SPEAKERS CORNER - HEALTH IN A TROUBLED REGION On approaching health in the Arab world Abbas El-Zein Published online: 5 August 2009 Ó Birkha ¨user Verlag, Basel/Switzerland 2009 There is a sentence that I still remember from one of my French geography textbooks in high-school: ‘‘Asia does not exist, has never existed, has never wanted to exist.’’ Arguably, the first two clauses of this statement can be applied to the Arab world. While we Arabs have wanted to exist as a single nation—this is what twentieth-century pan-Arabism amounts to—we have never succeeded in doing so, our efforts having mostly spawned authoritarian regimes. Furthermore, only some us, mostly urban elites in Cairo, Damascus and Baghdad, appear to have wanted this unity. Maziak (2009) draws a list of health problems plaguing our part of the world and rightly bemoans the lack of democratic practices and adequate social and institu- tional responses to these problems. He points astutely to some underlying dynamics—women’s inferior social status as a cause of honour crimes and poor physical and mental health; authoritarian structures of government leading to flawed data collection with detrimental effects on health monitoring and so on. However, his diagnosis could have gone further had it not been based on a less convincing premise, one that Maziak himself has brought to the fore: ‘‘Understanding the complexity of generalizing to such a vast and diverse region, there is a striking sense of unity and destiny among Arabs, and an ironic commonality of problems facing them nowadays.’’ I see no evidence of such a sense of unity. Rather, what is ironic is the lack of commonality in health problems, despite the shared language and culture. There is no escaping the fact that Yemen, Saudi Arabia, the United Arab Emirates, Lebanon, Iraq, Palestine and Libya—to pick a few countries almost randomly—appear to have very different health problems, which partly reflect the vast differences in their respective social, historical and geo- graphical settings. A central determinant of Palestinian and South Lebanese health over the last few decades has been Israeli occupations and military incursions (Batniji et al. 2009; Giacaman et al. 2009). Women in Saudi Arabia are constrained by patriarchal structures which are deeply entrenched, give rise to severe restrictions on freedom and can easily turn into abuse (Human Rights Watch 2008), while youth in Lebanon are subject to relentless tobacco advertising (Saade et al. 2008) and high levels of traffic- related trauma (Gerbaka et al. 1999). Islamist and secular political organizations have moved to fill in a gap in the provision of primary health care in countries where the state is relatively weak but not in others (Jabbour et al. 2007). Wars in Iraq, Sudan and Somalia over the last decade have led to the death and injury of hundreds of thousands of civilians. Occupational injury and violence appear to be significant health problems for foreign workers in the Arab Gulf, Lebanon and Jordan, although peer-reviewed research on this topic remains scarce (UNDP 2005). Palestinian refugees in some Arab countries suffer from systematic institutional and legal discrimi- nation with significant health implications. Cairo, a megalopolis of over 15 millions, may have more in com- mon with Sao Paolo, Casablanca or Calcutta, than Sanaa, Ryadh or Baghdad. Indeed, many health and socio-eco- nomic indicators at the end of the Arab Development Report 2005 do reflect this wide variability (UNDP 2005). The premise of ‘commonality of problems’ alas blights Maziak’s otherwise powerful and brave article. Many health dynamics are probably shared by a large number of Arab countries, without being mere reflections of broader globalization trends relevant to Asia, Africa and A. El-Zein (&) School of Civil Engineering, University of Sydney, NSW 2006 Sydney, Australia e-mail: aelzein@usyd.edu.au Int J Public Health (2009) 54:359–360 DOI 10.1007/s00038-009-0063-5