The countries of the Gulf Cooperation Council (GCC) have young populations and are economically classified as emerging markets, but in terms of public health they already rival the problems of much more developed countries. Epidemic health problems such as overeating, high-sugar diets, and a lack of physical exertion are eroding the gains in health and wellbeing that the six GCC countries made in the past generation, when they climbed from societies with limited nutritional resources to countries whose per-capita consumption is equal or in excess of more mature economies.
The evidence for this problem comes from the alarming pace at which non-communicable diseases (NCDs) are occurring across the region. NCDs such as cancer, diabetes, cardiovascular diseases, respiratory disease, and neuropsychiatric conditions are now common. Indeed, five of the 10 countries in the world where diabetes is most prevalent are located in the six-nation GCC, according to the International Diabetes Federation.
In Saudi Arabia, the World Health Organization (WHO) reports that two-thirds of citizens over 15 years old are classified as overweight (meaning they weigh more than is optimal), and more than a third of Saudi women are obese (their weight is excessive enough to affect their health). In the United Arab Emirates, according to the WHO, cardiovascular disease annually claims 244 lives out of every 100,000 people, whereas in the United States the death toll is 194 lives out of every 100,000 people each year, according to the Center for Disease Control and Prevention.
A costly killer
These figures show that the GCC is now in the category where NCDs are a leading cause of death and disability. The WHO warns that without proper health policy intervention, eight of the top 10 leading causes of death in 2030 worldwide will be related to NCDs, to devastating personal and economic effects. According to this scary scenario, the cumulative output loss caused by the top five NCDs over the next two decades could reach $45 trillion — roughly three quarters the size of today’s world economy.
The economic toll also affects economic growth through direct and indirect costs. Direct costs are typically associated with the treatment of patients including spending on healthcare human resources, medical equipment and consumables, and drugs. The World Bank estimates that the lost potential of future GDP annually stands between 1 to 5 percent, due to the impact of NCDs. For the GCC countries, which often have small populations of nationals with limited participation in the workforce, the impact of NCDs also means further dependency on expatriates in the workforce.
Even larger are the indirect medical costs which NCDs extract from patients, their families, and society. NCDs reduce productivity, diminishing economic output. They limit individuals’ productive potential and invariably reduce income and savings. Moreover, the need to provide long-term support and care to patients puts a strain on their families as well. From society’s perspective, NCDs reduce life expectancy, workplace efficiency and productivity, thereby depleting the quality and quantity of the workforce.
The GCC has a positive record of reducing infectious diseases; mortality from these illnesses is forecast by the WHO to continue its current decline. However, while the GCC’s diseases profiles are increasingly similar to those of developed countries, their level of investment in healthcare infrastructure remains much lower.
Working towards a solution
GCC governments have started to address this problem and recognize that much of the effort to limit the impact of NCDs involves preventative medicine. The six countries are already collaborating through the GCC Health Ministers Council.
The Saudi Ministry of Health has launched several programs to fight and prevent NCDs, such as cardiovascular diseases and diabetes.
In Abu Dhabi, the Weqaya (“Prevention”) initiative screened all citizens in the emirate and assigned them a risk score. Individuals with high scores were then either referred to specialists or invited to participate in healthy lifestyle classes. The screening program, which has cost the emirate around $10 million, or $60 per citizen, since its launch, is slated to be repeated every three years.
Abu Dhabi expects to save around $488 million by 2030 from the program and follow-up consultations, besides the improvements in quality of life and increased life expectancy to patients.
Such programs are critical to reducing the impact of NCDs on GCC societies and economies, but they need to be implemented on a grander scale. In order to achieve greater impact, governments must allocate resources to fight and prevent these diseases that are commensurate with the magnitude of the problem.
The next step has to be an urgent rethink of the GCC’s national healthcare systems — which were designed to fight infectious diseases and focus on treatment — and the development of capabilities that specifically tackle these new challenges. First, government should make NCDs a key priority for health planning. The official aim should be better quality of life for their populations, which will reduce unnecessary medical costs and lost economic productivity.
Second, governments should redesign their healthcare delivery models to allocate more resources to education and prevention, and less on the old approach of cure and treatment. Indeed, it is typically more cost effective to prevent diseases rather than cure them. For instance, a well-funded national tobacco control program in Saudi Arabia would require around $30 million per year, which is equivalent to the budget of a mid-sized hospital.
Third, the GCC should further strengthen the collaborative efforts of the Health Ministers Council. Specifically, the council should build on its valuable initial efforts and convene GCC countries to develop a clear and feasible plan of action for coming years, starting with a detailed, GCC-wide diagnostic. To carry out the diagnostic, countries first would need to build the capabilities to conduct a survey and analyze its data. This will allow governments to better understand the health profile of their populations and their burden of disease.
The knowledge acquired should then be used to develop national strategies and plans, as well as budget requirements and change legislation as required. In the meantime, preventative and educational programs should be further reinforced or developed. This diagnostic exercise will allow GCC countries to properly quantify the extent to which their populations are affected by NCDs and identify priorities for action.
Addressing the diseases of wealth
The Arab Gulf’s natural resources have propelled its countries into the ranks of the world’s prosperous nations. Life expectancy is longer, child mortality is down, and the population has access to good quality healthcare. If these gains are to be sustained, the diseases that come with wealth, the NCDs, will have to be addressed. With a strategic rethink of healthcare provision and more investment in prevention, GCC countries can reduce the human suffering of NCDs and the broader costs to society and the economy, and so add more to the region’s quality of life.