Human health in the region is variable, reflecting the economies of the different countries. The proportion of a population living in absolute poverty is considered to be an indication of human health. Nearly half of the developing world's poor-and nearly half of those in extreme poverty-live in south Asia; the next-largest numbers are (in order) in sub-Saharan Africa, the Middle East, and north Africa (IPCC 1996, WG II, Section 18.104.22.168). Estimates of rural poverty are available for nine countries of this region; they range from 6% (Oman) to 60% (Afghanistan). Access to safe drinking water in urban areas varies from 39% in Afghanistan to almost 100% in 13 countries in the region; in rural areas, the equivalent figures are 5% in Afghanistan to almost 100% in several countries (WRI, 1996). Because a high percentage of the population lives in urban areas, a high proportion of the population has access to safe drinking water, which diminishes the risk of waterborne infectious diseases.
Infant mortality rates and the prevalence of infectious diseases also are considered to be indicators of human health (WRI, 1996). Figures for infant mortality for 1970-75 varied between 23 deaths per 1,000 live births (Israel) to 194 deaths per 1,000 live births (Afghanistan), with a mean of 94 (the world average was 93). The equivalent figures for 1990-1995 varied from 9 to 163 (for the same countries), with a mean of 50 (the world average is 64). These statistics suggest that the health of the population has improved since the 1970s, in part as a result of better primary health care (Bener et al., 1993). During 1990-95, life expectancy varied between 43.5 years (Afghanistan) and 76.5 years (Israel), with a mean of 66.6 (compared with the world average of 52.8).
Generally, the health of the population in the region has been improving faster than the world average-with a few exceptions related to civil unrest (e.g., Afghanistan). Given the natural wealth, in terms of petroleum deposits, of many countries in the region, this trend should continue in the near future. However, political tensions remain high in parts of the region, and much of the region is subject to major earthquakes; both of these factors could cause major setbacks in public health.
The population of the region is increasing by an average of 2.7% annually; as the population increases, air pollution, waste management, and sanitation will become important issues. Given global trends, there may be an increase in motor vehicle ownership, which is likely to add to the problem of air pollution. Photochemical smog produced by the reaction of sunlight with ozone and photochemical oxidants-such as peroxyacetal nitrate (PAN) from nitrogen oxides (NOx) and hydrocarbon emissions-is particularly prevalent in cities in semi-arid regions with a high density of industrial pollution-producing industries (IPCC 1996, WG II, Section 12.3.3). This smog may lead to respiratory problems in the urban populations.
Climate change will have direct impacts (e.g., through heat stress) as well as indirect effects (e.g., through reductions in food, leading to poor nutrition and increased susceptibility to diseases) on human health. The overall impact of climate change on human societies will vary, depending on many factors-such as the amount of low-lying or arid land they occupy and their degree of dependence on agriculture or aquatic resources (IPCC 1996, WG III, Section 2.2.3).
Climate change is projected to increase the frequency of very hot days. Extensive research has shown that heat waves cause excess deaths (Larsen, 1990; McMichael et al., 1996). Recent analyses of concurrent meteorological and mortality data in cities in the Middle East provide evidence that overall death rates rise during heat waves, particularly when the temperature rises above the local population's threshold value. Therefore, it can be predicted that climate change would cause additional heat-related deaths and illnesses in the region via increased exposure to heat waves (IPCC 1996, WG II, Section 18.2.1).
In some areas-especially where access to safe drinking water is poor-waterborne gastrointestinal diseases related to fecal contamination (e.g., Giardiasis, diarrhea) are a problem. Such diseases often lead to high infant mortality in Saudi Arabia (Jarallah et al., 1993; Altukhi et al., 1996); Afghanistan, Jordan, and Pakistan (Azim and Rahaman, 1993; Nazer et al., 1993; Chavasse et al., 1996); and Turkey. Waterborne diseases also occur in tourist resorts (Kocasoy, 1995) in Israel (Lowenthal, 1993), Tajikistan (World Bank, 1995b), and Turkmenistan (World Bank, 1995c). Some countries of the region have made efforts to control these diseases through various programs-some implemented in the early 1970s. If flooding occurs as a result of more intense rainfall events, waterborne diseases may become frequent, mostly because of the overloading of sewage systems (McMichael, 1997).
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