EAPC Country of the Month - Lebanon

Report prepared by Georges A. Saade with the assistance and advice from:

• Dr.Jade Khalife, Researcher, Ministry of Public Health

• Dr. Nicola Moussallem, President of the Lebanese Society of Cardiology, Professor of Internal Medicine, Cardiologist at CHUN.D De Secours.

• Claude Maroun, PT, MPH, Director of Physical Therapy Department American University of Beirut

National CVD Prevention Coordinator for Lebanon:

Georges A. Saade
Associate Professor, MD, FESC, FACC
Consultant cardiologist
Lebanese University, Bellevue Medical Center

Contact: email

Health care | Risk factors | Prevention methods | Prevention activities | Cardiac Rehab. | Future

Documents to download

• Full report
• CV and Publications G.A.Saade

Baseline information about Lebanon

The Republic of Lebanon is a parliamentary democracy and a middle-income country with a population of 4.6 million inhabiting a land of 10,452 km2. Due to the conflict in neighbouring Syria, an additional 1.2 million refugees have entered Lebanon since 2011. Almost two-thirds of the population is between ages 15-64 years. It has one of the highest proportions of elderly in Middle East North African region.

Reforms over the past two decades have helped rebuild and develop much of the country; however challenges remain due to the political instability. Nevertheless numerous advances have been made, including in improved health services and key indicators such as life expectancy and maternal and child mortality.

Health care

The healthcare sector in Lebanon is a mix of public and private stakeholders. The total health expenditure has decreased in recent years and is currently at 7.3% of gross domestic product (GDP), or $2.8 billion. Out-of-pocket expenditure as a percentage of private expenditure on health is 43%, also having decreased considerably due to reforms undertaken over the past decade.

In terms of hospitalisation the Ministry of Public Health (MoPH) covers about 53% of the population, followed by the National Social Security Fund (NSSF) with 23%. The MoPH operates a network of 182 Primary Healthcare Centres (PHCs) which are nation-wide, providing mainly maternal and child health, vaccination and essential medications coverage.

PHCs vary in quality of services and a new initiative is being undertaken to expand the services provided, in particular related to preventing non-communicable diseases.

Risk factors

Non-communicable diseases (NCDs) are estimated to account for 85% of total deaths in Lebanon, with cardiovascular diseases accounting for 47% of deaths alone, followed by cancers (22%), chronic respiratory diseases (4%), diabetes (4%) and other NCDs.

Of the total mortality, ischemic heart disease accounts for about 24% deaths, cerebrovascular disease 9%, hypertensive heart disease 5% and inflammatory heart disease 2%.

Major risk factors in Lebanon include:

• cigarette and waterpipe smoking
• increasing trends for obesity and diabetes
• low physical activity
• relatively high prevalence of hypertension

Main actors & prevention methods

These include:

• the Ministry of Public Health
• municipalities
• the Lebanese Order of Physicians
• Lebanese Society of Cardiology (LSC)
• Lebanese Order of Nurses
• Syndicate of Private Hospitals
• non-governmental organisations (NGOs)
• WHO country office
• public health professionals at various institutions

Prevention activities

Since 2003 the LSC in collaboration with the MoPH has run the Lebanese Interventional Coronary angiographies and angioplasties Registry (LICOR). The 2011 tobacco control law banned all smoking in indoor public places (100% smoke free), all tobacco advertising, promotion and sponsorship, and increased the tobacco products warning label to 40% for both sides.

Other recent initiatives also include the Lebanese Action on Sodium and Health, which aims to reduce salt consumption in Lebanon, as well as national activities and campaigns on the World Health Day, Heart Failure campaign, Anti-Drugs campaign, the Beirut Marathon and the Walk-for-Diabetes.

Cardiac Rehabilitation

There is currently no national strategy regarding cardiac rehabilitation, and initiatives vary among various healthcare institutions. The Physical Therapy Department at the American University of Beirut Medical Centre is the only centre in Lebanon providing cardiac rehabilitation for adult patients. The program started in January 2014 and is divided into two parts:

1. Primary prevention addressing patients whose medical condition constitutes a risk factor for the development of cardiac problems i.e. diabetes mellitus, hypercholesterolemia;

2. Secondary prevention provided in four phases, addresses patients who have had a cardiac incident and starts in October 2014.

A major limitation is that patients pay out of pocket for these services.

Aims for the future

Increased collaboration among stakeholders within a national strategy is essential. The training of public health and medical professionals in cost-effective prevention strategies is also an essential factor to ensure success. Cardiac rehabilitation services need to be extended throughout the country.

Utilisation of low cost and effective approaches tailored for the local population may be the most appropriate response to the challenges being faced by health advocates in Lebanon today.