On February 8, 2015, CIRS held its second working group on the Healthcare Policy and Politics in the Gulf research initiative in Doha. Participants gathered for the second time to discuss their research findings and obtain feedback from their fellow working group members. The topics discussed during the day covered a wide range of healthcare issues including the historical transformation of health services in the Gulf region to the status of mental health and substance abuse issues that have arisen as a result of changing lifestyle patterns.
The historical overview provided on the transformation of healthcare in the Gulf region showcased four distinctive phases. A common denominator in the situation of healthcare prior to the 1950s amongst the six Gulf states was the role of American and Dutch missionaries in setting up hospitals and health services. Discussants emphasized the fact that the missionaries’ efforts were not intended to be civilizing force but were an extension of the British presence in the region meant to supplement the limited health services already available. Between the 1950s and 2000s, wealth generated by the oil revenues coming from the region invigorated the study and practice of medicine within departments in universities. In the case of Saudi Arabia, several health structures existed in parallel with one another, however, the annual Hajj pilgrimage forced the state to centralize healthcare efforts and create a unified system that would deal with the health epidemics that eventually arise from such events. Currently, the health sector in the Gulf is in need of reform due to the paternalistic feelings the states hold toward the provision of healthcare. Discussants argued that a severe lack of medical educational institutions exist in the Gulf, which is reflective in the quality of physicians and medical services being provided in the region. Moreover, the role of the private sector is in need of further study as there is no explanation as to why patients are shifting from public to private healthcare institutions.
In terms of human resources in the health sector, GCC countries seem to struggle with the workforce not being home grown. The UAE is a unique case whereby data has shown that the nationalities of the doctors practicing within the country encompass 110 different countries. Aside from data records on manpower in the health sector, data collection in the Gulf remains to be sporadic and imprecise. No routine data collection for the WHO exists at the moment, whereby actual data acquired is mere estimates given by hospitals. Also, a more standardized process for recruitment of physicians is necessary because it imposes essential safeguards and helps establish doctors in the region. Revalidation processes have been put into practice recently by the Qatari government to assess the competency of physicians practicing and to identify the quality of work being provided. In the case of the non-physician workforce, the affluent lifestyle enjoyed by many locals in the Gulf is a deterrent to entering the healthcare sector when a socioeconomic need does not exist. Non-physician positions such as nursing or technical staff are often hired from abroad due to the lack of medical institutions that train individuals in these professions. However, these conditions are gradually changing as both Qatar and Oman have recently opened nursing colleges to train the local and expatriate population based on the hiring needs of the local health sector. Participants questioned whether the lack of nationals in the health sector can be attributed to structural limitations of demography and whether the establishment of medical schools can be considered an integral part of the state-building process.
Healthcare in the Gulf region remains to be a political notion. Provision of free healthcare constitutes a facet of the social contract that is provided alongside education and housing by the Gulf ruling families. The lack of non-state actors such a political or civil groups means that healthcare, as a policy, is rarely debated from a bottom to top approach.
In the case of other countries in the region, such as Lebanon, non-state actors and civil society groups provide a good reference loop and prevent policies from becoming ad hoc. In 2015, $42.9 billion was spent collectively on healthcare by the Gulf states, indicating a dire necessity for development in the healthcare structure. A further exploration into the process of policy-making in healthcare is necessary. The rapid modernization faced by many Gulf societies has created a myriad of both mental and physical diseases as a result of unhealthy and affluent lifestyles. Additionally, the high percentage of expatriates within most GCC states impact healthcare policies dramatically because data does not always differentiate between local and non-local populations. As a result, diseases such as obesity, often associated with the local population, can seem to be epidemics even though the overall percentage of people diagnosed as obese is small comparatively, when the expatriate population is accounted for in the data gathering.
Examples of chronic lifestyle diseases that have recently emerged in the region as a byproduct of affluence and rapid modernization are cardiovascular diseases, diabetes and obesity. The profile of such diseases that have emerged alongside the changing lifestyles in the Gulf showcase the lack of exercise and high-fat diet as emerging trends in chronic diseases. Participants tried to quantify the chronic disease profile of the GCC, in comparison with other high and middle-income countries, using OECD base-line data. In addition to previous studies, the data showed that major depressive disorders and road injuries were the leading causes of a disability adjusted lifestyle in comparison to worldwide standards. Nonetheless, more health awareness campaigns are necessary in the Gulf because there seems to be a high level of societal ignorance towards the impact of chronic diseases on life expectancy rates. Awareness campaigns must also extend to mental health issues, whereby the percentage of people who require mental help and actively seek it constitute only 25% of the population. Additionally, the problem with mental health care providers is that they often have to be the primary, secondary and tertiary care providers instead of mental health clinics and support groups.
In terms of substance-use disorders in the Gulf region, the changing patterns in education and family structure have all contributed to an ‘urban drift’ amongst the youth population, who often find themselves unable to belong and relate to their societies. Such sentiments in youth can be problematic because it can lead to self-medication in the form of consuming excessive amounts of alcohol or the use of recreational drugs. Opinions on substance-abuse disorders in the Gulf region often oscillate between the two polar opposite views of approaching it as an immorality or as a disease. Existing scholarship explores the relationship between availability of substances and the level of drug usage however, it was argued that there should be an evolving mechanism that liberalizes some of the less harmful substances in society to combat the prevalence of more detrimental drugs.
Noteworthy to mention is the situation of the healthcare system in the Gulf which has become multi-tiered, primarily due to the lack of proper population health need assessments, including short-term health solutions for low-skilled workers. Even though the Gulf region has attained significant social and economic achievements in a short span of time, healthcare policies are still centered more on curative health and not enough on protective and preventive measures. Discussants argued that the Gulf states spending on healthcare is below average, by WHO standards, which is reflective in the ratios of physicians to residents and number of beds per population. Moreover, in terms of policy, different health policies exist within the healthcare structure for different patients within society. For instance, GCC legislation requires employers to buy health insurance that covers their expatriate workers. However, the insurance plans often only cover basics in healthcare, in comparison to the local population which receives the high-end health services available.
Participants and Discussants:
- Samir Al Adawi, Sultan Qaboos University College of Medicine
- Haya Al Noaimi, CIRS – Georgetown University School of Foreign Service in Qatar
- Mohamad Alameddine, American University of Beirut
- Zahra Babar, CIRS – Georgetown University School of Foreign Service in Qatar
- Suhaila Ghuloum, Hamad Medical Center
- Cother Hajat, Emirates Cardiac Society; UAE University
- Mehran Kamrava, CIRS – Georgetown University School of Foreign Service in Qatar
- Nabil Kronfol, Lebanese Healthcare Management Association; Center for Studies on Ageing
- Albert Lowenfels, New York Medical College
- Ravinder Mamtani, Weill Cornell Medical College in Qatar
- Dionysis Markakis, CIRS – Georgetown University School of Foreign Service in Qatar
- Suzi Mirgani, CIRS – Georgetown University School of Foreign Service in Qatar
- David Rawaf, Imperial College London; St. George’s Hospital Medical School
- Salman Rawaf, Imperial College London
- Elizabeth Wanucha, CIRS – Georgetown University School of Foreign Service in Qatar
Article by Haya Al-Noaimi, Research Analyst at CIRS