Lebanon, celebrated for its resilience and vibrant cultural identity, is confronting a quiet yet profound crisis: a decline in life expectancy. This vital indicator of societal well-being has been shifting alarmingly since 2019. Once a point of national pride, the decline in life expectancy now reflects deeper issues—disrupted lives, struggling families, and a healthcare system under strain. At the core of this challenge is rampant inflation, particularly affecting healthcare costs and essential sanitary products, which are indispensable to public health.
The statistics reveal the extent of the issue. Inflation has rendered basic healthcare unaffordable for countless families, pushing medications that were once accessible beyond the financial reach of even middle-class households. Hygiene standards have deteriorated as inflated costs of sanitary products add to public health challenges. UNICEF reports that over 90% of Lebanese families have faced increased medicine prices, with more than half unable to procure essential drugs. Treatable conditions are turning fatal, preventable deaths are rising, and the nation’s life expectancy is eroding as a result.
The depreciation of the Lebanese pound, which has lost 95% of its value, underscores this crisis. Importers are unable to bring in vital medications, and local pharmaceutical production has become prohibitively expensive due to rising costs of raw materials. NGOs such as the Amel Association have stepped in to provide assistance, yet their efforts are insufficient to meet the overwhelming demand. The Union of Drug Manufacturers’ decision to further increase pharmaceutical prices has only deepened the strain on households already battling economic instability.
To address these challenges, Lebanon could adopt a fixed exchange rate mechanism for pharmaceutical pricing. This solution, successfully used in countries like Turkey, separates drug prices from fluctuating currency values, ensuring affordability and stability for consumers and suppliers. Establishing a Price Evaluation Commission to periodically review and adjust the exchange rate would maintain flexibility while protecting patients from abrupt cost increases.
Turkey’s experience offers valuable lessons. By employing a fixed exchange rate for pharmaceuticals, Turkey has shielded its population from the worst impacts of currency devaluation while maintaining drug affordability. Regular rate reviews and government interventions have preserved market stability and ensured continued access to essential medications. Research highlights this approach as an effective framework for balancing affordability with adaptability, making it a viable model for Lebanon’s current economic conditions.
Lebanon’s government must act urgently to stabilize healthcare costs. Implementing a fixed exchange rate mechanism is an essential first step toward ensuring access to affordable medications. This strategy could reverse the decline in life expectancy and strengthen public health systems. The path forward is clear: stabilizing healthcare is not only an economic necessity but a moral obligation to protect Lebanon’s most vulnerable populations and secure a healthier future for all.
This does not start with a funny caption or a happy anecdote, but I assure you it’s an important topic and it touches the lives of everyone. This is Tarek Moukalled, and I hope that by the end of this session you can see the light at the end of the tunnel for patients in Lebanon.
Our story begins with rather an unfortunate observation. Patients in Lebanon are dying. As a matter of fact, the death rate has increased from 4.34 deaths in 2016 to 6.25 deaths in 2020 per 1,000 persons. That is drastic and an alarming increase of approximately 44 % during a span of 5 years. But why?
A close inspection of the healthcare expenditure per capita during the suggested years shows a considerable increase from 648 USD to 995 USD. Furthermore, the % expenditure of GDP on healthcare in Lebanon also shows a consistent trend of a little less than 8 % across the same years. So, things should be fine, if not better! Yet unfortunately, this is not the case.
It appears the Lebanese people have been taking things into their hands. With the economic recession and the subsequent governmental bankruptcy, GDP decreased from ~ 51.1 billion USD in 2016 to 31.7 billion USD in 2020. This led to the fact that the Lebanese people have been paying more and more from their own pockets for healthcare reaching a whopping 44.2 % of healthcare expenditure in 2020.
Comparing the above results with the healthcare sector of a different country that shares similar demographics and healthcare expenditure with Lebanon would help with the context and the subsequent validation of the proposed solution, the light at the end of the tunnel. Remember?
With a similar % expenditure of GDP on healthcare (~ 7.5 %) and a little lower starting point in death rate of 3.16 per 1,000 persons, Jordan’s death rate in 2020 reaches 3.47 per 1,000 persons. The healthcare expenditure per capita in Jordan is consistently way lower than that of Lebanon. The % of out-of-pocket expenditure on healthcare is also steady and lower than that of Lebanon. As to the GDP, it starts lower than Lebanon in 2016 at ~ 39.9 billion USD and ends higher than Lebanon at 43.6 billion USD. As such, the main considerable deviation between both countries is the GDP amount. For that matter, it’s important to note that economies and healthcare sectors grow through expenditure rather than stagnation or restriction.
The increase in the share of health expenditure as part of GDP will have positive results on both short-term and long-term.
Enhanced Healthcare Quality
Faster Healthcare Response
Improved Patient Health Outcome
Decreased Death Rate
Target for Healthcare Tourism
With that, it is imperative to urge whoever who is responsible to proceed with the increase in healthcare expenditure for the sake of our patients and our future.
“As declared by the unitednations Health and well-being are important at every stage of one’s life, starting from the beginning from the very start.”
A pivotal measure that parents can undertake during the early stages of their children’s lives is to ensure they receive the necessary vaccinations. These vaccinations play a crucial role in preserving the health of the child and contribute collectively to the well-being of society.
A high vaccination rate in countries can lead to:
Decrease in individual’s Health Risks
Decrease in disease Spread and vulnerability to outbreaks
Reduce the strain on Healthcare Systems
Economic stability
Alarming Drop in Immunization Rates Among Lebanese Children:
In 2020, Lebanon witnessed a substantial decrease in the percentage of immunization against Diphtheria, Pertussis, and Tetanus (DPT), Hepatitis B (HepB3), and measles among children aged 12-23 months. After more than ten years of stability, the immunization rate dropped to 67% in 2021, marking its lowest point in recent history.
Standing Out in a Global Context of Decline:
While middle-income and low-income countries experienced a decrease in immunization percentages in 2019 and 2020, Lebanon stood out with the most significant decline. Comparatively, when pitted against low-income, middle-income, and high-income countries, Lebanon witnessed the highest decrease in the percentages of DPT, Measles, and HepB3 immunization during these pivotal years.
This raises crucial questions about the specific factors contributing to Lebanon’s distinct challenges in maintaining essential childhood vaccination rates.
Economic Struggles Impacting children Immunization:
In 2019, Lebanon experienced a significant economic crisis, resulting in widespread job losses, with the unemployment rate reaching 13% by 2020. The cost of everyday items surged, approximately 85%, creating substantial challenges for individuals to afford medical expenses and seek necessary healthcare. Accessing healthcare has now become a luxury for many citizens, including children, as parents prioritize essential goods over vaccinations for their kids.
In addition, the Lebanese government allocated similar resources in Lebanese Lira to its healthcare system in 2019 and 2020 as it did in 2018. However, the impact of inflation eroded the purchasing power, diminishing the effectiveness of the government’s support, especially given that healthcare costs are often priced in US dollars.
Shielding the Health of the Lebanese :
In the world public health, the ramifications of low vaccination rates against DPT , Measles and HepB3 are far-reaching and dire. The repercussions extend from the heightened risk of individual health issues to the vulnerability of entire communities facing outbreaks. These outbreaks not only strain healthcare systems but also impose a substantial economic burden, creating a global health threat. The gravity of these consequences becomes most evident in the specter of preventable deaths looming over communities.
Recognizing the gravity of these consequences, urgent action is essential. The government must increase its investment in vaccination programs, ensuring free and universal accessibility. It should collaborate with international entities such as World Health Organization and NGOs to get financial support.
These efforts will not only promote individual well-being but also strengthen the communal defense against potential outbreaks, paving the way for a healthier and safer future for all.
In the wake of economic crises that shook nations, Lebanon in 2019 and Greece in 2010 faced turbulent times. Both crises were rooted in corruption, leading to drastic declines in GDP growth. However, the divergent paths they took in managing their public health expenditures reflected the crucial role of external support, particularly from the European Union (EU), in shaping their healthcare resilience. The following graph depicts the impact of each economic crisis on the growth of the GDP for each country.
Greece:
Greece’s Response in 2010: As the economic crisis unfolded in Greece, the government faced the daunting challenge of preserving essential public services, including healthcare. Despite severe austerity measures, Greece was able to maintain a relatively stable level of public health expenditure, thanks in part to support from the EU. The EU, in collaboration with the International Monetary Fund (IMF) and the European Central Bank (ECB), provided financial assistance and worked closely with Greek authorities to implement structural reforms.
In the tumultuous landscape of Greece’s economic crisis, the government, stood resilient in preserving public health expenditure due to the support of the EU. Aligned with SDG 3 (Good Health and Well-being) Greece’s commitment to maintaining health services during austerity was instrumental in ensuring equitable access to healthcare, mitigating potential disparities among its citizens.
Maintaining Public Health Expenditure: The EU support for Greece’s health sector included targeted funds, policy guidance, and technical expertise. Greece’s commitment to maintaining public health expenditure, even amid broader economic challenges, was seen as a strategic priority. The EU assistance helped Greece safeguard essential healthcare services, ensuring that the population continued to have access to medical care despite the economic downturn. Greece was able to increase its public health expenditures and decrease its private health expenditures even in light of the crisis.
Investment in Health Infrastructure: One key aspect of the EU support was the emphasis on investing in health infrastructure and promoting efficiency within the healthcare system. This approach aimed not only to address immediate needs but also to build a foundation for long-term sustainability. Greece utilized these funds to upgrade medical facilities, enhance healthcare delivery, and improve overall public health outcomes.
Lebanon:
Lebanon’s Struggle in 2019: In contrast, Lebanon faced a more challenging situation in 2019. The absence of a supportive regional union akin to the EU left Lebanon with fewer external resources to combat its economic crisis. Rampant corruption, compounded by political instability, hindered effective governance and the ability to mobilize funds for public services.
Public Health Expenditure Dilemma: As Lebanon grappled with economic turmoil, the public health sector bore the brunt of budget cuts. Public health expenditure decreased, leaving the population vulnerable, particularly in a time when healthcare needs were escalating with the rise of COVID 19. The lack of external support and a fragmented political landscape hindered Lebanon’s capacity to protect its citizens’ health. The economic crisis of 2019 prevented Lebanon from safeguarding the situation of its citizens. The public health expenditure decreased significantly and the private health expenditure increased which left citizens to bear the heavy load of the crisis.
Impact on Healthcare Accessibility: With decreased public health spending, the burden on private healthcare providers increased. Private health expenditure rose as individuals sought alternatives to strained public services. The divide in healthcare accessibility deepened, disproportionately affecting the most vulnerable populations who lacked the means to access private healthcare.
The divergent paths of Greece and Lebanon underscore the critical role of external support during economic crises. Greece’s ability to maintain a relatively stable level of public health expenditure with the assistance of the EU highlights the importance of collaborative efforts and financial support in times of crisis. In contrast, Lebanon’s struggle to secure external aid resulted in a significant impact on public health services. This tale serves as a reminder that international cooperation and support can play a pivotal role in mitigating the human costs of economic downturns, particularly in the realm of healthcare.
Lebanon’s public education sector has grappled with numerous challenges in recent years, such as a shortage of spots in public schools, strikes by primary and secondary teachers, and various other issues. As a previous student in the public sector, STRIKE! was the most common act I encountered from my teachers. A lot of strikes and movements were organized by teachers, asking for their rights, increased wages, etc.. This was a great disabler for an efficient learning journey, where stability, the most important aspect was absent. Such a state deprived students, in one way or another, of having access to free and inclusive educational institutions/schools. For that reason, a comprehensive study I conducted revealed that a significant number of students have turned to private schools as an alternative, highlighting a critical problem in achieving the Sustainable Development Goal (SDG) of providing quality and inclusive education for all students.
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To address the issue of the lack of educational opportunities in public schools, which should be guaranteed by the government, as the 4th goal of SDG states, an examination of Lebanon’s education expenditure as a percentage of GDP was undertaken, where reflects the amount of money the government spends on education, in addition to another factor, which is the percentage of government’s expenditures on education as a percentage of total expenditures, These 2 metrics are then considered particularly in comparison to France, given Lebanon’s adherence to the French Educational System. The analysis of these two metrics exposed a disparity, with Lebanon’s current education expenditure as a percentage of GDP having risen since 2019 due to the economic crisis, reaching 2% in 2022, compared to France’s 6%. Although Lebanon fares well in terms of the percentage of education expenditures compared to other sectors, with a steady increase since 2014, reaching nearly 8% in 2020 in contrast to France’s 10%, the gap in GDP percentage remains concerning.
In conclusion, addressing this issue requires recommending an augmented budget for Lebanon’s educational sector. Ideally, a tripling of the budget over the next decade is proposed. This increase could be implemented gradually, but decisive action must be taken to ensure progress towards the SDG of providing quality and inclusive education for all Lebanese students.
