. Medical education: • 22 medical colleges distributed all over Iraq • Iraq follows the British curriculum (6 years) • After graduation: rotating doctor countryside doctor residency training board certification (4-5 years)
- 14. Physician training • Lack of high quality graduate medical education programs.
- 15. Why physicians are leaving Iraq? • Lack of safety (threats, kidnaps, murders..etc) • Tribal law suits problems. • Abusive governmental regulations & abuse of power. • Lack of respectful residents’ schedule/ lounges in hospitals.
- 16. Social determinants of health: HEALTH Education Income Race & Ethnicity Community
- 17. I. Income: • Generally income is considered low. • 7 million Iraqis are living below poverty line. • In 2011, 50% of Iraqis lived in slum conditions • Many Iraqis can not afford private healthcare.
- 18. II. Education: • Adult literacy rate 78 45% 46% 9% Males % primary school attendacne % secondary school attendance No attendance 46% 34% 20% Females
- 19. Health literacy • USA ~ 86% • Iraq Unknown
- 20. III. Community: • Environment: ▫ Air: no safety & emission regulations ▫ Water: poor sewage system ▫ Food: no regulations on restaurants
- 21. III. Community: • Culture: ▫ Tribes more seen in rural areas ▫ Early marriage (rural) ▫ IPV ▫ Stigmatization of some diseases
- 22. III. Community: • Religious beliefs: ▫ Misinterpretation of Islamic religion and rules. ▫ Concealed sexual relationship increased STIs ▫ Spiritual healers
- 23. III. Community: • health policy regulations:
- 24. III. Community: • extraordinary situations: I. War(s) • Weakened the economy • Increased disability • Displacement • Psychological distress
- 25. III. Community: II. Ongoing violence and political instability: • More disability • Increased the number of internally displaced population • Many healthcare professionals fled Iraq
- 26. III. Community: • The role of non-profit organizations ▫ Iraq-based (e.g: Iraq builders, IHAO, Ghawth) ▫ International : General health and service programs (AMAR, UNHCR) Helping IDPs (IRC, UNHCR, WHO, AMAR..etc)
- 27. A look at the future? • Political stability is a major determinant of social life in Iraq • Need to improve infrastructure • Need to build a strong public health system • Need to provide a safer, more respectful environment for physicians.
- 28. Questions?
Editor's Notes
- Like WHO, UNICEF, UN As a physician who worked in Iraq for 3 threes I find some numbers over/underestimate the reality, I will try to express my point of view about each number according too my experience there.
- I will start with some health indicators to let you have a look at where health in Iraq is, Health indicators are used to compare countries to know how they stand in terms of health and wellbeing..those data are from UNICEF, 2010 The most important thing to note is that this data is before ISIS invasion, in areas where ISIS is, those numbers are worse now because of lack of healthcare in those areas and displacement of most of its people. Mortality rate: in __/1000
- Vaccination rates vary from urban to rural areas, parental education and transportation availability (esp rural, e.g some mothers I used to see in the PHC used to come late for the vaccination schedule because they were not able to get transportation to the PHC at vaccination date assigned for them). Also this data is before ISIS since now doctors and nurses are unable to reach areas invaded by ISIS . A study by UNICEF showed that each governorate in center/south Iraq has at least 20% malnutrition in children under 5, no difference between boys and girls, or urban and rural areas.
- From my experience, I believe the percentage of death due to diarrhea is much higher than 6% . And since last year, it is getting much worse again because IDPs are living in tents on the streets with lack of clean water
- * We don’t have a good judicial system that ensures everybody is getting his/her right nor to protect the healthcare workers against the repeated offenses from the public
- Healthcare is mainly governmental. The public sector is regulated by the ministry of health and departments of health in each governorate, but the problem is that the regulation is weak and there is a huge deficit in the equipment, medications, medical personnel due to corruption in these governmental offices. There are some private hospitals that are growing in addition to private clinics.
- Iraq GDP in 2010 was 81.1124 Billion US spends 17.4% on healthcare Physician: pop ratio is very low, for instance one day when I was working in the PHC, I checked the number of patients I received and it was 120 patients in less than 4 hours! (imagine the quality of care you can provide when you have this number to examine in this short time period). http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS (2014 data)
- We enter medical college directly from high school, so no 4 years of science, we study for 6 years, the first 3 years are basic knowledge, starting year 4 we go to hospital rounds and start to learn how to take Hx and perform PE After graduation we are hired by the government as a rotating doctor, depending on your performance in med school you are assigned to hospitals accordingly, after 1 year we are assigned to work in countrysides, usually in a primary healthcare centers for a year just after completing this year, we will be eligible to start residency training in the specialty we want and this takes 4-5 years based on the specialty. https://en.wikipedia.org/wiki/Medical_education_in_Iraq https://search.wdoms.org/
- One of the reasons was that Iraq relied on physicians trained in the UK during the 70s and 80s while after 1991, no more Iraqi physicians were able to get such training and those with high training got older, retired or left Iraq, so we can say that clinical training started to become less efficient over time. e.g) during my medical rotation, only one internist had MRCP and now he is retired.
- the doctor is responsible for his own security , no one will defend him if he was threatened or attacked by relatives on patients or corrupt hospital employees. Out of the 35 doctors who were assigned to the hospital I started my work at in 2009, 17 left Iraq! Tribal rules especially in rural areas are a major challenge for practicing physicians and other health care providers. News has mentioned these incidents more than once, yet we don’t have statistical data to show the impact of this problem. Many Iraqi doctors have fled Iraq escaping from such tribal demands. 2. After graduation, iraqi physicians have to follow certain regulations imposed by MOH in order to be able to get a specialty and/or to work in private sector at least as a GP. Those are: working for 1 year at hospitals in center of the city, 1 year in countryside PHCs, and then choose a specialty and start residency in that one. While these regulations seem easy and physicians should be aware of them when they started medical school, it is the abuse of these regulations is the problem. e.g: For instance few months ago, 150 countryside doctors we supposed to become specialty residents but because one of the physicians objected on the way of the unfair residents are distributed the MOH deferred all the 150 physicians’ distribution till this day as a punishment for objection. 3. Doctors are required to stay for weeks or sometimes months in hospitals but the MOH doesn’t provide them with a respectful place to stay in . (I used to bring my own food, my own blanket to sleep because food is bad and not always enough to feed all residents, and no enough beds for all residents). Another major issue was transportation to and from countryside, this is not paid and the physician is required to provide his/her own transportation to and from his work place, and usually this is very expensive because those places are rural, and of course dangerous!
- There is not data if there are certain diseases that affect Arabs more than Kurds or vice versa for instance, But we know that people living in certain regions are more vulnerable to certain diseases, for instance people living in the north of Iraq are more vulnerable to Iodine deficiency due to high altitude , also people living in the Marshes are subject to Bilharziasis because the water is stagnant in those areas, Malaria is more common in the north . Also, sickle cell anemia is found in North and south more commonly than the center of Iraq
- Iraq GNI per capita (US$), 2009 is 2210 % of Iraqis who lived in slum conditions year 2000 :17%, year 2011: 50% Many Iraqis can’t afford going to private doctors and hospitals despite the poor quality of care provided by the public healthcare system as mentioned before For instance, one day in my rotation year, a patient had SVT and I had to ask his relatives to buy Adenosine for him because it is not available in the hospital.
- As WHO put it “Education and Health go hand in hand” educated girls have fewer babies, and they have them later in life. Educated girls also make better mothers. A literate girl or woman is also far more likely to be health literate.
- Before 2003, there were many health education programs and ads on TV, after 2003 none! When I used to work in PHC, I tried to hand health education leaflets, and gave health education lectures, but this was considered a waste of time by some of my colleagues! (back to poor training and perception of medical career)
- Infrastructure Percentage of pop using improved drinking water sources= 79% (urban 91%, rural 55%) Percentage of pop using improved sanitation facilities=73% (urban 76%, rural 66%) *MOH is not doing its role well, no public health policies
- Tribal traditions remain culturally important to many Iraqis. Early marriage in rural areas or even in the urban areas means no more schooling for women. 4. Women may be victim of partner violence and she will not admit that. and there are no facilities or programs that help such women 5. Although there are mental healthcare facilities to treat mental illness and drug addiction, poor understanding of mental illnesses by the society and stigmatizing those patients, lead many mentally ill not to seek medical assistance. Other diseases are STIs.
- The majority of Iraqis are Muslims. Misinterpretation of the Islamic religion and rules can: 1.Lead to behaviors that in turn adversely affect health care (females can’t be examined by male physician) this can partly explain the high maternal mortality rate because female physicians might not be available all the time. 2. Religious- based sectarian violence which rendered many people disabled, many physicians unable to practice in certain areas. Male-female sexual relationship before marriage is prohibited by religion, such relationship is concealed STIs go undetected spread of STIs One day in the pediatrics hospital I worked in, an 18 month kid was admitted to the ER seizing, and when I took the history of the disease, the mother gave me something she said the spiritual healer have it to her to dissolve in water and give it to the kid to treat his diarrhea, after analysis there was some kind of poisonous material in it that obviously caused seizure
- Poor health care system and lack of regulations' on pharmacists. Medicines can be sold without prescription. Pharmacist though may have fairly good medical knowledge they are not trained to prescribe medications. And to consult a pharmacist will lead to faulty medical decision and will negatively affect health of the public.
- Increased number of psychologically distressed people due to traumatizing events in Iraq after 2003 including torture, kidnapping, blackmailing, intimidation and harassment by militias
- Have lead to many Iraqi to be internally displaced living poor lives poor access to clean drinking water and sanitation poor access to healthcarehealth crisis (Internally displaced people : 1.3 million) Percent of professionals who have left Iraq since 2003 - 40% Iraqi Physicians Before 2003 Invasion - 34,000 Iraqi Physicians Who Have Left Iraq Since 2005 - 12,000 Iraqi Physicians Murdered Since 2003 Invasion - 2,000
- Most of the help given to IDPs in terms of clothing, food, health services is provided by non for profit organizations that are either Iraq-based or international.. The iraqi based are dependant on people’s donations to help each other International NGOs are either supported by the international society such as UNHCR , IRC, WHO or by people’s donations such as AMAR.. They run programs that support people inside Iraq but since they are dependant on funds, sometimes they are forced to stop their humanitarian services due to lack of funds, (this is what happened with 184 programs that are managed by UNHCR Other organizations such as AMAR foundation, a London-based started long time ago in 1991 to help people of the marshes but expanded to implement many very helpful programs to support Iraqis, build schools, healthcare centers and with ISIS crisis now, helping IDPs as well, this organization is merely dependant on donations of supporters and have 2 offices in US one in DC and one in Utah as they are collaborating with LDS charities
- An urgent need to improve public health to educate people about how to take good care of their health