Rapid economic advances in the Gulf Cooperation Council (GCC) countries have improved living standards but simultaneously brought about an increase in public health problems prevalent in developed societies around the world. A wealthier population has adopted the sedentary lifestyles and similarly unhealthy eating habits of developed countries, with the younger generations taking the lead. The result is that more and more people are contracting non-communicable diseases (NCDs) also termed “chronic illnesses” associated with prosperity, such as cardiovascular illnesses, cancer, and respiratory ailments. These illnesses have become the leading cause of death in the GCC, imposing $36 billion annually in healthcare costs, making NCDs a problem whose severity undermines increased prosperity brought about by economic development.
It is widely accepted that the complex nature of NCDs increases the consumption of healthcare services. Patients typically require diligent follow-ups by physicians and frequent contact with the healthcare system. Dr. Margaret Chan, the Director-General of the World Health Organization, has dubbed NCDs “the diseases that break the bank.”
For GCC countries, which have been investing significant sums ($46.5 billion in 2010 and $49.7 billion in 2011) in their healthcare sectors, quantifying that cost is critical. It allows policymakers to alert citizens to the economic costs of chronic illnesses. Across the GCC, healthcare systems are devoting more resources than originally foreseen in order to deal with the five most common NCDs: cardiovascular ailments, malignant neoplasms, chronic respiratory diseases, neuropsychiatric conditions, and diabetes mellitus.
direct and indirect
The economic burden of NCDs comes in two cost forms, direct and indirect. Direct costs are typically those associated with the treatment of patients, such as consultations, medications, and clinical operations.
Direct costs, however, are just part of the problem. More significant is the indirect economic penalty of chronic diseases. NCDs reduce life expectancy, which means less output. In addition to the immense burden on the patients, NCDs affect their families, reducing their contribution to economic activity. Furthermore, chronic illness and shorter life spans deplete the quality and quantity of the work force. Labor productivity declines because workers are less effective and NCDs lead to increased rates of absenteeism.
At their current prevalence rates, the GCC’s five most common chronic diseases had total direct and indirect costs of close to $36 billion in 2013 — almost 1.5 times this year’s official healthcare budgets. This is based on calculations conducted in 2012 with 2011 data from the respective GCC countries. If governments fail to curb the rising direct costs associated with increasing outpatient and inpatient volumes and the rising indirect costs associated with loss of workforce productivity and rise in early mortality, the economic burden could nearly double to $70 billion by 2022.
The economic burden is unevenly distributed across the region, with different lifestyles having a clear effect. The highest economic cost is in Qatar, also the wealthiest state per capita in the GCC. The direct costs in Qatar in 2013 will be $416 per capita, with the indirect costs at $1,456 per capita.
The lowest economic burden is in Oman, which is still the most traditional society in the region. Omanis exercise more frequently than other GCC populations and the country has the lowest smoking rate. In 2013, the direct cost of NCDs in Oman will be $46 per capita, thanks to relatively few hospital admissions, and the indirect cost $392 per capita.
The NCDs that have the highest direct costs are cardiovascular diseases, which will account for 28 percent of all direct costs in 2013. When it comes to indirect costs, the greatest burden is imposed by malignant neoplasms, or cancers in non-scientific language, which will account for 41 percent of indirect costs in 2013.
Understanding the economic burden is an important step towards formulating policies to restrain this epidemic. Governments need to act rapidly to enact a comprehensive agenda that targets those at risk of developing NCDs and those already afflicted. The agenda must be systematic, not a series of sporadic initiatives. Similarly, while governments must take the lead, and coordinate the effort, they should also involve a wide array of public and private stakeholders to create the optimal enabling environment for lifestyle changes that will lower the incidence of NCDs.
time for action
The success of the NCDs agenda will come from a dynamic balance between short and longterm programs. In the shortterm, governments should limit the opportunities for unhealthy behaviors through financial incentives and disincentives. These include higher taxes on tobacco, which has helped reduce smoking in developed countries. They can set guidelines that favor healthy food in schools, an approach being adopted in the U.S.
Equally important are clinical screening programs for at-risk populations to obtain a better understanding of their health. For example, Abu Dhabi’s Weqaya [Protection] program screened 94 percent of Abu Dhabi nationals for cardiovascular disease. In the process, Weqaya found thousands of cases of other NCDs. Although this program has helped the population in seeking treatment and provided important information that can assist in national health planning, similar initiatives have yet to be established in other GCC countries.
Over the longterm, governments should aim to nudge their populations to change their unhealthy behaviors. They can encourage changes in individual behavior by providing specific guidelines for those at risk, educating those who care for children, informing adults, and raising awareness among health providers about NCDs. Governments should also reform their healthcare systems to further strengthen primary care and preventative care.
The private sector in the GCC also has means at its disposal to discourage bad habits and encourage healthier behavior among employees. To give some examples, companies have asked smokers to work one extra hour per day to make up for time lost on frequent smoking breaks. Other GCC employers are also starting to focus on occupational wellbeing programs to coach their employees on healthy lifestyle and injury prevention, offer physical exercise classes, and provide healthy food within their facilities. Programs to lower the risk of NCDs, and better manage them, ought to involve innovation and experimentation. With proper monitoring and measurement, successful schemes can be institutionalized, and lower impact programs curtailed. Though awareness of the impact of NCDs has been increasing, GCC countries should take more tangible action and appoint national NCDs coordinators to send a clear message to their population about the importance of NCDs as well as developing coordination across relevant entities such as the Ministry of Health and the Ministry of Education.
