The rapid changes over the past few decades in lifestyle in the Gulf Cooperation Council (GCC) countries have had a momentous effect on the world at large, but even more so on the indigenous population. The Burj Khalifa, indoor ski slopes when it’s 50°C outside, man-made islands – the advantages of wealth have become commonplace, and the population has, by and large, come to accept the situation as one in which the positives outweigh the negatives.
However, the negatives are there and beginning to seep into the fabric of the region, particularly with regard to health and lifestyle. Many of the health indicators for most of the GCC countries are pointing downwards. Obesity and diabetes pose a huge problem, but now, other complications of a sedentary lifestyle are beginning to afflict growing numbers of people. And those people are the young.
Young and restless
One place where this burgeoning health crisis has been causing a worried reaction is Oman. Diagnostics programmes have shown several health indicators that suggest the country is heading for a rocky and expensive future, unless something is done about the health of its young people.
According to government watchdogs, people as young as 24 are suffering neurological strokes and heart attacks, something senior medics, including Dr RR Sharma, a senior consultant and neurosurgeon at the Atlas Hospital in Oman, are worried about. New, plugged-in, sedentary lifestyles fuelled by sugars and junk food are becoming a ticking health timebomb for the young in the country and the wider MENA region, as various life-threatening conditions previously known to occur from middle age are striking the younger generation.
According to Sharma, the phenomenon of the young suffering illnesses that normally affect people their parents’ age is global, but felt much more in the Gulf countries. Sharma has spoken to the press in his country about these problems and where he sees solutions coming from.
“It is true that younger people are suffering strokes, and it is happening not only in the Middle East, but also around the rest of the world. Only the rate varies. In the Middle East and South-East Asia, it is far higher than in many other places in the world, and there definitely is a reason for that,” he says.
“People are resorting to eating at restaurants and junk-food joints, and are ignoring healthy home-cooked food. Salads and fruit have been taken over by fried foods,” the doctor adds.
Another important factor is stress, Sharma says. “Performance on the job has become a criterion for progress, and people are increasingly trying to better that to achieve success. This also leads to a habit of smoking, which is another contributing factor. We see people having heart attacks at 25 or 30 years of age.
“All these factors give rise to diabetes, high blood pressure, cholesterol, obesity, and all of these have implications for the body,” he concluded.
Sharma also mentions that Oman and the region experience intense heat, especially in the summer months. So when one is on the move, even normal dehydration makes one’s blood thick, because people are not drinking enough pure water.
These changes in diet and lifestyle have been rapid, and the culture shift has led a generation of the young in Gulf countries to have illnesses that have previously never been seen in people so young. This begs the question – how do we now fix the problem and prevent a downward spiral in public health?
Lifestyles of the rich
Soeren Mattke is the senior scientist and managing director of RAND Health Advisory Services and a professor at Pardee RAND Graduate School. He has studied public health concerns and focuses on chronic diseases and conditions, as well as reforms in healthcare. He sees one of the main reasons for the problem of the young getter sicker, earlier, is the lack of public health programmes and proper education in the region.
Mattke believes that, like all countries that develop rapidly, the Middle Eastern nations, to a certain extent, have eyed the wrong end of the prize on their path to progress.
“My general impression is that much of the money, and much of the emphasis of the health system, went into prestige projects. Each of the oil-rich countries now has some brand of a famous American medical school; they have the shining hospitals with fantastic architecture, fantastic infrastructure. But what they did not do is build a robust primary-care public-health infrastructure, which is actually what you need to combat population-level diseases,” he explains.
“You see this in almost all countries,” he notes. “Greater wealth brings with it unhealthy lifestyles. People eat too much, they exercise too little, and the consequence in all countries, even in relatively poor countries, is an increase in chronic illness: primarily diabetes, as the first indication, but then also hypertension, heart disease and other conditions.”
“In the Middle East, especially in the oil-rich countries, you see this at an accelerated pace. And that has two reasons: first of all, people of Arab origin have a biologically higher chance of developing diabetes. Even if they emigrate to other countries and grow up there, live there and adopt local lifestyles and eating habits, they just have genetically higher risks,” Mattke says. “So they have a very high starting point, and then this became the region of the world that got rich the fastest. The Middle East was a pretty poor society, which had very harsh circumstances – farmers and Bedouins who didn’t really have much, and who consequently actually had a healthy diet – and went from that to being immensely wealthy, and being able to enjoy the fruits of the oil wealth.
As a consequence, people have adopted, at an unprecedented speed, unhealthy lifestyles and eating habits. The diabetes rates are probably the highest in the world now, except for maybe some Southern Pacific Islands where the genetic risk is even higher.”
If this is the case, those primary-care public-health systems might be something that could help to prevent another generation from repeating the same mistakes. What is needed is “education programmes; dietary education; robust primary care; excellent primary-care doctors that will educate you, help you avoid and manage diabetes and its complications – and that’s just not as sexy as having a Johns Hopkins-branded hospital,” Mattke says, putting it very bluntly. “Primary care in these countries tends to [rely on] doctors from places like India and Pakistan, who have very limited prestige, are not particularly well paid, and are seen as the bottom of the totem pole.
“Highly paid and imported surgeons from places like the US and Europe are the superstars, even though, from
a population perspective, you need a lot more primary-care doctors than star surgeons.”
This top-heavy infrastructure may do more damage in the long run, but attitudes will change as the natural path of health corrects itself – societies can only go so far before they learn to self-correct in order to survive. “It’s the path that basically all countries take as they become wealthy. Unfortunately, the prestige objects are the ones that always have the most immediate attraction, and that’s where the money always goes.” Mattke concludes, “Since these countries got so much so fast, [the process] is accelerated and [has unfolded] in a much more extreme fashion than what you see in other countries.”
Curbing the conditions
Mattke sees some good things being done, but not enough. There are several projects now being undertaken, as GCC governments and health experts realise their younger generations are on a path of self-destruction. One positive aspect is that some parts of the GCC have taken it a step further and will enable themselves to save money and lives by going for the preventive measures, rather than battling the effects that have already taken hold.
One such project is Weqaya (Arabic for ‘prevention’), a population-wide cardiovascular screening programme in Abu Dhabi. It’s objective, according to the Health Authority of Abu Dhabi, is “to determine cardiovascular risk-factor prevalence rates among adults in [the emirate],” by using “self-reported indicators, anthropometric measures, and blood tests to screen 50,138 adults aged 18 years or older who are taking part.
“Data has consistently shown a rapidly rising global burden with respect to non-communicable diseases, placing them near the top of the World Economic Forum’s global risk landscape,” the report on the project states. “The key challenge in alleviating this burden is the development of effective, scalable interventions.”
The results of the Weqaya screenings showed that the risk-factor prevalence rate for obesity is 35%; 32% of those surveyed were overweight (central obesity stands at 55%); 18% have diabetes; those with symptoms linked to pre-diabetes accounted for 27%; dyslipidemia was at 44%; and the rate of hypertension was 23%. All of these are clear and worrying signs that health in young adults is poor.
“In addition, 26% of men were smokers, compared with less than 1% of women. Age-standardised diabetes and pre-diabetes rates were 25 and 30%, respectively, and age-standardised rates of obesity and overweight were 41 and 34%.”
The conclusions, according to doctors from the health authority, “demonstrated a high cardiovascular burden for our small sample in Abu Dhabi. The data forms a baseline against which interventions can be implemented and progress monitored as part of the population-wide Abu Dhabi cardiovascular disease programme.”
The report’s conclusion also noted that “The rates of obesity, overweight, and central obesity observed in our relatively young population were alarmingly high, at 35, 32 and 55%, respectively. A UAE cross-sectional survey conducted in 2000 revealed an overall UAE obesity rate of 34% (40% among women and 26% among men).”
Taking control
As Sharma and Mattke have said, there have been several region-wide causes of the current health crisis afflicting young people in the Gulf. But there are simple and effective ways of curtailing the illnesses: better education and primary care; an intensive public health campaign to teach young people about diet and exercise; and more public money spent on these essentials instead of prestige projects.
This could mean an entire reformation of the way public health is funded and carried out in the GCC countries. While it could lead to some pain (and a dip in profits as the area builds itself as a global medical tourism hub), the long-term effects will have massive benefits for the indigenous population, including a reduction in obesity, diabetes, and the strokes and heart attacks that are prematurely affecting the young.
More can and must be done to make sure that proper diagnostics are a part of the solution, and not just a reminder of the scale of the problem.
