Geographic Disparities in Saudi Mortality: Toward a Policy Relevant Analysis

Abstract

Health disparities rank as a leading public health challenge for much of the world. While many countries have launched national efforts to address health disparities, led by the United Kingdom, such themes have received little formal attention in Saudi Arabia. Despite the growing heterogeneity of the country by region, population and other dimensions, no formal efforts to date have attempted to document health disparities and address them from a policy perspective. Specifically, there has been: a) No published quantitative evidence of health disparities within Saudi Arabia. b) No national plan or policy to address such disparities, if they were shown to exist, and c) No clear understanding of how the Saudi Arabian government would address health disparities, if asked to do so. In 2015, King Salman Bin Abdulaziz, King of Saudi Arabia and the Custodian of the Two Holy Mosques, announced his Vision 2030 (Saudi Vision 2030), which promises to address national socioeconomic gaps and to improve the country’s health indicators in line with that of other, developed countries. As part of Saudi Vision 2030, for the first time, a major national theme has been to explore, for example, health disparities by region and begin a national process for addressing them. In this context, a royal decree established a High Level Committee (HLC) consisting of 20 high-ranking officials from a broad array of ministries, including health, to address regional health disparities for the first time. In this historic context, I have implemented a Harvard TH Chan School of Public Health dissertation effort as part of the Doctoral Engagement in Leadership and Translation for Action (DELTA) project. As part of the DELTA, this project generates new translational knowledge that will hopefully prove valuable to the effort for public health change for Saudi Arabia. This dissertation presents: a) The first quantitative mortality disparities report in Saudi Arabia, which employed a direct calculation methodology (viewed by the WHO as the “gold standard”) using civil registration and vital statistics mortality data to map regional mortality. This direct calculation methodology is superior to census mortality estimation currently used by the Saudi government. This quantitative work demonstrated that significant geographical mortality disparities, including infant mortality disparities, exist across the 13 administrative regions of Saudi Arabia. b) The first effort to document the process by which high-ranking government officials in Saudi Arabia would create policy to address health disparities. This qualitative analysis involved interviewing members of the Saudi Arabian HLC noted above and documenting major themes for addressing health disparities as part of future policy efforts. The analysis included comparing these themes with those previously established by the United Kingdom. c) The first effort to set specific goals and targets to address health disparities using an adopted Regional Infant Mortality Disparities Action Framework for Saudi Arabia. The outcomes from the DELTA project provide new learning tools for implementing public health change in the field of health disparities for Saudi Arabia. The findings and recommendations should be valuable to national and international practitioners, policymakers, and scholars interested in improving the practice of addressing health disparities.