Health
care is an integral part of basic needs. Failure to satisfy it is
considered to be a definite indicator of deterioration in living
conditions. Lack of information regarding the health situation of
households and individuals in the Population and Housing Survey
prevented the inclusion of health care and related indicators in the
construction of the living conditions index. An attempt is made in the
following paragraphs to partially remedy this deficiency based on
information obtained from another survey, namely: Lebanon Maternal and
Child Health Survey which was carried out by the Ministry of Social
Affairs and the League of Arab States in the period January-March 1996.
The
sample survey, derived from the same statistical frame as the Population
and Housing Survey, covered 4600 households. The completed
questionnaires included 3317 for women that qualified (whether married
or not, aged less than 55 years, and residing with the household), and
2156 child questionnaires (aged less than 5 years and residing with the
household).
The link between living conditions and the state of health is evident
from the overall health indicators examined such as life expectancy at
birth, level of calorie-intake or malnutrition, infant and maternal
mortality rates, the spread of disease and immunization, etc. National
averages, however, may not be adequate and should, therefore, be
supplemented by observing regional and social disparities, which are
more indicative of living conditions in the country.
Before the outbreak of war in 1975, the Ministry of Public Health was
providing various health services through the regional health centers,
including governmental hospitals. The war, however, caused most of these
centers to halt their operations, and stimulated an expansion in the
role of the private sector in this field. With the end of the war, and
the gradual restoring of the role of state institutions, the Ministry of
Health resumed part of its earlier functions, while adapting them to the
new developments. The Ministry of Social Affairs has also played an
important role in the provision of health care during the past years in
coordination with, and complementing the activities of, the Ministry of
Health. It continues to do so through its centers (numbering 40), which
are active in the different regions of Lebanon.
The results of the Lebanon Maternal and Child Health Survey allows the
observation of the link between living conditions and the health
situation through a number of indicators, in particular: the state of
child nutrition; infant mortality; health care for pregnant women and
mothers and level of health coverage.
In general, the national averages for overall health indicators are
satisfactory compared to countries in a similar situation as Lebanon.
During the last five years, Lebanon achieved positive results with
respect to the control of contagious diseases. At present, Lebanon is
considered among the countries in transition with respect to the nature
of diseases, where the importance of contagious diseases is diminishing,
while those related to modern urban life-styles are rising. Moreover,
the triple vaccine immunization (DPT3) stands at 97 percent (3 doses)
for children aged 12-23 months, while vaccination against measles
reaches 86 percent.
Regarding
maternal health care, the results of the Lebanon Maternal and Child
Health Survey show that 87 percent of women who became pregnant during
the years 1991-1995 have benefited from pre-natal care. At the same
time, 88 percent of all deliveries were carried out in private or public
health institutions; the remaining 12 percent continued to take place at
home. Deliveries performed with the help of doctors amounted to 72.8
percent of the total.
Nutritional indicators for children - reflecting the state of nutrition
at the time of completing the questionnaire and in the period
immediately preceding it - do not reflect the existence of acute and
wide-spread deficiencies in the overall rate of protein and calorie
intake. Available information relating to the weight, height and age of
children below 5 years indicates that 2.9 percent of children are thin
(insufficient weight relative to height), 3 percent are under-weight
(insufficient weight relative to age), while 12.2 percent of the
children were found to be short (insufficient height relative to age) -
an indicator that reflects cumulative malnutrition, especially vitamin
deficiency, poor quality and lack of variety.
A
distinct improvement can also be observed in infant mortality rates in
recent year despite the war, whose adverse effects it was possible to
contain. The infant (up to one year) mortality rate fell from 65 per
thousand live births in 1970, to 28 per thousand in the period 1991-1995
(Table 6). Similarly, life expectancy at birth rose from 64 years to 69
years over the same period. There remains, however, very important
disparities, as infant mortality rates in the deprived regions is three
to four times higher than in the less deprived regions.
|
| Educational
attainment of mother |
Infant
mortality rate (less than one year) |
Infant
mortality rate (less than 5 years) |
| Illiterate
|
54.5 |
57.7 |
| Can read and
write |
51.1 |
55.6 |
| Elementary |
29.6 |
33.9 |
| Intermediate |
30.5 |
31.7 |
| Secondary and
above |
14.8 |
16.5 |
| National
average |
27.9 |
32.2 |
Source: Same as in Table 6.
The
disparities observed in tables 6 and 7above reflect the combined effect
of a number of factors including: an unhealthy environment,
malnutrition, inadequacy or lack of health services, and weakness of
preventive and primary health care - factors that reflect the strong
link between the health situation and living conditions.
This link is at its strongest in a country as Lebanon, where health
coverage provided by social and health insurance institutions is
limited, and where citizens themselves continue to settle the bulk of
the health care bill. Around 62 percent of total outlays on health in
the country are covered by users, compared to 31 percent for the
government and 7 percent for donor parties. The Lebanon Maternal and
Child Health Survey indicates that around 60 percent of the Lebanese are
not covered by any of the insurance schemes operating in the country.
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