27 Jan 2011

Leaders in Healthcare

Good morning and, to those of you who are visiting, a warm welcome to Dubai and the UAE.

One billion people have no access to healthcare -- either because medical facilities do not exist where they live or they simply cannot afford to see a doctor. Even modest healthcare is fast becoming unaffordable for many and each year medical bills drive more than 100 million people into poverty. With the costs of healthcare outpacing inflation in many countries, those statistics may well get worse not better.

These are the harsh realities we face according to the World Health Organization. Sadly, we live in a world where in most places, healthcare is not a right, but rather a privilege given solely to those who can afford it.

Perhaps you could say these disturbing trends need not concern us in the Gulf States because of our relative wealth, but that is far from the case. Political battles over the economics of healthcare have raged in North America and Europe and there are no signs of their abating, especially with the new drive to curb government deficits. While our expenditures in the region are still lower -- both per capita and as a percentage of GDP -- there is a clear warning to us on the horizon and we best not ignore it.

How do we shape health care systems that are both effective and affordable? How do we ensure that quality, efficiency and coverage are thoroughly considered to achieve optimum healthcare? Is a government run system for medical care ultimately better than a private sector approach? Or is a joint partnership more effective?

These questions are sure to set the stage for a lively debate throughout the day.

In the last few years, there have been exciting developments on the healthcare front globally. We are reducing infant and maternal mortality sharply and bringing malaria under control. A new vaccine against meningitis will soon be given to more than 300 million Africans, and there are advances in both the prevention and treatment of AIDS.

Yet, as we are learning to eradicate diseases, we are unwittingly creating them at the same time.

The most destructive maladies worldwide and in the Gulf Region are not infectious diseases -- they are diseases we create with our own behavior -- noncommunicable diseases such as -- cardiovascular diseases, cancer, diabetes and some respiratory afflictions. They have reached epidemic proportions, even outside the West. In low- and middle-income countries, millions of lives – almost half the disease burden - are lost to non-communicable diseases.

For better or worse, today we are part of a global health economy. The health of Emiratis and others in the region is increasingly tied to developments abroad.

For example, global challenges lie in the lack of research, patient-centric care, smart technology and treatment. Additionally, another very disturbing phenomenon is the growing commercial links between private sector providers of medical goods and services and academia. Increasingly, academic institutions are operating as if they were profit making enterprises and while this trend began in the United States, it is clearly spreading into other OECD states and beyond.

In some countries, the costs of medical interventions and drug development have been distorted by a costly explosion in litigation. It is unlikely that we will ever get a handle on the steady inflation in medical costs until this is somehow brought under control since it has a global effect on the pricing of drugs in particular.

But the biggest bank buster for healthcare is, oddly enough, success. When people live longer, overcoming cardiovascular diseases and other killers common to middle age, they then struggle with the cancer, Alzheimer’s and other dementias, and other afflictions that beset those living into their 80s and 90s. The challenge presented by the skyrocketing costs related to home or institutional care related to these diseases is enormous.

Furthermore, in countries without universal health coverage, there is the pressing issue of caring for the uninsured. While most of the debate about this has dwelled on costs, we must all remember this is a moral issue....not just a financial one.

The awe-inspiring economic growth in the Gulf Region has transformed our lives. But this change in lifestyles has come with a high price -- a surge in noncommunicable disease.

The largest single killer here today is type 2 diabetes and the UAE ranks second in the prevalence of the disease globally. Saudi Arabia is third, Bahrain fifth, Qatar sixth and Kuwait eighth. In some Gulf countries, diabetes causes one death out of every four that occurs between the ages of 25 and 64 -- a chilling statistic.

Obviously, obesity plays a major role.

Saudi Arabia and Qatar both exceed the United States in rates of obesity. But genetics, the composition of the diet and the decreasing amount of exercise all play roles as well. In the UAE obesity is rising at a faster rate than in the United States, where health authorities often use the term "epidemic" to describe their current situation. What is interesting about the UAE is the major disparity in obesity rates between men and women. Men continue to have a far lower rate of obesity -- 17 percent -- than women who have climbed to an incidence level of 31 percent.

It is not only diabetes that we need to worry about. In the next 15 years, the cancer incidence in the Middle East will surpass that in any other region, increasing between 100 and 180 percent.

It is clear that an effective health strategy that serves all must be far broader than medical interventions. A whole range of actors -- both public and private -- must work in harmony and focus on prevention far more than we do today. The key is promoting healthy lifestyles -- raising the level of physical activity, improving the quality of our diets, reducing tobacco and other harmful substances and following simple public safety measures.

There are practices that we can all take to improve our health -- regular physical checkups with particular attention to cholesterol, blood sugar and other key markers and dietary changes like consuming more fruits and vegetables and lowering salt intake can go a long way toward reducing the burden that cardiovascular disease and diabetes take on the people of the Gulf Region.

In Dubai, we instituted the Fat Truth Campaign to educate our children to the perils of poor diet and insufficient physical activity. We are very pleased that UNICEF has adopted the campaign's approach for use throughout the region.

By global measures, standards for health care in the UAE are considered generally high thanks to increased government spending over the last few decades. We face many challenges – one of the most prominent is a "brain drain" in the medical profession. Like much of the developing world, the Middle East struggles with limited trained medical personnel and we need to devise more effective strategies to retain the talent our societies have paid to educate.

Whatever practical steps we take in the UAE on issues like healthcare financing, we cannot avoid the simple fact that each of us has a role to play in public health -- in our own personal health, our family’s, and our community's.

We can adopt healthier lifestyles and create a culture of prevention to cope with the health challenges that now face us. Will we? I hope so. And each of you here today can help.

Thank you.