Taking action: Combating the rise in lifestyle-related illness

In line with the rapid development of its economy, Abu Dhabi has experienced rising demand for health services, particularly for treatment of non-communicable diseases. More robust diagnosis and treatment options are responsible for increasing identification of diseases from cancer to diabetes. However, the rise in non-communicable diseases is also attributable to the shift in lifestyle and norms among nationals. To combat the rise in non-communicable diseases, the Health Authority - Abu Dhabi (HAAD) has enacted a range of preventive measures. If successful, the investments in prevention and case management may provide a model for improving health outcomes while cutting costs.

Lifestyle- Related Disease

 HAAD is particularly focused on tackling the rise in lifestyle-related diseases among nationals. Emiratis rank among the top 10 populations globally for obesity and diabetes. Linked to these indicators, cardiovascular diseases are the leading cause of death in Abu Dhabi. In 2008, HAAD implemented a new health insurance scheme for nationals and screened 95% of the local population. The regulator discovered that 36% of all nationals were obese – 33% of men and 38% of women. In addition, 21% of nationals suffered from diabetes, with this breaking down to 22% for men and 20% for women. Based on a series of indicators – obesity, smoking, hypertension and high lipids – nearly 60% of nationals aged 50-59 were at risk of diabetes and among nationals aged 60-69 over 60% were at risk. Diabetes and related illnesses ranging from kidney and circulatory diseases to eye and foot disorders have placed a heavy burden on the system. According to HAAD, diabetes treatment accounted for 12% of outpatient care costs in 2012, second only to the category of “symptoms ill-defined”. In terms of inpatient health care costs, cardiovascular diseases comprised 11% of all inpatient costs, following symptoms ill-defined and maternity. “Throughout UAE the population is ageing, and there are more and more cases of diabetes, high blood pressure and kidney disease. The need for specialised services is increasing with the growth of these health risks,” Dr Shamsheer Vayalil, chairman of Burjeel Hospital and LLH Hospital, told OBG.

Treatment

 In 2006 the Imperial College London Diabetes Centre (ICLDC) opened a facility to provide services to people in Abu Dhabi living with diabetes. Owned by Mubadala Healthcare, a unit of government-owned investment firm Mubadala Development Company, with clinical services supported by the eponymous international institution, the centre tracks patient health records electronically and specifies a series of appointments with specialists, from diabetes doctors and dieticians to pharmacists, Shukri Abu Ata, operations manager at ICLDC, told OBG. ICLDC’s services have been in high demand since day one – 95% of the patients are nationals – and Mubadala opened a second centre in Al Ain in May 2012 to help cater to demand.

Private providers are also investing in treatment options for the growing number of diabetic patients. Al Noor, for instance, is continually expanding its diabetes services, Sami Alom, chief strategy officer at Al Noor Hospitals Group, told OBG. Yet investment in the capital-intensive facilities needed to treat diabetes-related complications is often left to the government. "We need dialysis and podiatric care and cardiovascular services,” Ata told OBG. “The government is typically making these investments.” For example, Mubadala Healthcare is constructing the 364-bed (expandable to 490) Cleveland Clinic Abu Dhabi, which will provide heart and vascular care for local patients as one of five centres of excellence, and in September 2013 the Abu Dhabi Executive Council approved $28m to build a dialysis centre in Sheikh Khalifa Medical City. Kay Zwingenberger, CEO of Siemens UAE, told OBG, “We anticipate strong demand for advanced diagnostic equipment as hospitals expand their capacity to address an ageing and growing population, which has a high rate of lifestyle-related illnesses such as diabetes.”

Prevention Possibilities

 In addition to improving the quality and availability of treatment, HAAD is also promoting prevention programmes ranging from public-awareness campaigns to pay-for-health initiatives. “Diabetes. Knowledge. Action” is one such programme. Organised by ICLDC, it is the longest-running campaign for diabetes awareness in the UAE, and has been ranked sixth internationally by the International Diabetes Federation for its ability to mobilise communities and encourage individuals to take up exercise and lead a healthier lifestyle. “Awareness programmes are essential. Given that around 50% of people living with diabetes are unaware of their condition, awareness initiatives positively spur people to get screened early and get the right treatment, as well as to encourage prevention,” Bashar Al Ramahi, CEO of ICLDC and senior vice-president at Mubadala Healthcare, told OBG.

Primary causes and triggers for diabetes include poor nutrition and limited exercise. As the rise in incidence is attributable to specific behaviour, HAAD and national health insurer Daman are trying to change local habits. “We take a holistic approach,” Sven Rohte, chief commercial officer at Daman, told OBG.

In February 2012 Daman launched the Activelife initiative, through which the company organises and sponsors various events and initiatives to promote healthy lifestyles. Daman, through Activelife, sponsors triathlons, sporting events and weekly public access to Abu Dhabi’s Formula 1 track for running and walking.

HAAD runs Weqaya, a web programme in which all nationals can access the results of their health screenings and monitor their health risks. With chronically ill patients, Daman takes a more proactive role and provides access to disease-management programmes. The insurer provides its members suffering from certain chronic diseases such as diabetes and asthma with health coaches who may offer direct nutritional counselling, track exercise goals with phone calls or support members in coping with their condition. Daman launched the first of such programmes, Diabetes Management, in 2009 and has developed similar plans to manage pregnancy, asthma, arthritis and cancer. “We have had very positive responses from our members on all the programmes we have launched,” Rohte told OBG. “In 2012, hospitalisations of members in the Diabetes Management Programme have been reduced by 90%. For those in our Asthma Management Programme, the hospitalisation rate was reduced by 70%.”

Boosting Awareness

 HAAD has also launched public-awareness campaigns with the aim of increasing cancer screenings and thereby reducing fatalities. Cancer caused 14% of all deaths in Abu Dhabi in 2012, according to HAAD statistics, and breast cancer was responsible for 28% of cancer-related deaths among women, the highest percentage of such deaths.

Oncology is a field in which both the government and the private sector are expanding capacity. HAAD is also working to increase early detection and now requires all Emirati women aged 40-69 to be screened for breast cancer as part of their annual insurance renewal. With the aim of raising the number of annual mammograms to 20,000 from the 2012 figure of 16,000, HAAD relaunched its “Live Healthy and Simply Check” public education campaign. Scheduled to run to early 2014, the prevention campaign uses TV, radio and social media to encourage women over 40 to get screened every two years and women over 20 to get screened every three years. The campaign also encourages screenings for colorectal, lung and cervical cancer.

Previous efforts through HAAD’s Breast Cancer Control Programme reduced late detections from 64% of all breast cancer cases in 2007 to 16% in 2012. The number of deaths from breast cancer among female nationals also fell from 11 per 100,000 women to 5.6.

Treating Addiction

 Since 2002 the National Rehabilitation Centre (NRC) has been treating alcoholism and addiction in Abu Dhabi as a public health issue. While the prevalence of alcoholism and addiction is difficult to measure in any society, there is evidence that the problem is increasing, particularly among adolescents and young adults, Dr Hamad Al Ghafri, director-general of the centre, told OBG. Several indicators, including the rise in alcohol imports, the increase in confiscated illegal drugs and the drop in median age of drug users, point to growing usage. The number of patients treated at the NRC has quadrupled since 2008. The centre opened in 2002 and had treated only 392 patients by 2009; however, in 2013 alone, the NRC treated a total of 1450 alcoholics and addicts. “Globally, it is estimated that addiction and alcoholism costs the economy 2-3% of GDP every year when the health, financial, legal and social consequences are taken into account,” Dr Al Ghafri told OBG. “Saving in this regard would enable us to invest in other useful projects every year,” he said.

The government continues to invest in both prevention and treatment programmes. The NRC is adding an additional 50 beds to its treatment facility for a total of 200. There are ambulatory care and therapeutic homes across the country too, bringing services closer to patients. With significant resources behind the organisation, the NRC has become a centre of excellence for treatment in the Middle East and served as a consultant to the UN Commission on Narcotic Drugs.