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Major inequalities in health exist within Pakistan and between Pakistan and the United States

Pakistan, one of the world's poorest countries, bears a double burden. The nutritional deficiencies and infectious diseases that dominated mortality in the past have not yet been conquered, while the chronic diseases associated with development have increased to become leading causes of death. A new study by Peter J. Gergen, M.D., M.P.H., of the Agency for Healthcare Research and Quality, and colleagues shows that there are major inequalities in health both within Pakistan and between Pakistan and the United States.

Pakistani children suffer from a high rate of undernutrition as well as diarrhea. Nutritional problems among Pakistani adults are related to economic status. For instance, the prevalence of anemia ranges from 12 percent among urban young men of high economic status to 28 percent among rural young men of low economic status.

The gap between Pakistan and the United States is dramatic, and can be seen in patterns of diseases, risk factors, and quality of health care. While Pakistanis have a higher rate of undernutrition than Americans, they have a lower rate of high cholesterol and about an equal rate of high blood pressure. Anemia is more than 10 times as prevalent in Pakistani men as in U.S. men and about four times as prevalent in Pakistani women as in U.S. women. In contrast, hypertension was present only slightly more often in U.S. than Pakistani men, and hypertension occurred at the same rate in both Pakistani and U.S. women. Smoking rates for Pakistani and U.S. men were similar; smoking was rare among Pakistani women, but more than one-quarter of U.S. women smoked.

Forty-eight percent of U.S. men and 64 percent of U.S. women with hypertension were being treated compared with 7 percent and 16 percent of Pakistani men and women, respectively. Also, only 16 percent of Pakistanis who could benefit from glasses had them. These findings are based on results from the National Health Survey of Pakistan, the first comprehensive national health examination survey in a less developed country to document a country's health problems, and the Third U.S. National Health and Nutrition Examination Survey.

More details are in "Health status of the Pakistani population: A health profile and comparison with the United States," by Gregory Pappas, M.D., Ph.D., Taslim Akhtar, M.B.B.S., F.R.C.P., Dr. Gergen, and others in the January 2001 American Journal of Public Health 91(1), pp. 93-98.

Reprints (AHRQ Publication No. 01-R022) are available from the AHRQ Publications Clearinghouse.

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