The World Health Organization (WHO) is the directing and coordinating authority for public health within the United Nations system.

The WHO Regional Office for the Eastern Mediterranean is one of WHO’s six regional offices around the world. It serves the WHO Eastern Mediterranean Region, which comprises 22 Member States with a population of nearly 583 million people.

The Regional Office, together with country offices in 17 countries of the Region, works with governments, specialized agencies, partners and other stakeholders in the field of public health to develop health policies and strengthen national health systems. Countries of the Region are represented in the World Health Assembly, WHO Executive Board and Regional Committee for the Eastern Mediterranean.

The official languages of WHO in the Eastern Mediterranean Region are Arabic, English and French. However, national languages such as Farsi, Urdu, Dari, Pashto and Somali are also of great importance in communicating health messages and delivering health programmes in the Region.

The Regional Office for the Eastern Mediterranean’s media and communications programme promotes a regional visual identity for WHO and enhances the organization’s image by producing region-specific advocacy and communication materials.

The programme provides technical support to country offices and collaborates with ministries of health to raise awareness and provide key messages on local and regional public health issues, events, health campaigns and activities.

In times of emergencies, the programme works with responsible technical programmes to promote public awareness through the production of critical health messages, advocacy materials and multimedia products.

To enhance capacity-building, the programme organizes training workshops for communication officers from WHO and relevant ministries of health, and also hosts media workshops and events for media professionals in the Region.

The programme organizes annual health days, a regional public health campaign for World Health Day, and produces advocacy materials for many other campaigns and events that are co-organized with technical programmes.

The programme enhances a network with a pool of partners including sister United Nations agencies, academia, nongovernmental organizations and other stakeholders.

To ensure that WHO’s work on a regional level is promoted to as wide an audience as possible, the programme is also responsible for establishing the Regional Office’s social media policy, and oversees its pages on Twitter and Facebook.

The control and prevention of blindness and deafness programme works with Member States, partners and collaborating centres to develop strategies for eye health and the prevention of blindness and visual impairment in the Region. As part of the global initiative to eliminate avoidable blindness by 2020, "VISION 2020: The Right to Sight"' aims to eliminate the main causes of avoidable blindness in the Region by 2020.

Activities for the prevention of deafness and hearing impairment include working with Member States in reducing and eventually eliminating avoidable hearing impairment and disability through preventive and rehabilitative measures.

The child health and development programme of the Eastern Mediterranean Region works to promote the health and psychosocial development of children under the age of five. It provides technical assistance to countries in the development of child health policies, strategies and operational plans.

The programme supports implementation of cost-effective interventions under the integrated primary child health care strategy “Integrated Management of Child Health (IMCI)” in countries, in collaboration with partners. It collects, analyses and shares information on child health in the Region. The programme also works with teaching institutions to enhance the teaching of public child health-related approaches in pre-service education in medical and allied health professional schools. It engages in child health research of regional public health significance to update guidelines and interventions.

To support planning, implementation, monitoring and evaluation of national child health programmes and initiatives, the child health and development programme has developed regional guidelines on national child health policy development and planning at district level plans, a framework for planning for the community component of the integrated child health care strategy, training materials on counselling on infant and young child feeding and on caring for sick children in the community, and a comprehensive package for medical teaching institutions to introduce, implement and evaluate the IMCI strategy in their teaching programmes.

The WHO regional AIDS and sexually transmitted diseases programme addresses acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV) and sexually transmitted infections (STIs).

The programme supports Member States to strengthen their health sector response, develop national capacity and scale up all aspects of HIV/STI prevention, treatment and care.

It works closely with national governments, academic institutions, civil society, and United Nations and other international partner organizations to:

• increase national political commitment and leadership in HIV/AIDS programmes within the health sector
• link these programmes to the main health and development plans of the countries
• strengthen programme planning, management, monitoring and evaluation
• strengthen national capacity in the delivery of interventions and services.

The work of the Tobacco Free Initiative in the Eastern Mediterranean Region aims to reduce the burden of death and disease caused by tobacco use, and protect present and future generations from tobacco's devastating health effects.

The Initiative assists countries to implement WHO’s Framework Convention on Tobacco Control and develop national legislation that is in line with the Convention, provides technical support to undertake research in various aspects of tobacco control, strengthens capacities of the national workforce in tobacco control, and conducts communication and media advocacy to enhance public awareness, including celebrating World No Tobacco Day on 31 May each year.

Tuberculosis (TB) is a major public health concern in the WHO Eastern Mediterranean Region. The Stop TB programme aims to halve the regional burden of TB by 2015 and works towards its eventual elimination.

Though the incidence of TB in the Region declined at a rate of less than 1% per year from 1990 to 2010, a significant decline in regional prevalence and mortality rates has been reported. In 2010, the Region achieved the global target of halving TB mortality compared to 1990.

Reductions in prevalence have been considerable since 1990, and appear to have accelerated since 2000. Nonetheless, current forecasts suggest that the Region needs to do more to achieve the 2015 target of halving prevalence compared to 1990.

eHealth is the use of information and communication technologies (ICT) for health. eHealth is increasingly being used to eliminate geographical and financial barriers to health. Its application includes diagnosis and treatment, data management, education, and facilitation of communication between patients and physicians.

The WHO eHealth services programme provides technical support to countries on eHealth governance issues and policy frameworks. It supports Member States in implementing globally-approved standards and norms within national systems to enhance interoperability between different systems and between countries of the Region.

The programme also seeks to build an evidence base for the field of eHealth and develop monitoring and evaluation models and methods to measure the impact of e-Health interventions.

Violence

Violence is a public health challenge defined by the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in, or has a high likelihood of resulting in, injury, death, psychological harm, maldevelopment or deprivation.

Injuries

Injuries are a major public health problem claiming more than 5 million lives every year and harming many millions more. It is caused by acute exposure to physical agents, such as mechanical energy, heat, electricity, chemicals and ionizing radiation.

Disabilities

Disability is an umbrella term, covering impairments, activity limitations and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; and a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and the features of the society in which he or she lives.

Communicable diseases are a primary challenge for several Member States in the WHO Eastern Mediterranean Region, with children incurring a disproportionate share of the burden.

The communicable disease surveillance, forecasting and response programme of the WHO Regional Office for the Eastern Mediterranean provides technical and logistical support to Member States in the Region to develop capacities for preparedness planning, prevention, prompt detection, characterization, and the containment and control of emerging and reemerging diseases including epidemic and pandemic-prone diseases.

The overall objective of the programme is to contribute to the reduction of communicable disease burden through the implementation of integrated disease surveillance and response systems.

Health technology pervades all aspects of modern health care and has contributed to increased life expectancy and better health outcomes over the past decades. To realize its full benefits, it needs to be complemented by good staff training and effective organization of health services where application is sought.

The Eastern Mediterranean Regional programme for health and biomedical devices supports Member States capacities to improve access and ensure adequate provision, rational use, and proper management of medical devices. It coordinates and implements technical cooperation activities aimed at strengthening national capabilities.

Countries in the Eastern Mediterranean Region spent US$ 92 billion on health in 2008. This accounts for 1.6% of global health spending for 8% of the world's population. About 34% of this amount is spent by the six high-income countries in the Region, representing only 6.6% of the Region's population.

Regionally, 7.8% of general government expenditure is allocated to health. In most low-income countries, almost 60% of health spending is paid out-of-pocket. This figure reaches 80% in some countries. This out-of-pocket payment is the main cause of catastrophic expenditures that push families into poverty.

Universal coverage of health care helps to limit the financial barriers to accessing health services. Moving towards universal coverage is done through increasing the percentage of the population, services and costs covered by prepayment schemes.

An estimated 1.239 million children under five years of age died in 2008 in the Eastern Mediterranean Region. More than 20% of these deaths are attributed to diseases for which potent vaccines are available.

Immunization is one of the most efficacious, cost-effective and safe public health interventions. Vaccines continue to have a tremendous impact on public health, saving millions of lives each year.

Regional immunization programmes provide vaccines against at least six diseases as part of the national Expanded Programme on Immunization: tuberculosis, diphtheria, pertussis, tetanus, polio and measles.

Recent years have witnessed remarkable improvements in routine vaccination coverage in several countries of the Eastern Mediterranean Region, and hence, in control and prevention of several vaccine-preventable diseases. Despite this, a lot of work is still needed if the regional targets of immunization programmes are to be achieved.

The Centre for Environmental Health Activities (CEHA) is a specialized WHO centre for environmental health. It was established in 1985 to promote environmental health through building national capacity and strengthening environmental health programmes in countries of the Eastern Mediterranean Region.

Human resources are considered one of the key determinants of health services performance. The WHO's Framework for Action for strengthening health systems recognizes human resources as one of the six interrelated and interacting building blocks of health systems.

The human resources development programme of WHO Regional Office for the Eastern Mediterranean provides technical support to Member States in strengthening national capacity and achieving balanced deployment and access to more motivated and skilled health workers, particularly in underserved areas.

In the WHO Eastern Mediterranean Region, neglected tropical diseases represent a major public health problem. Some diseases, such as leishmaniasis, are endemic in most countries. Other diseases, such as leprosy, lymphatic filariasis, schistosomiasis (bilhirzia) and soil-transmitted helminthiases, affect only some countries of the Region or are of low prevalence. Dracunculiasis (Guinea worm) and human African trypanosomiasis (sleeping sickness) are only endemic in one country.

A skilled health workforce is necessary for the attainment of national health goals. A competent and committed health workforce plays a pivotal role in the efficient functioning of a health care system. To bring about the intended qualitative benefits from a health care system, there is a need to provide a competent health workforce with an appropriate skills mix.

The educational development and training programme of the Regional Office for the Eastern Mediterranean supports countries of the Region to strengthen national human resources for health capacity and align the education of health workers with population health needs.

The blood safety, laboratory and imaging programme of the WHO Regional Office for the Eastern Mediterranean works with Governments and health authorities in the Region to ensure that populations have access to safe and affordable blood and blood products. The programme works to ensure that blood is transfused only when necessary and is provided as part of a sustainable blood programme within the existing health care system.

The programme contributes to national health laboratory capacity strengthening, with particular emphasizes on norms, standards and national laboratory policy, as well as strengthening the quality of laboratory procedures, and establishing and expanding External Quality Assessment Schemes. Quality assurance in imaging and Dosimetry are also assets to the programme in helping establish legislation in transplantation and surgical care at district level aspart of clinical procedures.

Research for health is a vital component in developing health systems, in understanding the causes of poor health and predicting and mitigating the effects of other factors on health. The increasing calls for equity and rising expectations in the Region for a better life and improved health call for more research to guide the process and to rationalize the effective use of limited resources. Promoting and enabling a culture and environment of research is necessary to plan, design and conduct research and to disseminate, utilize and translate the findings into health policy and interventions, including in times of difficulty.

The research policy and cooperation programme provides technical support to Member States in the Eastern Mediterranean Region to promote and strengthen a culture of research for health in the Region.

The concept of "reproductive health", as an essential component of public health, has been receiving increasing attention and has now been adopted in almost all countries of the Eastern Mediterranean Region. Research, surveillance and data use for evidence-based decision-making and advocacy are strategic priorities for reproductive health and research programme development at regional and country levels.

Due to the high rates of maternal and neonatal death in some countries, specific focus has been given to the Making Pregnancy Safer programme. Other priority areas include:

• reproductive tract infections
• sexually transmitted infections including HIV/AIDS
• reproductive health in adolescence and post-menopause
• reproductive system cancers
• practices harmful to reproductive health
• premarital and genetic counselling
• neonatal screening for inherited disorders.

The objectives of WHO’s essential medicines and pharmaceutical policies programme are to save lives and improve health by ensuring the quality, efficacy, safety and rational use of medicines, including traditional medicines. It promotes equitable and sustainable access to essential medicines particularly for the poor and disadvantaged.

Operational research in tropical and other communicable diseases is a scientific programme that coordinates, supports and promotes efforts to combat infectious diseases of regional importance. It supports operational research projects by:

• funding specific research covering infectious diseases and examining the cultural and environmental factors that contribute to these diseases
• conducting research methodology workshops and follow-up visits
• recruiting consultants and providing online technical assistance in proposal development and data management to strengthen the capacity of institutions and national health research systems.

The gender in health and development programme supports countries in the Eastern Mediterranean Region to achieve gender and health equity. The goal is health for all. Gender-equitable health policies and programmes increase the coverage and effectiveness of health service delivery for all men, women, boys and girls by identifying and addressing their differential needs and constraints in attaining optimal health.

The work of the gender in health and development programme includes strengthening institutional and national capacities, readiness and mechanisms to formulate, implement and monitor gender-equitable health policies, strategies and plans. Increasing information and evidence on achieving gender and health equity is another core function of the programme.

WHO’s Eastern Mediterranean Regional Office addresses patient safety through a comprehensive programme that tackles the problem from various angles. It provides tools, training for nationals and national capacity building, education, advocacy and awareness raising programmes, all in a package that ensures that the patient voice is heard and that the community is actively involved. The programme also aims to shed light on the magnitude of the patient safety problem and to liaise with relevant counterparts and policy makers to take actions for improvement.

In 2010, an estimated 281 million people were at risk of malaria in the Eastern Mediterranean Region, almost 40% of whom were in high-risk areas. Within the same year, countries in the Region reported about 7.3 million cases, of which only 2.1 million (28.5%) were confirmed parasitologically. Malaria remains problematic in some areas; where large numbers of cases were reported between 2000 and 2010 with no discernable downward trend noted.

The information resources section of the Regional Office and country office web site provides full access to medical and health-related publications and other information products. Health professionals, researchers, policy- and decision-makers, students and the public can download all of WHO's publications for free or order them online. Information resources also offers a wide variety of professional and technical reference and information services covering a broad range of subject areas within the biomedical and public health field.

Improving access to, and availability of, health knowledge is an essential component of WHO technical support for WHO regional office, country offices and field staff, staff from other United Nations and international agencies, ministries of health and other government sectors relevant to health development. Access to knowledge will help all of us in efforts to achieve equitable health for all and the targets of the Millennium Development Goals.

The IHR (2005) are a global framework to prevent, protect against, control and provide a public health response to the international spread of disease while avoiding unnecessary interference with international traffic and trade. Their entry into force on 15 June 2007 was a public health landmark.

The IHR (2005) require countries to detect, assess, notify and report events that could result in a public health emergency of international concern (PHEIC) to the World Health Organization (WHO). They are legally-binding on 194 countries (States Parties) across the globe, including all WHO Member States.

Food safety can be threatened by hazards of both a chemical or microbiological nature. There are many possible reasons why food may be unsafe. Over time, knowledge has evolved about how to keep food safe through the phases of production, storage, preparation and consumption. In spite of this, incidents are reported on a daily basis in which food intake leads to health-related problems.

Chemicals may be natural or manufactured. Chemical safety is concerned with the effect of human exposure to chemicals in natural environment settings as well as with chemicals in industrial extraction, synthesis, production, transport and use. Most industrial chemicals have the potential to be hazardous to human health if not managed appropriately. Safe disposal of chemical waste poses a particular challenge.

The health of elderly programme supports the move towards building "societies for all ages”, within the framework of prevailing positive cultural norms and provides technical support to develop national strategies and plans of action on active, healthy ageing and old age care, based on the revised regional strategy (2006–2015).

Member States in the Region are encouraged to adopt and adapt the WHO initiatives on age-friendly primary health care centres and age-friendly cities/communities and to establish regional, subregional and national networks of age-friendly cities in coordination with other existing WHO programmes and projects, such as the healthy city and healthy village programmes.

Malnutrition remains the most serious child health problem and the single biggest contributor to child mortality in the World Health Organization (WHO) Eastern Mediterranean Region. Nearly one-third of children in the Region are either underweight or stunted, and more than 30% of the population suffers from micronutrient deficiencies.

Most rich and middle income countries in the Region are experiencing a double burden of malnutrition that includes both undernutrition and overweight. This is leading to an increasing burden of disease in many countries. This double burden is having a negative impact on health systems.

Overweight and obesity are closely related to food consumption, dietary patterns, nutrition and lifestyles. Changes in food habits are visible in all countries, in which the traditional diet, which has generally consisted of dates, milk, fresh vegetables and fruits, whole wheat bread and fish, has been diversified, with an excess intake of energy-dense foods rich in fat and free sugars and deficient in complex carbohydrates.

The major nutrition problems due to an inadequate dietary intake in the Region are:

• protein-energy malnutrition
• high prevalence of low birth weight
• iodine deficiency disorders
• vitamin A deficiency
• iron deficiency anaemia in young children and women of childbearing age
• calcium deficiency
• zinc deficiency
• vitamin D deficiency.

Since the initiation of the regional polio eradication programme, the response of all Member States to polio eradication has been extraordinary. Even the least developed countries have contributed to reaching this goal. The contributions of many partners, especially in the acceleration phase, have been of tremendous value.

Several initiatives have been adopted in the Region to ensure the continued commitment of national authorities at all levels to reach all children in the Region with oral polio vaccine and coverage with effective surveillance activities, as well as preparation for eventual certification of polio eradication.

The Regional Committee for the Eastern Mediterranean follows developments closely and has adopted the required resolutions to maintain the necessary efforts until polio eradication is achieved.

Although the programme in some countries is facing difficulties due to natural and manmade disasters, everyone is fully confident that polio will be eradicated.

Noncommunicable or chronic diseases account for over 50% of annual deaths and 60% of disease burden in the Eastern Mediterranean Region.

The four main noncommunicable diseases, including cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, are the largest contributors to mortality in the majority of countries in the Region. Deaths attributed to cardiovascular disease range from 49% to 13%. Cancer deaths are reported to range from 20% to 3%. There are very high rates of diabetes in the Region; 6 countries out of the 10 globally with the highest prevalence of diabetes are in the Region. Prevalence rates of over 20% are reported in some countries.

The noncommunicable disease epidemic is being driven by population ageing, progressive unplanned urbanization and globalization of trade and marketing leading to increased exposure to risk factors for noncommunicable diseases. The prevalence of noncommunicable disease risk factors is high in most countries of the Region. Data indicate that more than one quarter of the adult population has high blood pressure. A high prevalence of hypercholesterolemia was noted with a range of between 20% and 40% among adults aged 15–65 years. The Region has the highest rates of physical inactivity, among other regions. About 50% of women and more than a third of men are insufficiently active. Tobacco consumption, prevalence of smoking among adult men ranges between 12% and 60%.

The Eastern Mediterranean Human Resources for Health (HRH) Observatory is a cooperative initiative funded by the European Commission to promote, develop and sustain a knowledge base for human resources for health in the Region. It provides evidence for policy decisions to strengthen health systems and improve health service delivery.

The purpose of this initiative is to assist Member States in sharing and using proactively the best and most innovative options to tackle HRH challenges. The Observatory offers up-to-date statistical data, policy briefs, research publications and other resources.

In the Eastern Mediterranean Region, approaches and concepts for engaging in effective health education and promotion activities are still not well understood. The traditional approach focuses on knowledge dissemination and awareness raising about diseases or behavioural risk factors. It does not address the capacity of individuals to apply this knowledge. One-time interventions are not effective or sustainable.

Health education and promotion needs to address social determinants of health and use participatory and collaborative approaches to improve population health. Focusing only on lifestyle or behavioural risk factors without also addressing conditions of risk or environmental factors is denying people the right to achieve a better state of health.

Mental, neurological and substance abuse disorders are universal. These disorders affect about one in every 10 people at any given time. About 25% of families have a family member with a mental disorder. In the Eastern Mediterranean Region, these disorders are responsible for 12.1% of disability-adjusted life years (DALYs) lost due to disease and injury.

The mental health and substance abuse programme provides evidence-based technical support to countries for mental health and substance abuse policies, strategies, legislation and service development, in addition to mental health and psychosocial support for countries in emergencies.

A regional mental health strategy has been developed to promote mental health and prevent and manage mental, neurological and substance use disorders, with respect for human rights and social protection. The principles and aims of the regional strategy are aligned with the recommendations of the World Mental Health Report 2001 and the global mental Health Gap Action Programme (mhGAP) of WHO.

NCDs, commonly known as chronic or lifestyle-related diseases, include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. These diseases are the world’s biggest killers and a leading cause of death in the Eastern Mediterranean Region. Every year, more than 1.7 million people in the Region die from these 4 diseases alone, and yet many of these deaths could be prevented through simple lifestyle-related changes and cost-effective interventions implemented by national governments. 

The emergency preparedness and humanitarian action programme works closely with Member States, international partners and local institutions to help communities prepare for, respond to, and recover from emergencies, disasters and crises. The programme is committed to:

• saving lives and reducing suffering in times of crises
• building efficient partnerships for emergency management and ensuring these are properly coordinated
• advocating for political support and consistent resources for disaster preparedness, response and recovery
• developing evidence-based guidance for all phases of emergency work in the health sector
• strengthening the capacity and resilience of health systems and countries to mitigate and manage disasters
• ensuring international capacity is available to support countries for emergency response through training and establishment of surge capacity.

Health workforce policies, strategies and plans provide a strategic vision to address health workforce challenges in the medium and longer term in countries. Some countries have developed their health workforce strategic plans in the region, however, there are a number of countries yet to develop comprehensive health workforce strategic plans. Effective coordination among various stakeholders is crucial for planning and implementation of health workforce strategies and management. Ministry of Health, Ministry of Education, Ministry of Finance, Ministry of Civil Service/Labor, professional councils and associations, academic institutions and others have critical roles in addressing health workforce challenges. Ensuring effective mechanisms and platforms for effective collaboration and cooperation requires effective governance structures.

The World Health Organization, Regional Office for the Eastern Mediterranean Epidemic and pandemic-prone diseases unit supports Member States in the Region in prevention and control of emerging and re-emerging infectious diseases with epidemic and pandemic potential through forecasting; characterization of diseases, health events and outbreaks; and the development of evidence-based strategies to manage infectious hazards.