International Journal of Public Health

, Volume 60, Supplement 1, pp 31–37 | Cite as

Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment

  • Faten Tlili
  • Francine Tinsa
  • Afef Skhiri
  • Shahaduz Zaman
  • Peter PhillimoreEmail author
  • Habiba Ben Romdhane
Original Article



The growing prevalence of non-communicable diseases across the Middle East and North Africa poses major challenges for underfunded health services. This article presents data on the perspectives of ordinary Tunisians who are coping with two of these diseases—diabetes and hypertension—and who are obtaining treatment through Tunisian public health clinics. Little has been written to date on patient experiences of biomedical treatment in Maghreb countries.


Based on qualitative methods and semi-structured interviews with 24 patients attending two clinics, one urban and one rural.


We examine popular aetiological beliefs, ideas about biomedical treatment and its implications, and comparative views on the benefits and drawbacks of treatment in both public and private clinics.


We highlight two main themes. One was nostalgia for a recent past when ‘pure’ and ‘natural’ food, ‘proper’ meals and less stressful lives meant less chronic illness, with demanding and costly treatment. The other concerned communication in the clinic, and the recurrent dismay patients felt at what they saw as the cursory attention and guidance they received from clinic staff in public facilities.


Tunisia Diabetes Hypertension Qualitative research Patient perspectives 



The research on which this article is based was conducted as part of MedCHAMPS, a project funded by the European Commission under the Framework 7 Programme (Grant No. 223075). We would like to acknowledge the contribution of Professor Julia Critchley, the Scientific Coordinator of MedCHAMPS.


  1. Adib S (2004) From the biomedical model to the Islamic alternative: a brief overview of medical practices in the contemporary Arab world. Soc Sci Med 58:697–702PubMedCrossRefGoogle Scholar
  2. Ben Romdhane H, Skhiri H, Khaldi R, Oueslati A (2002) Transition épidémiologique et transition alimentaire et nutritionnelle en Tunisie. In: Sahar A (ed), Le Bihan G (coord) L’approche causale appliquée à la surveillance alimentaire et nutritionnelle en Tunisie. Montpellier, CIHEAM, pp 7–27. (Options Méditerranéennes: Série B. Etudes et Recherches; n. 41).
  3. Ben Romdhane H, Haouala H, Belhani A, Drissa H, Kafsi N, Boujnah R, Mechmeche R, Slimane ML, Achour N, Nacef T, Gueddiche M (2005) La transition épidémiologique, ses déterminants et son impact sur les systèmes de santé à travers l’analyse de la tendance des maladies cardiovasculaire en Tunisie. Tunis Méd 83:1–7PubMedGoogle Scholar
  4. Ben Romdhane H, Husseini A, Jabbour S (2012) Non-communicable diseases-II: focus on cardiovascular diseases. In: Jabbour S, Giacaman R, Khawaja M, Nuwayhid I (eds) Public health in the Arab World. Cambridge University Press, Cambridge, pp 164–177Google Scholar
  5. Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W, Zaman S, Ben Romdhane H, Fouad F, Phillimore P, Unal B, Khatib R, Shoaibi A, Ahmad B (2012) Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop. Bull World Health Organ 90:847–853PubMedCentralPubMedCrossRefGoogle Scholar
  6. Boym S (2001) The future of nostalgia. Basic Books, New YorkGoogle Scholar
  7. Dole C (2004) In the shadows of medicine and modernity: medical integration and secular histories of religious healing in Turkey. Cult Med Psychiatry 28:255–280PubMedCrossRefGoogle Scholar
  8. Dole C (2006) Mass media and the repulsive allure of religious healing: the Cinci Hoca in Turkish modernity. Int J Middle East Stud 38:31–54CrossRefGoogle Scholar
  9. Elasmi M, Feki M, Senhaji H, Jemaa R, Hej Taieb S et al (2009) Prévalence des facteurs de risque cardiovasculaires conventionnels dans la population du grand Tunis. Revue d’épidémiologie et santé publique 57:87–92. doi: 10.1016/j.respe.2008.12.010 CrossRefGoogle Scholar
  10. Giacaman R (1988) Life and health in three Palestinian villages. Ithaca Press, LondonGoogle Scholar
  11. Good B, Del Vecchio Good M-J (1992) The comparative study of Greco-Islaami medicine: the integration of medical knowledge into local symbolic contexts. In: Leslie C, Young A (eds) Paths to Asian medical knowledge. University of California Press, Berkeley, pp 257–271Google Scholar
  12. Mateo Dieste J (2012) Health and ritual in Morocco: conceptions of the body and healing practices. Brill, AmsterdamCrossRefGoogle Scholar
  13. Maziak W, Critchley J, Zaman S, Unwin N, Capewell S, Bennett K, Unal B, Husseini A, Ben Romdhane H, Phillimore P (2013) Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modeling of population socio-economic transitions (MedCHAMPS)—rationale and methods. Int J Public Health 58:547–553. doi: 10.1007/s00038-012-0423-4 PubMedCrossRefGoogle Scholar
  14. Mokhtar N, Elati J, Chabir R, Bour A, Elkari K, Schlossman NP, Caballero B, Aguenaou H (2001) Diet culture and obesity in Northern Africa. J Nutr 131:887S–892SPubMedGoogle Scholar
  15. Morsy S (1988) Islamic clinics in Egypt: the cultural elaboration of biomedical hegemony. Med Anthropol Q 2:355–369CrossRefGoogle Scholar
  16. Morsy S (1993) Gender, sickness and healing in rural Egypt: ethnography in historical context. Westview, Boulder, COGoogle Scholar
  17. Obermeyer CM (2000a) Pluralism and pragmatism: knowledge and practice of birth in Morocco. Med Anthropol Q 14:180–201PubMedCrossRefGoogle Scholar
  18. Obermeyer CM (2000b) Risk, uncertainty and agency: culture and safe motherhood in Morocco. Med Anthropol 19:173–201PubMedCrossRefGoogle Scholar
  19. Phillimore P, Zaman S, Ahmad B, Critchley J (2013) Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. Glob Public Health 8. doi: 10.1080/17441692.2013.830756
  20. Ploubidis G, Mathenge W, De Stavola B, Grundy E, Foster A, Kuper H (2013) Socioeconomic position and later life prevalence of hypertension, diabetes and visual impairment in Nakuru, Kenya. Int J Public Health 58:133–141. doi: 10.1007/s00038-012-0389-2 PubMedCrossRefGoogle Scholar
  21. Ricoeur P (2005) The course of recognition. Harvard University Press, Cambridge, MAGoogle Scholar
  22. Saidi O, Ben Mansour N, O’Flaherty M, Capewell S, Critchley J, Ben Romdhane H (2013) Analyzing recent coronary heart disease mortality trends in Tunisia between 1997 and 2009. PloS One. doi: 10.1371/journal.pone.0063202
  23. Spadola E (2009) Writing cures: religious and communicative authority in late modern Morocco. J North African Stud 14:155–168CrossRefGoogle Scholar
  24. Tinsa F (2011) La maladie chronique en Tunisie: approche sociologique. Faculte de Medecine de Tunis, Tunis Google Scholar
  25. Turner B (1987) A note on nostalgia. Theory Cult Soc 4:147–156CrossRefGoogle Scholar
  26. Wong M, Leung M, Tsang C, Lo S, Griffiths S (2013) The rising tide of diabetes mellitus in a Chinese population: a population-based household survey on 121,895 persons. Int J Public Health 58:269–276. doi: 10.1007/s00038-012-0364-y PubMedCrossRefGoogle Scholar
  27. Yehya N, Dutta M (2010) Health, religion and meaning: a culture-centered study of Druze women. Qual Health Res 20:845. doi: 10.1177/1049732310362400 PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Faten Tlili
    • 1
    • 2
  • Francine Tinsa
    • 3
  • Afef Skhiri
    • 1
  • Shahaduz Zaman
    • 4
  • Peter Phillimore
    • 4
    • 5
    Email author
  • Habiba Ben Romdhane
    • 1
  1. 1.CVD Epidemiology and Prevention Research Laboratory (CAVEPLA), Faculté de Médecine de TunisTunisTunisia
  2. 2.Institut National de Santé Publique (INSP)TunisTunisia
  3. 3.Department of SociologyUniversité de SfaxSfaxTunisia
  4. 4.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
  5. 5.School of Geography, Politics and SociologyNewcastle UniversityNewcastle upon TyneUK

Personalised recommendations