Introduction

The unity of the Mediterranean region, based on a long seafaring tradition and the mutual interplay of histories and cultures, has in more recent times been rediscovered by the European Union (EU). Yet there is a question as to whether there is any continuing commonality between the countries bordering on the Mediterranean. Political and cultural divisions have made one unity of the Arab region, as adopted by the World Health Organization (WHO), with countries such as Turkey and Israel situated in a no-man’s-land between the Arab world and Europe. The countries in the Balkan Peninsula, mostly once part of a Yugoslavia that could claim to be Mediterranean, are now divided between smaller countries and independent provinces with access to the sea, for example, Slovenia, Croatia, Montenegro and Bosnia, and those cut off, for example, Kosovo and Macedonia (FYROM). The sea, for the purposes of this chapter, has to be the defining feature of the Mediterranean region, suggesting a common maritime-based history of cultural interchanges; thus the ‘Mediterranean countries’ examined here are those with a Mediterranean shoreline. Yet there are large differences between these countries – in their recent histories of development, their GDP and their demographic profiles – with implications for the size and health of their older populations.

Health, the focus of this chapter, may show significant variations reflecting these differences, but a major problem in discussing health in this region is the lack of either systematic or longitudinal comparable data for many health-related issues. Country data is available from the WHO database, but again Mediterranean countries are part of different WHO regions (Africa, Europe and the Eastern Mediterranean), and there are also countries, such as Palestine, where almost no data is available. So, whether using individual or population-based indicators for health, there are problems of comparability over time, between cultures and sub-populations.

The focus on health, using the established WHO definition, ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or disability’ (WHO 1948), is important as it requires us to take into consideration the many and varied socioeconomic and cultural factors that have an impact on health and, with special reference to older people, on healthy life expectancy (HLE).