The determinants of health status in Jordan, 1960-1988
This thesis aims to contribute to the debate surrounding the underlying medical, social, economic and political determinants of health status improvement. The Hashemite Kingdom of Jordan was chosen as the case study because of its exceptional performance as evidenced from various international comparative data studies. An added dimension which contributes to the benefit of studying a country like Jordan, is its status as an Arab society and a middle-income country. The processes affecting health in countries that fall in these categories have not been sufficiently assessed. The primary measure of health status used is the infant mortality rate, which had fallen to 35/1000 by 1987. A review of the theoretical literature and of previous case studies on the inter-sectoral determinants of health is presented. Economic performance, national and international politics, urbanization, housing, water and sanitation, nutrition, education, fertility and the availability of health services are examined to ascertain their relative impact on the overall health status of the Jordanian population. Particular emphasis is accorded to the way in which these factors affect Jordanian women and their roles in society and the economy. Separate sections of the study are allocated to each of the above-mentioned variables. In a separate section of the thesis, the same variables are examined for the Palestinian refugee population. The refugees comprise a significant proportion of the population and their needs are met almost entirely by UNRWA. The multi-sectoral elements which have led to the success of the Jordanian experience in health development are examined closely in the concluding chapter. These include regional and international favourable conditions, strong government commitment and a high level of awareness among the population. Policy recommendations for future health sector planning in Jordan and other Arab and middle income countries are outlined.