Oil prices, climate change--health challenges in Saudi Arabia.

In December, 2015, Saudi Arabia reported a US$98 billion budget deficit (about 15% of gross domestic product [GDP]) in 2015 with no improvement projected for 2016. Saudi Arabia has been resilient during oil price fluctuations in the past, so the new government budget came as a surprise. The new spending plan reflects several measures to curb subsidies, raise revenue, and improve healthy lifestyles. Health and social affairs consume about a fifth ($45 billion, 5% of GDP) of Saudi Arabian Government spending. There are not many relevant examples of the health effects of recession and structural adjustments for countries with a similar development trajectory of Saudi Arabia. Economic growth in Saudi Arabia (19th highest GDP worldwide) contrasts with its position on the Human Development Index (39th in the world); this gap indicates substantial development challenges. Further, the economic changes are occurring amid other challenges unique to the region. First, along with the rising oil revenues in recent decades, Saudi Arabia has seen a rapid epidemiological transition in the population (table). The uptake of some health-promoting behaviours has been limited by Saudia Arabia’s unemployment rate (11·7% in 2014), moderate levels of education, and climatic and sociocultural conditions. The high burden of undiagnosed and uncontrolled diabetes and hypertension, will consume a large proportion of the health budget. Second, future temperature in the region is projected to increase consistently and exceed the threshold deemed unsuitable for human adaptability. This changing climate will have an effect on the promotion of some healthy lifestyle habits, the country’s production of fresh fruits and vegetables, and micronutrient deficiencies. For example, vitamin D deficiency from inadequate exposure to sun and limited intake of enriched products is common in Saudi Arabia. Finally, there is a need for sustained investment in the control of emerging infectious diseases in the region. Such control efforts are important given the risk of emerging diseases within Saudi Arabia, such as Middle East respiratory syndrome, and as a result of disease importation through the large expatriate workforce and the 2–3 million pilgrims for Hajj and 5–6 million pilgrims for Umrah who come to Saudi Arabia each year from more than 180 countries. Although economic recession is often feared as a “health tragedy”, evidence from high-income countries is mixed and related to variations in social and political contexts. In high-income countries, some health indices showed counter-cyclical effects with economic contractions (eg, increases in suicides, depression, and anxiety disorders and worsening reproductive health outcomes). However, mortality is shown to be pro-cyclical and it decreases during rapid economic contractions. In high-income countries, there are generally slower declines in mortality during periods of economic growth and greater declines in mortality during recessions. In low-income countries, economic growth seems to improve health through improvements in basic services, until a country reaches $5000–10 000 GDP per person. Declines in mortality in high-income countries during recession could be related to decline in excess mortality from modifiable causes of death, such as those arising from alcohol abuse and motor vehicle accidents. Given that Saudi Arabia has one of the highest rates of traffic-related deaths globally, the country might benefit from the austerity measures in this regard. If Saudi Arabia maintains increased relief spending on child health, improvements in access to nutrition and health, and strong infectious diseases control then these approaches can also help reduce mortality. Since Saudi Arabia’s sociodemographic and geopolitical foundation is different from that of the case studies available thus far, it is difficult to predict potential health effects of the present economic recession and newly