The People’s Democratic Republic of Algeria is located in the Maghreb region of North Africa; by total land area, Algeria is the largest country in Africa. It is bordered by Tunisia, Libya, Niger, Mali, Mauritania, Western Sahara, Morocco, and the Mediterranean Sea. As much as 90 percent of Algeria’s total area is covered by the Sahara Desert, leaving the population of 43.6 million to reside predominantly in the more fertile and habitable north. The capital, Algiers, is also located in the north, close to the Mediterranean coast. The population is 99 percent Arab-Berber in ethnic makeup and speaks mostly Arabic, French, Berber, or Tamazight, and several other dialects. Ninety-nine percent of the population identifies as Muslim.
Algeria is considered a regional power in North Africa, having the highest human development index of all continental (non-island) countries in Africa. It also has one of the largest economies on the African continent, based mostly on the export of energy resources. Algeria supplies large quantities of natural gas to Europe, in addition to petroleum. These commodities make up one-third of Algeria’s gross domestic product. As such, the country quickly industrialized after gaining independence from France in 1962. As a result of its rapid industrialization and growth, Algeria cleared all of its debt and invested heavily in infrastructure and social policies
As the country developed over time, its health indicators improved as well. Life expectancy has increased to about 77 years. As the population lives to older ages, non-communicable diseases contribute most to death in Algeria. These include ischemic heart disease, stroke, hypertensive heart disease, chronic kidney disease, congenital defects, diabetes, and COPD. Notably, death due to diabetes and Alzheimer’s disease increased by over 60 percent between 2009 and 2019. Other leading causes of death include road injuries, neonatal disorders, and lower respiratory infections. The risk factors driving these leading causes of death include high blood pressure, high body-mass index, high fasting plasma glucose, malnutrition, dietary risks, tobacco use, air pollution, high LDL, kidney dysfunction, and occupational risks.
The Republic of Moldova is a landlocked country in Eastern Europe. With Chisinau as its largest city and capital, the country is bordered by Romania to the west, and Ukraine to the north, east, and south. Predominantly influenced by the Eastern Orthodox Catholic Church, the Republic of Moldova has a proportionately older population of 3.3 million people, comprising ethnic groups such as Moldovan/Romanian, Ukrainian, Russian, Gagauz, and Bulgarian. The official language is Moldovan/Romanian, which also serves as the native language of about 82 percent of the population. Available natural resources include lignite, phosphorite, gypsum, limestone, and arable land.
Formerly part of Romania, Moldova was incorporated into the Soviet Union at the close of World War II. Moldova gained independence from the Soviet Union in 1991 and has been working toward successfully integrating into the European Union. Although economic reforms have been slow, largely due to corruption and strong political forces, there has been some market-oriented progress. The country’s economy is dependent on agriculture, specifically fruits, vegetables, and tobacco, making it one of the poorest countries in Europe with a small lower-middle-income economy. But Moldova has made significant progress in reducing poverty and promoting inclusive growth, as well as expanding the economy on average by 4.6 percent yearly for the past two decades.
Since independence, Moldova has recorded a steady increase in the rates of both communicable and non-communicable diseases. Life expectancy hovers around 72 years, and the leading causes of death are ischemic heart disease, stroke, cirrhosis, hypertensive heart disease, Alzheimer’s disease, lung cancer, colorectal cancer, COPD, lower respiratory infections, and self-harm. Heavy tobacco and alcohol use accounted for a total of 60 percent and 16 percent of male and female deaths respectively in 2010. Mortality due to non-communicable diseases has increased between 2009 and 2019, most notably hypertensive heart disease, which increased by over 95 percent.
Solomon Islands is a sovereign state in the Melanesia subregion of Oceania in the Western Pacific Ocean. It comprises six major islands and over 900 smaller islands largely located to the east of Papua New Guinea. Honiara, the capital, is situated on Guadalcanal, the largest island, and its bustling central market showcases the islands’ produce and traditional handicrafts. The other principal urban centers include Gizo, Auki, and Kirakira. The population is young: 53 percent of Solomon Islands’ 690,598 people are under 24. There are over 80 spoken local languages and dialects in Solomon Islands, with English designated as the official language and Melanesian pidgin as the lingua franca. Solomon Islanders are predominantly Christians of various denominations, with about 5 percent of the population maintaining traditional beliefs.
Solomon Islands gained self-government in 1976, and two years later attained independence. Having endured a five-year ethnic conflict on Guadalcanal, spanning 1999 to 2003, coupled with frequent natural disasters such as cyclones and earthquakes, the country has faced serious economic, political, and environmental challenges. While efforts are being made to improve economic conditions, the situation remains unstable. Over 75 percent of Solomon Islanders work in agriculture and engage in subsistence farming and fishing. The nation, however, is rich in underdeveloped mineral resources such as lead, zinc, nickel, and gold.
There are only two fully trained doctors for every 10,000 people in Solomon Islands, and a lack of other properly trained healthcare workers, including nurses. Non-communicable diseases account for 60 percent of total deaths, while communicable diseases are responsible for about 35 percent of deaths. The most common diseases that contribute most substantially to mortality are ischemic heart disease, stroke, lower respiratory infections, diabetes, diarrheal diseases, COPD, road injuries, breast cancer, self-harm, cirrhosis, neonatal disorders, and malaria.
The Kingdom of Bhutan, in the Himalayas of south-central Asia, is well known for its unique development philosophy. It measures Gross National Happiness (GNH), in which the progress of the country is guided by the well-being and happiness of its population. Bordered by China and India, Bhutan is also close to Nepal and Bangladesh. It holds a strategic location in the region, controlling several major mountain passes into the Himalayas. Ethnically, the population of 857,423 is 50 percent Ngalop; other groups include Nepali and Lhotshampas. Languages spoken include Dzongkha (the official language), Sharchokpa, and Lhotshamkha, as well as other foreign languages. The Bhutanese are predominantly Lamaistic Buddhist; there are also Indian and Nepali-influenced Hindus. As much as 43 percent of the population lives in urban areas, including about 200,000 in the capital of Thimphu.
Bhutan was historically a remote kingdom, isolated from the world by the vast mountains in which it is located. However, in the second half of the 20th century, the country became more connected to the global community. In the 1990s, Bhutan moved away from its status as an absolute monarchy, and in 2008 the country became a multiparty parliamentary democracy. Bhutan has since enjoyed economic stability and development, due in large part to its significant water resources and hydropower revenues. Overall, the country has made significant progress, reducing poverty from 36 percent of the population to 12 percent between 2007 and 2017. Bhutan’s GDP has increased about 7.5 percent annually since the early 1980s, making it one of the fastest-growing economies in the world.
In addition to boosting economic development, Bhutan has improved many of its healthcare indicators. Average life expectancy increased from 60 years in 1990 to 72 years in 2019. Nonetheless, non-communicable diseases have increased over time as leading causes of death. These include ischemic heart disease, COPD, stroke, cirrhosis, diabetes, and chronic kidney disease. Communicable diseases also contribute to deaths in Bhutan, including lower respiratory infections, neonatal disorders, diarrheal diseases, and tuberculosis. The risk factors that contribute most to deaths and disabilities include malnutrition, air pollution, high blood pressure, dietary risks, high fasting plasma glucose, high body-mass index, tobacco use, occupational risks, high LDL levels, kidney dysfunction, and lack of sanitation and clean water.
The Republic of Rwanda is a landlocked country just south of the equator in East-Central Africa. While small geographically, the country is home to 12.9 million people, making it one of Africa’s most densely populated countries. Rwanda has been highly influenced by Christianity. Its three official languages are Kinyarwanda, English, and French. Rwanda, also called “the land of a thousand hills,” is widely known for its nature and wildlife, especially the protected gorillas of Volcanoes National Park.
Rwanda’s history has been marked by tension between the Hutu and Tutsi ethnic groups and the brutal genocide of the 1990s. Since the end of the genocide, Rwanda has undergone a period of reconstruction and worked to turn a new chapter, having greatly improved its political stability and economic conditions. This primarily agricultural country has significantly reduced its poverty rate from 77 percent to 55 percent between 2001 and 2017. Rwanda has also made improvements in its social policies, such as near-universal primary school enrollment. At its current rate, the country strives to reach middle-income status by 2035 and high-income status by 2050.
For both males and females, life expectancy has steadily increased. Similarly, child mortality rates have declined by over two-thirds. While some health indicators have improved, the population experiences high levels of death caused by lower respiratory infections, neonatal disorders, tuberculosis, diarrheal diseases, malaria, and HIV/AIDS. Nearly 100 percent of the country is at risk of contracting malaria. Death due to non-communicable diseases is also significant, with congenital defects, stroke, ischemic heart disease, and cirrhosis causing substantial mortality. Rates of cirrhosis, which may be caused by excessive alcohol consumption, are significantly higher than those of other countries in the region. Road injuries also cause significant numbers of deaths in Rwanda.
The Arab Republic of Egypt officially spans two continents: the northeast corner of Africa and the southwest corner of Asia, bordered by the Gaza Strip (Palestine), Israel, the Gulf of Aqaba, the Red Sea, Sudan, and Libya. Several other countries are located in close proximity to Egypt on the other side of the Gulf of Aqaba. Its population of 106.4 million is ethnically homogenous, identifies as overwhelmingly Egyptian, and speaks mostly Arabic, the country’s official language. In some instances, English and French are spoken as well. As much as 90 percent of the population is Sunni Muslim. Much of the population lives within 20 kilometers of the Nile River and the Nile River Delta, leaving large swaths of the country completely uninhabited. About 43 percent of the population live in cities, with 21 million people living in Cairo, the capital. Egypt is unique in that it has one of the longest documented histories of any country, going as far back as the 6th millennium BC.
The history of modern-day Egypt is commonly noted as beginning in 1922, when it gained independence from the British Empire. Since then, Egypt has experienced decades of social and religious upheaval and political unrest, in addition to a social revolution in 2011. As a result, local terrorism continues to be a problem, and economic underdevelopment is pervasive. Rapid population growth of 46 percent between 1994 and 2014 has put considerable stress on the country, affecting jobs, housing, education, sanitation, and healthcare. Unemployment of youth ages 15–24 is particularly high, with males experiencing unemployment rates of 25 percent and women 38 percent.
Since the 1990s, the Egyptian Ministry of Health has increased its expenditure on public health programs, and as a result the number of government health centers, beds in hospitals, doctors, and dentists has increased. In addition to the public health system, there is also a system of Islamic healthcare centers and private clinics, which together have been able to serve most of the population. Most deaths in Egypt are caused by ischemic heart disease, cirrhosis, stroke, road injuries, chronic kidney disease, hypertensive heart disease, lower respiratory infection, diabetes, COPD, and liver cancer. Notably, non-communicable diseases such as diabetes, ischemic heart disease, and cirrhosis have all increased between 2009 and 2019. In addition, while diarrheal diseases and neonatal disorders have decreased substantially over the same period, they are still considered to be the top causes of death in Egypt. About 32 percent of the population is considered obese, and infectious diseases such as hepatitis A, typhoid fever, and schistosomiasis are prevalent.
Myanmar (also known as Burma) is located between Bangladesh and Thailand, and bordered by the Andaman Sea and the Bay of Bengal. With an asymmetrically adult population, Myanmar has about 57.1 million people. Myanmar is the largest country by area in Mainland Southeast Asia. The more than 135 officially recognized and distinct ethnic groups are broadly categorized into eight major national groups: Bamar, Chin, Kachin, Kayin, Kayah, Mon, Arakanese, and Shan. Though there are more than 100 languages spoken in Myanmar, two-thirds of the nation’s population speak Burmese, the official language. With bustling markets, and numerous parks and lakes, Yangon is the country’s largest city, while Naypyidaw, called “the abode of kings,” is the capital. The main religions include Buddhism, Christianity, Islam, and Hinduism.
Following Japanese occupation, Myanmar was reconquered by the Allies and granted independence in 1948. The country became a military dictatorship under the Burma Socialist Programme Party in 1962 after a coup d’etat. Since independence, civil wars have become a feature of the country’s sociopolitical landscape. Contributing to its vulnerability, Myanmar is prone to persistent and highly destructive natural disasters such as earthquakes, cyclones, flooding, and landslides. With a nominal per capita income of $1,400, unemployment nearing 37 percent, and 26 percent of people living in poverty, Myanmar is one of the poorest countries in Southeast Asia.
The life expectancy of the Burmese people is 67 years, the lowest in Southeast Asia. Despite a steady increase in health expenditures by the government in recent years, the health system is still weak due to decades of neglect. Non-communicable diseases increasingly contribute to the most deaths in the country, including stroke COPD, ischemic heart disease, diabetes, chronic kidney disease, cirrhosis, and asthma. Other ailments such as lower respiratory infections, neonatal disorders, and diarrheal diseases continue to cause significant numbers of deaths. While incidence of death due to HIV/AIDS and tuberculosis has decreased over time, they still continue to pose a major threat to the country’s healthcare system, as well as being a significant cause of death.
The Republic of Tunisia, in North Africa, is bordered by Algeria, Libya, and the Mediterranean Sea. Geographically diverse, Tunisia is home to part of the Atlas Mountain range as well as the Sahara Desert. The city of Cape Angela is located on the coast and is the northernmost point on the African continent, while Tunis is its largest city and also the capital. The population of 11.8 million people is predominantly ethnically Arab and identifies as Sunni Muslim. Arabic is the official language, while French and Berber are also spoken widely throughout the country. As much as 70 percent of the population lives in urban areas, specifically in the northern half of the country. The southern half remains sparsely populated.
Tunisia was a French colony from 1881 until it declared independence in 1957. In 2011, the Tunisian Revolution took place in reaction to the lack of freedom and democracy under the prolonged rule of President Zine El Abidine Ben Ali—an event that ignited the Arab Spring across the region. Despite this political turmoil, Tunisia is one of the few countries in Africa ranking high on the human development index, and has one of the highest GDPs per capita on the African continent. Education is free and mandatory for school-aged children.
Tunisia’s national health system provides nearly the entire population with access to quality medical care. Hospitals and clinics contribute to rising health indicators, such as one of the lowest infant mortality rates in Africa. Life expectancy has increased substantially as well and is projected to continue rising. While most people in Tunisia enjoy relatively good health, non-communicable diseases cause the majority of deaths in the country. Leading causes of death include ischemic heart disease, stroke, hypertensive heart disease, chronic kidney disease, Alzheimer’s disease, lung cancer, road injuries, lower respiratory infections, COPD, diabetes, and neonatal disorders. The risk factors that contribute most to deaths and disabilities include high blood pressure, high body-mass index, high fasting plasma glucose, tobacco use, dietary risks, high LDL, air pollution, kidney dysfunction, malnutrition, non-optimal temperature, and occupational risks.
The Republic of The Gambia is a small West African country surrounded by Senegal on all sides except along its short coast. Referred to as the “smiling coast of Africa,” The Gambia’s long and winding shape was determined by British and French territory divisions established in the 19th century and follows the outline of the Gambia River. The majority of its more than 2.2 million person population is Muslim. It is one of the most densely populated countries in Africa, with about 57 percent of The Gambia’s population concentrated in urban and peri-urban centers. The most commonly spoken language is English, in addition to several local languages representative of a variety of Gambian ethnic groups.
Since the country’s independence from Britain in 1965, The Gambia has remained politically stable. Stability has not directly translated into prosperity, as nearly half of the population lives in poverty and almost 10 percent faces food insecurity. Two-thirds of the population earns their livelihood from the agricultural sector, but the overall output of the sector is low relative to the amount of arable land.
The poor socioeconomic situation in The Gambia is reflected in the health indicators of the escountry as well. Poverty in addition to a deteriorating infrastructure, a shortage of healthcare personnel, and an inadequate referral system contribute to a population in poor health. The top causes of death include lower respiratory infections, neonatal disorders, HIV/AIDS, tuberculosis, malaria, diarrheal diseases, maternal disorders, and increasingly, non-communicable diseases such as ischemic heart disease, stroke, liver cancer, and cirrhosis. Despite a precarious health situation in the country, some progress has been made: Life expectancy has continued to improve over the past few decades, as well as the under-five mortality rate, which is now nearly half of what it was in 1990.
The Federal Democratic Republic of Nepal is a landlocked Asian country flanked by China and India. Located in the Himalayas, Nepal is best known for its mountainous terrain, which includes the tallest peak in the world, Mount Everest. The predominantly Hindu nation is home to 30.4 million people, most of whom live in the southern plains region or the hilly central region. Nepal has an incredibly diverse population of 125 different ethnic and caste groups speaking 123 different languages.
For the past several decades, Nepal has experienced periods of turmoil and change, including a Maoist insurgency and the abolition of its monarchy. The creation of a multiparty parliamentary system has resulted in greater political stability as well as opportunities to improve infrastructure and economic conditions. While the poverty rate has largely improved, dropping from 15 percent to 8 percent between 2010 and 2019, around 31 percent of people face significant risk of falling into extreme poverty, and substantial inequities persist in regard to urban-rural areas, gender, and caste.
Free basic health services are available to all citizens, which may have contributed to improving health indicators. The country’s life expectancy has increased from 60 years to 71 years since the 1990s. Additionally, Nepal has made significant progress in reducing HIV and TB and is on track to be malaria-free by 2025. Non-communicable diseases increasingly contribute to the most deaths in the country, including COPD, ischemic heart disease, stroke, cirrhosis, asthma, and chronic kidney disease. Ailments such as lower respiratory infections, neonatal disorders, tuberculosis, and diarrheal diseases continue to cause significant deaths, but have decreased over time. Epidemics still occur frequently, leading to high rates of both morbidity and mortality. It should be noted that mental health challenges and depressive disorders also contribute greatly to disability in Nepal, with self-harm being a top cause of death.
One of Africa’s most stable and democratic countries, the Democratic Republic of Sao Tome and Principe is located in the Gulf of Guinea, off the western equatorial coast of Central Africa. The people of this island country are predominantly Christian with a Catholic majority. The population is young, with 61 percent of Sao Tome and Principe’s 213,948 people under the age of 25. About 98 percent of residents of Sao Tome and Principe speak Portuguese, the official and de facto national language. With a population comprising descendants of immigrant Europeans and African slaves, Sao Tome and Principe has Mesticos, Angolares, Forros, Servicias, Tongas, Europeans, and Asians as its major ethnic groups.
Sao Tome and Principe gained independence in 1975. The country has a relatively small economy and is dependent on the export of cocoa beans, which in recent times has substantially declined due to drought and mismanagement. The country is import-dependent, with real GDP growth of 3.9 percent, dropping from 4.2 percent in 2016. Per capita GDP is $2,157. The country has considerable potential for developing tourism and petroleum resources, but these are yet to be explored. Close to 66 percent of the Sao Tomean population live below the poverty line. Despite this fact, 97 percent of the population has access to clean drinking water.
The population of Sao Tome and Principe face many challenges as a result of high poverty rates, including challenges in health. Non-communicable and communicable diseases such as ischemic heart disease, lower respiratory infections, stroke, chronic kidney disease, cirrhosis, COPD, neonatal disorders, asthma, road injuries, tuberculosis, malaria, and diarrheal diseases are the cause of most deaths in Sao Tome and Principe. While some communicable diseases have decreased on average, particularly malaria and diarrheal diseases, they continue to be significant contributors to deaths in the country.
\nThe Ivory Coast is located on the south coast of West Africa, bordered by Guinea, Liberia, Mali, Burkina Faso, Ghana, and the Gulf of Guinea. The Ivory Coast has a growing population of 28.1 million people, the majority of which live on the southern coast, in cities along the Atlantic Ocean. Much of the country’s northern areas remain more sparsely populated. The population comprises several ethnic groups, including Akan, Voltaique/Gur, Northern Mande, Kru, Southern Mande, and some groups that are non-Ivorian. The population is equally religiously diverse: the majority are Muslim, followed by Catholic, Evangelical, Methodist, Christian, and animist. French is the official language and is most commonly spoken; there are also 60-plus native dialects. Music is an important part of the culture in the Ivory Coast, and various instruments and songs are used to share historical stories.
After the Ivory Coast gained independence from France in 1960, its economy grew due to its cocoa and coffee industries. However, during the 1980s, the economy declined, followed by political unrest, civil war, and the internal displacement of large portions of the population. Recently, the country has experienced rapid economic growth, with a robust agricultural sector based primarily on the production and export of cocoa beans, coffee, and palm oil. About two-thirds of the population is involved in agriculture or activities related to agriculture. Despite the growing economy, approximately 46 percent of the population lives below the poverty line, and the country has one of the highest gender inequality rates in the world.
A 2002 civil war disrupted the delivery of healthcare services to the population, and caused many healthcare practitioners to leave the country. In addition, with a large portion of the population living below the poverty line, health is overall poor. A pressing health challenge in the Ivory Coast is HIV/AIDS, one of the leading causes of death. Other leading causes of death include malaria, neonatal disorders, lower respiratory infections, ischemic heart disease, stroke, diarrheal diseases, tuberculosis, congenital defects, and cirrhosis. The risk factors that contribute most to deaths and disabiliies in the Ivory Coast include malnutrition, air pollution, unsafe sex, high blood pressure, high body-mass index, alcohol and tobacco use, high fasting plasma glucose, dietary risks, and insufficient water, sanitation, and hygiene.
The Republic of Nicaragua, in Central America, between the Pacific Ocean and the Caribbean Sea, is bordered by Honduras to the northwest, the Caribbean to the east, Costa Rica to the south, and the Pacific Ocean to the southwest. Known for its dramatic terrain of lakes, volcanoes, and beaches, the country has a population of a little over 6.2 million people, with 74 percent age 15 and above. Nicaragua has a multiracial population comprising Africans, indigenous Europeans, and people of Asian heritage. Spanish is the official language. Managua is the country’s largest city and capital. Nicaragua’s constitution guarantees and promotes religious freedom and tolerance. Though Christianity is the dominant religion, the country has no official religion.
The Republic of Nicaragua gained independence from Spain in 1821 and subsequently became an autonomous territory in 1860. Since independence, the country has faced the challenges of political instability, dictatorship, occupation, fiscal crises, riots such as the Nicaraguan Revolution of the 1960s and 1970s, and the Contra war of the 1980s. Nicaragua has one of the most constricted and challenged economies in the Americas. According to the United Nations Development Programme, 48 percent of the Nicaraguan population lives below the poverty line, with 79.9 percent living on less than $2 per day. With poverty and under-employment on the rise, Nicaragua remains the poorest country in Central America.
The Nicaraguan population faces many challenges as a result of pervasive poverty and lacking economic development, including challenges in health. Life expectancy in Nicaragua is 74 years. Despite some improvements in health indicators, the main contributors to death in the country are predominantly non-communicable diseases, including ischemic heart disease, chronic kidney disease, stroke, diabetes, cirrhosis, COPD, Alzheimer’s disease, hypertensive heart disease, and congenital defects. Additionally, lower respiratory infections, road injuries, and neonatal disorders are significant causes of death.
The Republic of Niger is a landlocked West African country with a population of about 23.6 million mostly living in rural areas. The country’s name stems from the presence of the Niger River that winds through the country. The Niger landscape is unique, composed predominantly of desert plains and sand dunes. The terrain is matched by a desert-like climate: hot, dry, and dusty, with extreme heat sometimes reaching 46 degrees Celsius. A predominantly Muslim country, Niger has a variety of linguistic groups, such as Hausa, a name which also refers to its largest ethnic group.
Following its independence from France in 1960, the country experienced several periods of violence and coups. To this day, access to basic rights remains a problem in Niger; slavery was banned only in 2003. About 41 percent of the population live in extreme poverty.
Despite extreme poverty, life expectancy and child mortality rates have been improving over the decades. The leading causes of death include diarrheal diseases, malaria, lower respiratory infections, neonatal disorders, measles, meningitis, tuberculosis, and invasive nontyphoidal salmonella (iNTS). Non-communicable diseases such as stroke, ischemic heart diseases, and congenital defects have also increased to contribute to a significant number of deaths over time. Malnutrition is the main risk factor for death and disability, as 46 percent of children under age five suffer from chronic malnutrition, and about 10 percent suffer from acute malnutrition. Pediatric ailments persist due to a young population, with death from neonatal disorders rising dramatically. Niger has the highest fertility rate in the world, with approximately seven children per woman.
Called the “Land of Blue Sky,” with incredible natural features such as mountains in the north and the Gobi Desert in the south, Mongolia is also famous for having more horses than people. It’s a landlocked country in East Asia, bordered by Russia to the north and China to the south. While it does not officially border Kazakhstan, it is considered a close neighbor, being only 37 kilometers away in some areas. Mongolia’s population of just 3.2 million makes it the world’s most sparsely populated country; there are only two people per square kilometer. About half the population lives in the capital city of Ulaanbaatar, while 30 percent of Mongolians remain nomadic and semi-nomadic, with horse culture playing an important role in daily life. Mongolia’s ethnic majority is Khalkh, with smaller groups including Kazak, Dorvod, Bayad, Buryat-Gouriates, and Zahkchin. Languages spoken include Mongolian (Khalkha dialect), Turkic, and Russian. About 50 percent of the population is Buddhist, in addition to Muslim, Shamanist, and Christian. Nearly 40 percent of Mongolians do not identify with a specific religion.
Mongolia has an ancient and rich history. The Mongol Empire, led by Genghis Khan, was once the largest empire in the world. Mongolia was absorbed by China but declared independence in 1921. By 1924, it had become a satellite of the Soviet Union. After anti-communist revolutions, a peaceful democratic revolution took place in 1990, and by 1992 Mongolia gained independence. Mongolia is rich in mineral deposits, such as copper, gold, coal, molybdenum, fluorspar, uranium, tin, and tungsten. The extractive industries helped switch the economy from primarily herding and agriculture, and now exports make up 40 percent of the Mongolian GDP. Education in Mongolia has greatly improved since 1921, when the country began building networks of public schools and providing free education. Since then, the networks of schools have expanded, and children are expected to attend school for at least 11 years. As a result, literacy is high, with 98 percent of the population over the age of 15 able to read and write.
Over the past 30 years, Mongolia has made tremendous progress in health indicators. There has been a sharp decline in maternal mortality, which is still improving annually. Child mortality has been decreasing steadily since 1990, while life expectancy has been increasing. Leading causes of death in Mongolia include ischemic heart disease, stroke, liver cancer, cirrhosis, stomach cancer, road injuries, lung cancer, self-harm, alcohol use disorders, neonatal disorders, and lower respiratory infections. The risk factors that contribute most to deaths and disabilities include high blood pressure, dietary risks, alcohol and tobacco use, high body-mass index, air pollution, high LDL, malnutrition, kidney dysfunction, and high fasting plasma glucose.
The Republic of Vanuatu, an archipelago in the South Pacific Ocean, consists of 13 main islands and many more smaller ones. Distant neighbors include Australia, New Caledonia, New Guinea, Solomon Islands, and Fiji. Vanuatu is home to active volcanoes, including Yasur, one of the most active volcanoes in the world. The population of about 300,000 is majority ethnic Melanesian, and they speak more than 100 local languages, in addition to Bislama, English, and French. As much as 70 percent of the population identifies as Protestant, with a smaller proportion of Roman Catholics. Over two-thirds of Vanuatu’s population lives in rural areas; urban dwellers reside in the capital of Port-Vila and in Luganville.
During its colonial history, Vanuatu was colonized and governed by Spain in the 1600s, and later France and the United Kingdom. However, a movement for independence started in the 1970s, and by 1980 the Republic of Vanuatu was established. Since then the economy has remained grounded in small-scale and subsistence agriculture, with a few larger commodities such as kava, beef, copra, timber, and cocoa. However, because of climate instability and fluctuations in commodity prices, the country is diversifying its economy with manufacturing, service-sector businesses, and tourism.
Residents and visitors to Vanuatu face a high risk of infectious diseases, such as malaria and bacterial diarrhea. These have decreased over time, but continue to contribute to the leading causes of death in the country. In addition, non-communicable diseases have increased substantially over time as causes of the most deaths in Vanuatu. These include ischemic heart disease, stroke, diabetes, COPD, and chronic kidney disease. The risk factors that contribute most to deaths and disabilities include high blood pressure, air pollution, high fasting plasma glucose, high body-mass index, dietary risks, malnutrition, tobacco use, high LDL levels, kidney dysfunction, and insufficient sanitation and clean water.
The Republic of Djibouti is located in the Horn of Africa, bordered by Somaliland, Eritrea, the Red Sea, and the Gulf of Aden. While small in geographical size, Djibouti benefits from a particularly strategic location, jutting out into the Gulf of Aden. Its modern port serves important traffic coming across the Red Sea and the Indian Ocean. Djibouti is home to the lowest point in Africa, the saline Lake Assal, which is 509 feet below sea level. The population of about 940,000 is composed of 60 percent Somali and 35 percent Afar people, speaking the official languages of French and Arabic, in addition to Somali and Afar. The vast majority of the population is Sunni Muslim, with a small portion, mostly foreigners, identifying as Christian. More than 78 percent of Djiboutians live in cities. The capital of Djibouti, also named Djibouti, is home to 600,000 people. Other cities throughout the country have significantly lower populations, none exceeding 50,000.
Formerly known as French Somaliland and the French Territory of the Afars and Issas, Djibouti adopted its modern name after it gained independence from France in 1977. Due to Djibouti’s harsh climate and limited arable land, agriculture is not a key economic sector. Rural areas are known for raising sheep and goats in small herds for meat, milk, and skins. Overall, Djibouti faces high levels of unemployment because there are few natural resources, agriculture is not a viable industry, and there is limited development in the manufacturing and industrial sectors. Therefore, the country focuses primarily on the service sector, which accounts for the majority of its GDP. Many Djiboutians struggle with unemployment, and poor housing and insufficient water and sanitation facilities contribute to poor overall living conditions.
Chewing khat, a practice that dates back thousands of years in the Horn of Africa, is widespread in Djibouti, and can lead to adverse health effects, such as depression. In addition to pervasive khat chewing, other factors that contribute to poor health include: malnutrition, unsafe sex, air pollution, high blood pressure, tobacco, dietary risks, high fasting plasma glucose, high body-mass index, kidney dysfunction, non-optimal temperature, and a lack of water, sanitation, and hygiene. The causes of most deaths in the country include HIV/AIDS, neonatal disorders, lower respiratory infections, ischemic heart disease, stroke, tuberculosis, diarrheal diseases, cirrhosis, diabetes, protein-energy malnutrition, and congenital defects. Notably, deaths due to non-communicable diseases such as ischemic heart disease, stroke, cirrhosis, and diabetes have all increased by at least 48 percent or more over the past decade
The Islamic Republic of Mauritania is located in the northwest of Africa, bordered by the Atlantic Ocean, Western Sahara, Algeria, Mali, and Senegal. The majority Muslim population of 4.1 million people is ethnically made up of Black and White Moors, Sub-Saharan Mauritanians, Halpulaar, Fulani, Soninke, Wolof, and Bambara ethnic groups. The official language is Arabic—however, French, Pular, Soninke, and Wolof are all widely spoken. About 90 percent of Mauritania’s land area is located in the Sahara Desert, and large swaths of the country are completely uninhabited. Most of the population lives in the southern half of the country, with about half the people living near and in the capital, Nouakchott.
Mauritania was a French colony until it gained independence in 1960. A series of coups, periods of authoritarian military rule, and instability followed, and the country has often been criticized for a poor human rights record. There is little arable land in Mauritania but large expanses of pastoral land. As such, much of the economy is based on livestock and some agriculture, with other major industries being mining of iron ore, petroleum production, and fishing. The economy is vulnerable to international prices on food and commodities. Other risks include environmental fluctuations, such as drought in an already arid country. Mauritania relies heavily on foreign aid and investment: Approximately 31 percent of the population lives below the poverty line, with 10 percent of the population facing unemployment.
Mauritania has experienced a drastic rise in mortality due to malaria between 2009 and 2019, with the rate of death increasing by over 400 percent. Other leading causes of death include neonatal disorders, ischemic heart disease, lower respiratory infections, diarrheal diseases, stroke, road injuries, diabetes, cirrhosis, chronic kidney disease, maternal disorders, and tuberculosis. The risk factors that contribute most to deaths and disabilities include malnutrition, air pollution, high blood pressure, high body-mass index, dietary risks, high fasting plasma glucose, tobacco use, kidney dysfunction, non-optimal temperatures, and a lack of water, sanitation, and hygiene.
The Republic of Tajikistan is a mountainous, landlocked country in Central Asia. The country's history is ancient: The Silk Road once passed through Tajikistan. In a population of 9 million people, 90 percent live in lower elevations, predominantly in settlements called qishlaqs, with population density increasing from east to west. The population is overwhelmingly of the Tajik ethnicity, and the majority of Tajikistanis are Muslim. The nation is rich in mineral resources such as iron, lead, zinc, salt, fluorite, and precious stones.
The country is relatively young, having broken off from the Soviet Union in 1991. Shortly after independence, anti-government demonstrations sparked a five-year civil war ending in 1997. Despite the turmoil, Tajikistan has since increased its political stability and made significant economic progress. Over two decades, from 2000 to 2018, the country dramatically decreased poverty rates from 83 percent to 27 percent.
Tajikistan must still work to repair its healthcare system after infrastructure damage from the civil war and decades of underinvestment. The country continues to have the lowest health expenditure in the WHO European Region. Since its civil war, Tajikistan has made gains in life expectancy, hitting a plateau of around 71 years. Likewise, the under-five mortality rate has improved, dropping from over 90 deaths per 1,000 live births in the early 1990s to under 50 deaths per 1,000 live births in 2019. Lower respiratory infections, neonatal disorders, and diarrheal diseases continue to cause a significant number of deaths, but have improved over time. Significantly, non-communicable diseases contribute most to death in Tajikistan, with ischemic heart disease, stroke, cirrhosis, congenital defects, diabetes, hypertensive heart disease, stomach cancer, and COPD causing the most deaths.
The Democratic Republic of the Congo (DRC) is the largest country in sub-Saharan Africa, with an area equivalent to Western Europe. A beautiful country, the DRC is home to vast reserves of resources ranging from diamonds to hydroelectric potential. The population of more than 105 million comprises more than 200 ethnic groups, most of which are Bantu. As much as 45 percent of the population lives in urban areas, predominantly in the cities in the northeast and in the capital, Kinshasa. French is the official language of the DRC; many people communicate using Lingala, the lingua franca.
The Democratic Republic of the Congo won its independence from Belgium in 1960, followed by years of political and social instability. The country has experienced conflict stemming from decades of civil war and corruption, which still exists today. And while the economic situation in the DRC has improved over the past two decades, in 2018 about 72 percent of the population lived in extreme poverty. Less than half of the population has access to clean drinking water, and only 20 percent has access to sanitation.
The country’s largely rural population faces a high burden of communicable and non-communicable diseases, as well as injuries. Significant causes of death include malaria, tuberculosis, lower respiratory infections, neonatal disorders, diarrheal diseases, stroke, ischemic heart disease, road injuries, hypertensive heart disease, cirrhosis, congenital defects, and HIV/AIDS. A number of Ebola outbreaks has also burdened the DRC. Fears of epidemic coupled with violence across the country has contributed to a growing public health challenge: poor mental health and depressive disorders. Unfortunately, maternal and child health indicators have not improved significantly since the beginning of the century.
The Kingdom of Eswatini, formerly known as Swaziland, is a mountainous, landlocked country in Southern Africa, with neighbors that include Mozambique and South Africa. It is one of the smallest countries in Africa, but despite its small size, it is home to a diverse geography and climate. Because of Eswatini’s mountainous geography, the population is unevenly distributed, with most people living in homestead settlements called imithi located in valleys and plains. About 25 percent of the population lives in urban areas, including Mbabane, the capital, home to 68,000 people. The country’s population of 1.1 million are majority ethnically Swazi, with English and siSwati as both the common and official languages. About 90 percent of the population identifies as Christian.
Eswatini is governed by an absolute monarchy. Formerly a protectorate of Britain, Eswatini gained independence in 1968. Since then, the country has suffered from high rates of poverty, with nearly 60 percent of the population living below the poverty line as of 2017. Poverty is exacerbated by weak economic growth, high rates of unemployment, inequality, extreme weather events, and one of the world’s highest rates of HIV/AIDS.
Eswatini faces several health challenges. The population has a life expectancy of 60 years, one of the lowest in the world. Contributing to this alarmingly low life expectancy is a high burden of infectious disease. While death due to HIV/AIDS decreased by over 60 percent between 2009 and 2019, it remains the top cause of death in the country. Other leading causes of death in Eswatini include lower respiratory infections. diabetes, tuberculosis, stroke, ischemic heart disease, diarrheal diseases, neonatal disorders, road injuries, and chronic kidney disease. The risk factors that contribute most to deaths and disabilities include unsafe sex, malnutrition, high body-mass index, insufficient clean water and sanitation, high fasting plasma glucose, air pollution, high blood pressure, alcohol use, dietary risks, and intimate partner violence.
The Republic of Honduras, in Central America, is bordered by Guatemala, El Salvador, Nicaragua, the Pacific Ocean, and the Gulf of Honduras. The population of 9.3 million is overwhelmingly ethnically Mestizo, with smaller portions of the population identifying as Amerindian. The official language is Spanish, with Amerindian dialects spoken throughout the country. About 60 percent of the population lives in urban areas, predominantly in two major metropolitan centers: Tegucigalpa (the capital) and San Pedro Sula. About 46 percent of the population identifies as Roman Catholic, while 41 percent is Protestant. The name Honduras translates into “great depths,” which is an accurate description of the deep waters off the coast of the country, home to the second largest coral reef system in the world.
Honduras has a long, rich history of Mesoamerican cultures, including Mayan. Colonized by Spain in the 16th century, Honduras gained independence in 1821 and has since experienced extended periods of political and social instability. Honduras has recently benefited from high levels of economic growth, the second highest in Central America and above average for the Latin American and Caribbean regions. Despite economic progress, Honduras is still challenged with high levels of poverty and inequality. The poverty rate is the second highest in the region, with more than half the population living in poverty. While enrollment in primary school is nearly universal, the quality of education is low, with poor school accountability and high dropout rates.
While life expectancy has increased, death rates remain high among those in lower economic demographics. Malnutrition and malaria remain persistent problems among the population’s poorest. Leading causes of death include ischemic heart disease, stroke, interpersonal violence, chronic kidney disease, cirrhosis, COPD, neonatal disorders, lung cancer, diarrheal diseases, road injuries, and lower respiratory infections. The risk factors that contribute most to deaths and disabilities include high blood pressure, high fasting plasma glucose, malnutrition, high body-mass index, air pollution, dietary risks, kidney dysfunction, alcohol and tobacco use, high LDL, and insufficient water, sanitation, and hygiene.
Located in the Atlantic Ocean 500 kilometers off the western coast of Africa, Cabo Verde is an archipelago consisting of 10 volcanic islands. These islands were entirely uninhabited until the 15th century, when the Portuguese discovered and colonized them. Also known as Cape Verde, the Republic of Cabo Verde is home to 590,000 people distributed throughout the islands, with more than half living on Sao Tiago Island, site of the capital, Praia. About 67 percent of Cape Verdeans are urban dwellers. The population identifies mostly as ethnically Creole, with other ethnic groups including African and European. Portuguese is the official language, while Krioulo is also widely spoken throughout the country and diaspora.
Since gaining independence from Portugal in 1975, Cabo Verde has maintained one of the most stable democratic governments in Africa, as well as one of the continent's most stable economies. Only about 10 percent of Cabo Verde’s land is arable, and there are few mineral resources. Instead, much of the economy is grounded in tourism, drawing visitors with its pleasant climate, attractive beaches, stable economy, and close proximity to Europe. Tourism contributed substantially to the country’s rapid economic and social progress between 1990 and 2008. Much of the population is employed in the service industry, and also commerce, trade, transport, and public services.
Non-communicable diseases have increased since 2009 to become the leading cause of death in Cabo Verde. Death due to ischemic heart disease, stroke, diabetes, prostate cancer, stomach cancer, and chronic kidney disease all increased by 50 percent or more between 2009 and 2019. Other leading causes of death include lower respiratory infections, cirrhosis, Alzheimer's disease, self-harm, and interpersonal violence. While neonatal disorders and HIV/AIDS continue to contribute substantially to death in Cabo Verde, these decreased by nearly 50 percent between 2009 and 2019, indicating substantial progress. Risk factors that contribute most to deaths and disabilities include high blood pressure, malnutrition, air pollution, high body-mass index, high fasting plasma glucose, dietary risks, alcohol and tobacco use, high LDL, kidney dysfunction, insufficient sanitation and clean water, and unsafe sex.
Filled with incredible wildlife and known for its variety of national parks, the Republic of the Congo is located on the western coast of Central Africa, bordered by Angola, Gabon, Cameroon, Central African Republic, and the Democratic Republic of the Congo. The population of 5.4 million resides mostly in the southern regions of the country, especially in the coastal area of Pointe-Noire, the second largest city after the capital, Brazzaville. Nearly 70 percent of the population lives in these two cities and along the railroad that connects them; the rest of the country is sparsely inhabited by contrast.The population comprises a variety of ethnic groups, including Kongo, Teke, Mbochi, Sangha, Mbere/Mbeti/Kele, Punu, Pygmy, Oubanguiens, Duma, and Makaa. About three-fourths of the population is Christian. Interestingly, about one-sixth of the land in the Congo is set aside for conservation.
Formerly a French colony, Middle Congo became the Republic of the Congo in 1960 when the country gained its independence. While poverty rates have decreased over time, they are still quite high: 41 percent in 2011 compared to 51 percent in 2005. Extreme poverty rates have increased due to a drop in the price of oil, a key Congolese export. Health and education remain underdeveloped and lacking throughout the country.
The high poverty rate is reflected in the health of the population. Maternal and infant mortality are high: approximately 5 percent of children do not live to their fifth birthday. Chronic malnutrition affects 21 percent of children. Leading causes of death include HIV/AIDS, ischemic heart disease, stroke, malaria, lower respiratory infections, neonatal disorders, tuberculosis, diarrheal diseases, road injuries, diabetes, and cirrhosis. In addition to malnutrition, the risk factors that contribute most to deaths and disabilities include unsafe sex, air pollution, high blood pressure, high body-mass index, high fasting plasma glucose, dietary risks, alcohol and tobacco use, and insufficient water, sanitation, and hygiene.