An empirical and historical question is still the subject of many studies on the reasons and factors that distinguish the emerging countries of Asia and South America from other poor countries. Why these countries were able to succeed in the battle for development, while African countries are still struggling to take off in a concrete and sustainable way?

There are many assumptions on the factors lying behind the miracle that made these countries succeed better than the majority of African countries, including North African countries. At each time, savings, culture or institutions were used to explain this difference. However, the human capital is obviously the major difference between emerging countries and other poor countries, since the 1960s.

As a component of the human capital, health plays an essential role, and emerging countries -mainly in Asia‐ have been lifted out of poverty when they started to make progress in terms of health and education. North African countries were fully aware of the importance of this prerequisite in their respective development policies.

Tell me what is your health policy, and I will tell who you are!

Indeed, in North Africa, significant efforts are being made since the 80s to develop the health sector. Thus, investments in medical insurance, vaccination, access to water and to a better nutrition have resulted in the decrease of infant and maternal mortality and in longer life expectancy. This latter increased from an average of 42.4 years in 1950 to 68.3 years in 2010, meaning an increase of nearly 26 years. According to the 2013 report on human development, Algeria, Libya and Tunisia are among the 20 countries that witnessed the largest decrease in HDI deficit between 1990 and 2012. Egypt, Mauritania and Sudan have also improved their average HDI.

These countries have made efforts to adopt health policies based on a horizontal and inclusive approach and to strengthen interactions between health, education, access to drinking water and to other facilities, especially that the majority of them have already started their demographic transition. Thus, the average fertility rate in the region fell down from 5‐6 children per women to 2‐3 children, thanks mainly to the education of the population in general, and of girls in particular, to policies of family planning, access of women to the labor market, the later age of marriage, the development of women's work, as well as the impact of the economic crisis.

The combination of the three factors‐ namely the ongoing rapid socio‐economic changes, demographic transitions leading to the increase of juvenile population and a population which started ageing (in most North African countries, the proportion of people aged over 60 will jump to 20% within 40 years), and the evolution of lifestyles‐ has given rise to new patterns of consumption, new diseases, and new needs that will constitute challenges to the countries of the region.

The other side of the coin

Obesity is an example to illustrate the new health challenges facing North African countries and is considered today as a real public health problem that needs action and solutions, which will necessarily involve more expenses and overload the budget of the States. The few studies already made in this area show that this is a growing issue that affects increasingly young people. Besides, women are more affected than men. For example, in Egypt, a study by the National Nutrition Institute in 2002 showed that 48.5% of Egyptian women and 16.7% of Egyptian men aged over 20 were obese. In Cairo, one in two women and one in five men aged over 20 suffer from this problem; this ranks Egypt among the 20 countries most affected by this disease in the world.

In Morocco, the figures of the High Commissioner for Plan published in June 2011 on adult population aged over 20, show that 33.7% are affected by pre‐obesity. In total, 10.3 million adult Moroccans, of which 63.1% women, are in a situation of obesity or pre‐obesity.

In Tunisia, obesity is a health problem since one in three women aged 35 to 70 is obese. In Algeria, a study carried out in 2011 on overweight, obesity and overweight‐related factors among junior students enrolled in public junior high school of Bouzareah, states that the prevalence of overweight is 19%, with 17% of boys and 22% of girls.

The improvement of the standard of living of the middle class, the new consumption patterns, the "junk food" due to the lack of resources of some social categories, the decreasing trend in physical activity, etc. are some of the reasons underlying the resurgence of this phenomenon.

Another growing challenge facing the countries of the region is the emergence of some diseases associated with the population ageing, such as cancer, hypertension and diabetes. This situation is likely to put additional pressure on the budget of social security.

The inevitable need for reforms

To overcome these new challenges, including those relating to health inequalities, health systems have to develop a clear vision and strategy, reforms have to be made in order to implement more equitable health funding policies and achieve the universal coverage. Moreover, better advantage should be taken of the potential of the private sector as a support to the public health system.

These reforms imply also that policymakers in the region should tackle the issue of infrastructure and human resources in health sectors (accessibility and proximity of health care, diversification and adaptation of medical specialties to the new needs, job creation in medical and paramedical sectors, etc.).

This is indeed the only way to strengthen the effectiveness of health policies in North Africa, to ensure a real inclusive development with a human dimension in this region which is preparing to the critical turning point of the Post‐2015.