Introduction

The ongoing Lebanese economic crisis has been affecting the country for several years, with roots in political instability, high public debt, a weak banking sector, and lack of economic reforms. The crisis reached a peak in 2019, when the government was unable to secure funding to repay its debt and the value of the Lebanese pound plummeted. This led to a shortage of foreign currency, making it difficult for people to purchase basic goods and services, including healthcare.

The crisis has had a profound negative impact on the lives of the Lebanese people, particularly on their health. The shortage of foreign currency has made it difficult for the government to import medical supplies and medicines, leading to a shortage of essential medicines and a decrease in the quality of healthcare. The crisis has also caused widespread poverty, leading to malnutrition and a rise in communicable diseases. The economic crisis has exacerbated existing inequalities in the health sector, as the poor and vulnerable populations suffer the most. This has led to calls for action to address the root causes of the crisis and to find alternative solutions to remedy the health crisis in Lebanon.

Background of the study: 

There are 4.2 million people living in Lebanon, a Middle Eastern nation. Since the 1970s, Lebanon’s health system has often been hit by shocks, such as the Lebanese civil war, widespread population relocation, economic downturns, and political instability, resulting in a nation that has been without a president for two years. Furthermore, the inflow of Syrian migrants caused a 30% population increase between 2011 and 2013, which has added greater weight to the already dilapidated health facilities and infrastructure of Lebanon, thus, threatening the health service delivery continuity and exacerbating health inequality (Ammar et al. 1). Health inequality refers to disparities in access to quality health care and health outcomes among different groups within a population. Socially disadvantaged groups (such as the poor, members of racial or ethnic minorities, women, or other groups who have endured social disadvantage or discrimination) consistently face higher health risks compared to more privileged groups (Salti et al. 2). 

 Apart from the influx of Syrian refugees, another cause of health inequality in Lebanon is poverty, which affects a large proportion of the population. People living in poverty are more likely to experience poor health outcomes and have limited access to quality health care. This is due to a lack of resources to pay for health services and a shortage of facilities and health workers in the areas where poor populations live (Ammar et al. 4). 

Furthermore, the current economic crisis has only intensified these disparities in the health sector, as the shortage of foreign currency has made it difficult for the government to import medical supplies and medicines, leading to a shortage of essential medicines and a decrease in the quality of healthcare. It is therefore important to address the issue of health inequality in Lebanon in order to ensure that all members of society have access to quality health care.      

Research Questions: 

Below are some of the pertinent questions that this research seeks to find suitable answers to 

1. Is there a link between Lebanon’s prolonged economic crisis and the country’s current health situation?
2. Are residents, particularly refugees, able to afford basic healthcare services in light of the economic crisis?
3. What is the role of voluntary civic engagement in promoting health equity amongst the vulnerable Lebanese citizens including refugees?

Research Objectives: 

The research objective of this study is to examine the impact of the Lebanese economic crisis on health inequality in the country, and to explore the potential for civic engagement to address this issue.

The research aims to achieve the following specific objectives:

1. To understand the relationship between the economic crisis and health inequality in Lebanon, and to identify the ways in which the crisis has impacted access to quality health care and health outcomes for marginalized and vulnerable individuals.
2. To examine the role of civic engagement in addressing health inequality in Lebanon, and to identify the potential of civic action to mitigate the impact of the crisis on health outcomes.

Through this research, it is hoped that a better understanding will be gained of the impact of the economic crisis on health inequality in Lebanon. 

Literature Review: 

Examining the relationship between economic conditions and health outcomes

The relationship between economic conditions and health outcomes has been widely studied, and research has shown that economic crises can have a significant impact on health. During economic crises, people’s income and purchasing power decrease, which in turn affects their ability to access quality health care and obtain essential medicines and medical treatments (Lindo 2015). In addition to affecting access to health care, economic crises can also impact health outcomes directly by increasing the prevalence of stress, anxiety, and depression, and by exacerbating existing health conditions. Having conducted a longitudinal survey data describing 6,190 subjects (Catalano & Dooley, 1983), they delineated in their research that an economic downturn increases the likelihood of unfavorable financial and employment outcomes, which in turn raises the likelihood of illness and injury (7). Economic hardships can also lead to unhealthy behaviors, such as smoking, drinking, and poor diets, which can have a negative impact on health.

Overview of Lebanon’s Economics crises and its impact on Health 

Since 2019, Lebanon has been dealing with a serious economic crisis that has had a significant impact on a number of economic sectors, including health. The Economic crisis has been characterized by high inflation, devaluation of the local currency, and a shortage of foreign currency, among other factors, it is evident that its effects are widespread (Shallal et al.10). This has resulted in longer waiting times and a decrease in the availability of necessary medical treatments and procedures, particularly for those who are most in need.

In addition to the shortage of essential medicines and supplies, the economic crisis has also led to a decrease in the availability of health workers, as many have left the country in search of better economic opportunities elsewhere (Shallal et al. 9). This has further strained the already overburdened health system and has made it more difficult for people to access quality health care. The economic crisis has also had a disproportionate impact on the poor and vulnerable populations in Lebanon, who are more likely to experience poor health outcomes and have limited access to quality health care (Salti et al. 9). 

Role of Voluntary Civic Engagement in Promoting Health Equity 

A possible way to shrink the widening gap in access to healthcare services that exist between the poor and the well-off is to leverage civic engagement. Civic engagement refers to the active participation of citizens in public life and decision-making processes of their communities (Youniss et al. 8). It connotes participation in activities that advance the public good (Nelson et al. 3). Moreover, it is a form of social capital that can play a crucial role in addressing health inequality by empowering communities to act on health issues and to advocate for their rights and needs. According to Rosas et al. citizen scientists who are members of the general public that participate in the scientific process in collaboration with professional scientists have been employed to promote health equity, particularly in the areas of environmental contaminant exposures, physical activity, and healthy eating (5). Further, making health a shared value is key to building a culture of health in an entire community and nation at large (Chandra et al.1). 

The majority of the research indicates a connection between rising civic involvement, as evidenced by volunteering and membership in civic organizations, and improvements in physical and mental health well-being (Nelson et al. 4).

There are several ways in which civic engagement can contribute to addressing health inequality in Lebanon, including:

1. Increasing access to quality health care: Through civic engagement, communities can advocate for their right to access quality health care and hold their elected officials accountable for ensuring that essential health services are available and accessible to all (Nelson et al. 7).
2. Promoting health equity: Civic engagement can help to raise awareness of the unequal distribution of health outcomes and the barriers faced by vulnerable populations in accessing quality health care. This can help to build momentum for change and drive the development of policies and programs to promote greater health equity  (Rosas et al. 5).
3. Strengthening community networks: Civic engagement can help to build strong and supportive networks of citizens who can work together to address health issues and to advocate for their rights and needs (Rosas et al. 6).
4. Fostering public-private partnerships: Civic engagement can encourage partnerships between government, the private sector, and civil society to address health inequality and to promote greater access to quality health care for all (Chandra et al. 7).

Overall, civic engagement can serve as an important means of addressing health inequality in Lebanon, by empowering communities to take action on health issues and to advocate for their rights and needs.

Conclusion: 

In conclusion, the economic crisis in Lebanon has had a profound impact on the country’s healthcare system, leading to increased poverty, unemployment, and reduced access to essential healthcare services. This has resulted in a rise in non-communicable diseases due to stress and poor living conditions and has heightened the need for action to address health inequalities and promote health justice.

However, despite these challenges, there are also examples of successful community-led initiatives aimed at improving access to healthcare in Lebanon, and the power of civic engagement in promoting health justice should not be underestimated.

 Through the efforts of community organizations, health education campaigns, outreach programs, volunteer programs, and health insurance schemes, communities are working to increase access to essential healthcare services and improve health outcomes.

Moreover, advocacy and lobbying play a crucial role in shaping health policies that address inequality. By raising awareness, influencing policy making, holding policy makers accountable, mobilizing resources, and building collaborative relationships, advocacy organizations are working to create a more equitable and accessible healthcare system.

References 

Ammar, Walid, et al. “Health System Resilience: Lebanon and the Syrian Refugee Crisis.” Journal of Global Health, vol. 6, no. 2, 2016, https://doi.org/10.7189/jogh.06.020704.

Catalano, Ralph, and David Dooley. The Health Effects of Economic Instability: A Test of the Economic Stress Hypothesis. 1983, pp. 225–62, https://doi.org/10.1007/978-3-662-07891-4_8.

Chandra, Anita, et al. “Drivers Of Health As A Shared Value: Mindset, Expectations, Sense Of Community, And Civic Engagement.” Health Affairs, vol. 35, no. 11, Nov. 2016, pp. 1959–63, https://doi.org/10.1377/hlthaff.2016.0603.

Das, Manjulika. “Lebanon Faces Critical Shortage of Drugs.” The Lancet Oncology, vol. 22, no. 8, Aug. 2021, p. 1063, https://doi.org/10.1016/S1470-2045(21)00396-X.

Lindo, Jason M. “Aggregation and the Estimated Effects of Economic Conditions on Health.” Journal of Health Economics, vol. 40, Mar. 2015, pp. 83–96, https://doi.org/10.1016/j.jhealeco.2014.11.009.

Nelson et al. Examining Civic Engagement Links to Health . RAND Corporation , 2019.

Rosas, Lisa G., et al. “The Role of Citizen Science in Promoting Health Equity.” Annual Review of Public Health, vol. 43, no. 1, Apr. 2022, pp. 215–34, https://doi.org/10.1146/annurev-publhealth-090419-102856.

Salti, Nisreen, et al. “Health Equity in Lebanon: A Microeconomic Analysis.” International Journal for Equity in Health, vol. 9, 2010, http://www.equityhealthj.com/content/9/1/11.

—. “Health Equity in Lebanon: A Microeconomic Analysis.” International Journal for Equity in Health, vol. 9, 2010, http://www.equityhealthj.com/content/9/1/11.

Shallal, Anita, et al. “Lebanon Is Losing Its Front Line.” Journal of Global Health, vol. 11, Mar. 2021, p. 03052, https://doi.org/10.7189/jogh.11.03052.

Youniss, James, et al. “Youth Civic Engagement in the Twenty-First Century.” Journal of Research on Adolescence, vol. 12, no. 1, Mar. 2002, pp. 121–48, https://doi.org/10.1111/1532-7795.00027.