Diseases of Lifestyle

Diabetes in the UAE
– Portrait of a country at risk


In its few short years of existence the United Arab Emirates has achieved remarkable economic growth, significantly raising the prosperity of its citizens and the many expatriates who have come to work in the country. However, along with this new-found wealth the country is struggling to cope with a growing epidemic of diabetes, that if left unresolved could significantly affect the future prosperity of this land. Grant McLaughlin, Jason Kemp, and Katherine Stoltz of Booz Allen Hamilton highlight key issues raised during a convention of business leaders who came together to discuss this critical issue.

The United Arab Emirates (UAE) has achieved an impressive level of economic development. In particular, its healthcare sector is among the best performing in the world. By many measures of health status (infant mortality, life expectancy, eradication of numerous infectious diseases), the UAE has reached levels comparable with other developed nations. In addition, the health infrastructure which includes facilities, equipment, and staff, are of high quality. This healthcare is offered freely or at low-cost to citizens and highly subsidised to residents and tourists. The fact that the UAE has made such great strides in achieving a high level of excellence in accommodating the healthcare needs of so many people is a testament to wise resource management policies. However, at least one health pandemic threatens to unravel the system’s stability: diabetes.

The World Health Organisation (WHO) and the International Diabetes Federation (IDF) call diabetes the 21st century’s leading healthcare challenge. Diabetes complications and mortality create social and economic challenges that affect individuals, families, businesses, and society as a whole. Six Middle East North Africa (MENA) region countries – Bahrain, Egypt, Kuwait, Oman, Saudi Arabia, and the United Arab Emirates (UAE) – are among the world’s 10 highest for prevalence of diabetes and impaired glucose tolerance. By 2020, 32% of the adult UAE population (age 20-79) may have diabetes or pre-diabetes, while other data indicate that the adult UAE population (ages 18 and above) has already reached a diabetes or pre-diabetes rate of 44%. If trends continue, the IDF projects that by 2030, the number of people with diabetes in the Middle East North Africa (MENA) region will almost double, reaching 59.7 million.

Booz Allen Hamilton, a leading provider of management and technology consulting services, has been studying the effect of diabetes on governments, business, and society in the MENA region. On November 5, 2012, Booz Allen Hamilton convened executives from leading companies operating in the UAE in an event, “Diabetes in the UAE: Workplace Strategies Tabletop,” which aimed to foster collaborative solutions to the crisis. It is the first in a comprehensive series of events across the Gulf Cooperation Council (GCC) countries over the next six months that will explore various elements of economic competitiveness and the role that issues like the diabetes crisis can play with regard to charting the course for long-term sustainable socio-economic growth in the region. Due to the rapid increase in diabetes cases and complications that threaten to overstrain the health system within the near future, it is important to begin conversations now.

The diabetes pandemic

In order to inform diabetes prevention efforts in the UAE, Booz Allen Hamilton commissioned two studies in 2012. The first assessed diabetes prevalence and incidence, risk factors, prevention programmes, and economic costs in the country; reiterated the scope of the problem; and examined contributing lifestyle and genetic factors. This study also categorised existing prevention programmes and highlighted collaborative efforts and outcomes. Booz Allen Hamilton then commissioned a survey to understand the attitudes and behaviours that put Emiratis at risk of developing diabetes and to identify possible ways to mitigate risk factors and encourage healthy behaviours. This survey found that while high levels of awareness exist among Emiratis, there are widespread obstacles to preventative behaviours.

The UAE has the second-highest diabetes rate in the world, with an estimated 20% of residents and 25% of nationals suffering from the disease. Nearly three-quarters of diabetes patients in the UAE do not have their diabetes under control, a challenge particularly pronounced among children and young adults. It is estimated that 40 to 50% of diabetics in the UAE are unaware they even have the disease. Left unchecked, the spread of diabetes portends devastating social and fiscal consequences, including threats to economic progress and investment stability in the region.

Obesity, hypertension, and cardiovascular diseases (CVD) are often comorbid to diabetes. Diabetics in the UAE, along with Qatar, have the highest prevalence of cardiovascular disease among GCC countries. This is significant because comorbidities complicate treatment and contribute to mortality rates. Of adult Emiratis, 71% have at least one risk factor for CVD. In 2005, 31% of all deaths in the country were due to diabetes and CVD. The risk of a heart attack is three times greater and the risk of a stroke is two to four times greater for all individuals with diabetes, leading to the sobering statistic that approximately 50% of diabetics eventually die from CVD. However, studies have demonstrated that effective treatment can lead to over a 50% reduction in heart failure.

Economic costs of diabetes to the UAE

These startling statistics regarding diabetes in the UAE are driving the enormous associated costs borne by the government, civil society, and private sectors. Direct treatment of diabetes constitutes approximately 40% of the UAE’s overall healthcare expenditures. In 2011, the total cost of diabetes to the Emirates was nearly $6.6 billion or 1.8% of GDP, higher than in any other GCC country (See Table 2). As diabetes is predicted to escalate in the region, associated costs will skyrocket. By 2020, if current trends continue, diabetes may cost the country $8.52 billion. The growth of diabetes is so serious that healthcare systems are already struggling to cope with treatment costs. Medical expenditures for those with diabetes are on average 2.3 times higher than for those without the disease, while at the same time health insurance premiums have seen a 20% rise due to the withdrawing of premiums that were sold at far below cost in an extremely competitive market. The high level of undiagnosed and poorly controlled diabetes threatens to lead to an increase in related complications and to increased healthcare costs in the future.

Exploring solutions: Private sector participation

These epidemiologic and economic findings demonstrate an imperative need to dramatically increase diabetes prevention and management efforts within the UAE. Healthcare professionals are a critical piece of the puzzle, but commitment is needed from every sector of society to prevent and mitigate the disease.

The event, “Diabetes in the UAE: Workplace Strategies Tabletop,” held on November 5, 2012, in Abu Dhabi included representatives from the food and beverage, hospitality, pharmaceutical, and healthcare industries, among others. The group engaged in a dynamic, participant- driven simulation exercise designed to provide stakeholders an opportunity to explore cooperative strategies about how to effectively address the growing problem of diabetes amongst employees and their families. During the simulation, participants acted as managers of a fictional multinational corporation operating in the UAE and had to make choices to address employee health circumstances in near-, mid- and long-term time frames. Using a fixed budget, participants had the opportunity to evaluate, prioritise and purchase choices from a menu of programmes that could help their employees. Recommended programmes were evidence-based and designed specifically for this event by subject matter experts at Booz Allen Hamilton; they focused on nutrition, fitness, mobile health, disease management, screening, cash incentives, and awareness.

Over the course of the exercise, participants found the highest value in prioritising three types of programmes: disease management measures, fitness and nutrition programmes offered by employers, and cash incentives. Most participants consistently chose to support a comprehensive disease management programme that would provide automatic prescription refills and weekly meetings with an on-site wellness coach. They prioritised nutrition and fitness programmes, wanting to provide literature on healthy eating habits and company-sponsored memberships to an on-location gym, given that the company had sufficient resources to carry out these initiatives. Participants also expressed a strong interest in implementing cash incentive programmes to promote healthy practices, but understood that such initiatives would not be appropriate for many types of workplaces. As participants explained and debated their choices, several valuable insights became clear throughout the course of the day that should influence future decision making:

- Institutions cannot take a “one size fits all” approach to implementing corporate wellness programmes. It is especially important for multinational organisations to establish wellness programmes that can be customised and adapted for the unique needs and challenges of employees within its operating countries.

- Leadership is critical for motivating behaviour change. Methods such as setting a positive example and creating an environment where employees feel safe and encouraged to participate in programmes can drive behavioural changes.

- Comprehensive wellness programmes should not be limited to workplace solutions. Programmes that also encourage employees to extend behavioural changes to other critical areas of their lives (e.g., the home) and other risk behaviours (e.g., smoking cessation) are integral elements of a comprehensive wellness programme.

Underscoring the importance of the event’s open dialogue, Don Pressley, Regional Managing Director for Booz Allen Hamilton Middle East said: “Increasingly, leaders are realising that in an era of growing complexity, old ways of approaching problems are no longer successful. [During this event,] business leaders from all over the Emirates demonstrated unique insight and strong motivation to fight our number one public health priority – the diabetes crisis. Given our unique position in Abu Dhabi, we are eager as a firm to support future collaboration between sectors on mutually-important goals such as antidiabetes initiatives.”

Encouraging behaviour change in the UAE

The November 5th event yielded a number of important observations. Participants across industries recognised the need for collective action to address the challenge of diabetes in the UAE. They noted, however, that a sense of urgency around the problem is still missing from the conversation. Participants agreed that the overwhelming evidence about diabetes presenting a growing health and economic challenge required more than just a series of short-term solutions. These business leaders suggested that in order to create a sense of public urgency around a crisis of this magnitude, multiple sectors across the healthcare spectrum – providers, patients, and payers (often private businesses) – would need to collaborate to identify solutions. In particular, participants recognised not only the important role the government could play to encourage this dialogue and to foster a sense of urgency, but also that the government was not the only actor that could promote change. Reggie Van Lee, Executive Vice President at Booz Allen Hamilton and co-author of “Megacommunities: How Leaders of Government, Business and Non-Profits Can Tackle Today's Global Challenges Together,” (www.megacommunities.com) underscored the importance of what such cross-sector engagement can achieve: “Stakeholders are brought together based on their overlapping vital interests, and they can pursue those interests, to their benefit, without worrying about giving up their identities or betraying their core constituencies.”

The following day, on November 6, 2012, Booz Allen Hamilton convened a group of leaders representing public relations, advertising and mass media institutions at a roundtable event as a corollary to the “Diabetes in the UAE: Workplace Strategies Tabletop” event to discuss the role that the media could play in addressing diabetes in the UAE. Participants agreed with their business leader counterparts that while awareness around diabetes in the UAE is high, the public perception of its importance is low.

To increase awareness and create a sense of urgency, a longer-term and more comprehensive communication strategy is necessary. Sustained awareness campaigns which use multiple methods such as testimonials, social media, and mass media can help create the necessary public sense of urgency to influence lifestyle behaviour changes. Media leaders agreed with the private sector participants that leadership and government support is critical to generating the kind of awareness necessary to encourage the behaviour change needed to stop the spread of diabetes in the UAE. They cited examples of how a champion from the governing leadership or another prominent figure supporting and bringing attention to an issue can motivate this form of behaviour change. They also thought that a key to the future of changing behaviour around diabetes prevention and management might be finding ways to engage personally with individuals through innovative methods such as mobile phone applications that can help individuals manage their disease through fitness, nutrition, and overall health tracking.

A call to collective action

Organised public responses and research have argued that as the diabetes crisis continues to grow, the need for more collaborative and effective efforts to improve the health and well-being of Emiratis increases. Though public, private, and civil sector organisations across the country have worked hard to positively impact the escalating diabetes crisis, it is clear that more remains to be done to raise the level of action in the UAE around it. Through a dedicated network of stakeholders, tailored interventions can be designed that are both culturally appropriate and can engage all sectors of society to create immediate, sustainable impact on behalf of Emiratis and their families.

The authors

Grant McLaughlin is Vice-President, Jason Kemp, Senior Associate and Katherine Stoltz, Lead Associate at Booz Allen Hamilton.

 Date of upload: 22nd Jan 2013


                                               Copyright © 2013 MiddleEastHealthMag.com. All Rights Reserved.