From soft drink taxes to detecting people at risk, the United Arab Emirates is promoting health by beating noncommunicable diseases
His dizzy spells came often, as did feelings of tiredness and passing of urine. For 10 years, Salem Hamad Al Mehairi knew something was wrong, but he couldn't put his finger on it.
But the mystery was solved with just one visit to his local primary health centre in Dubai, which had been upgraded, in line with WHO recommendations, to routinely screen all patients for noncommunicable diseases (NCDs), like cardiovascular and lung diseases, some cancers and type 2 diabetes.
"My tests revealed my blood sugar was very high, and it was confirmed I had type 2 diabetes," Salem says. "My doctor prescribed medicines but I was not really compliant."
Dedicated care for NCDs
Combined with a mix of poor diet, sugary drinks and limited physical activity, Salem’s health did not improve. He was later referred to a clinic where a multidisciplinary team, comprising a diabetes nurse, dietician and family doctor, implemented a strict regime of counselling, dietary advice and treatment.
"Soon, my overall health improved and I began feeling more energetic," he says. "Having close access to quality care from the health centre helped improve my condition."
Across the United Arab Emirates, authorities have been tackling the rising trend of NCDs, taking strong measures to protect people from exposure to harmful products, like taxing tobacco and sugary drinks, to scaling up chronic disease screening, including for cardiovascular disease risk, and care at primary health centres.
NCDs on the rise
NCDs account for 76% of all deaths in the UAE, or 11,600 every year. There is almost a one in five chance of dying prematurely – between the age of 30 and 70 – from one of these largely avoidable conditions.
Thirty percent of people in the United Arab Emirates die from cardiovascular diseases, and deaths from diabetes are rising. Almost 20% of adults live with diabetes.
"We are witnessing an increasing number of NCDs, especially diabetes, including seeing young people with the disease, something we had never seen before," says Dr Buthaina Bin Belaila, Director for the Ministry of Health and Prevention’s NCDs unit. "The risks that cause NCDs, like poor diet, sugary drinks and tobacco, are increasing."
Prevention and treatment – two sides of the NCD response
The UAE government has taken a two-pronged approach to address the NCD threat – prevention and increasing access to health care.
On the prevention front, the government hiked taxes on cigarettes and energy drinks by 100% and sugar-sweetened beverages by 50% in October 2017. It is also working on regulations to control marketing on fast foods, and implement healthy canteens and increase physical activity in schools.
Revenues raised from the tobacco and beverage taxes will go towards strengthening the country’s second approach to NCD care – detecting those at risk, like Salem, and ensuring access to treatment for those living and working in the United Arab Emirates.
UHC and primary health care – essential for beating NCDs
"Universal health coverage is a priority for the UAE," says Dr Hussain Al Rand, assistant under-secretary for primary health care and public health at the UAE Ministry of Health. "Taxes raised from sugary drinks and tobacco will allow the Ministry of Health to have more funds for the health system."
Scaling up NCD services in the country’s 71 primary care clinics is a pillar of the UAE’s health system strengthening. NCDs-specific units have been integrated in 21 of the clinics since March this year, and all staff have been trained on NCDs.
"Primary health care is the closest form of care to the public. This is the first access to any kind of healthcare," says Dr Bin Belaila. "Any person aged 18 and above attending a clinic is screened for NCDs and their risk factors – blood sugar and pressure levels are assessed. People who are smokers are being checked for chronic obstructed pulmonary disease. Treatment is being provided."
The scaling up of NCD services is in line with WHO’s package of essential noncommunicable (WHO PEN) disease interventions for primary health care in low-resource settings nationwide. The package includes treatment protocols for managing people identified through screening as being at risk.
Learning from the UAE experience
A United Nations mission recently saw first hand the progress the UAE is making on NCDs, and both sides are collaborating to protect people’s health.
“The UAE is successfully scaling up multisectoral action to prevent heart disease, diabetes, cancers and chronic respiratory disease, and undertaking a number of recent innovations to improve the way the health system is responding to NCDs,” says Dr Nick Banatvala, from the WHO-led UN Interagency Task Force on NCDs. “There is the potential for a deep and long-lasting partnership between the UN and UAE on NCDs - one that can bring great benefits to both sides. We have agreed to work together to see how we can best take this forward.”
Dr Asmus Hammerich, Director of NCDs for WHO’s Eastern Mediterranean Regional Office, says the UAE is an example of a country prioritizing action against chronic conditions in light of the health and economic burdens of NCDs.
"We are very encouraged by the recent legislative action for health in the UAE and some of its neighbouring countries," says Dr Hammerich. "As the rise of NCDs has been acutely felt in the Gulf region, WHO is working closely with countries there to strengthen their systems and services to prevent and control these conditions."
A national agenda has been set for the health system with 10 specific goals to be achieved by 2021, five of which are related to NCDs: tackling CVD, diabetes, cancer, obesity and smoking.
"We are a developed country, so people are living longer," says Dr Bin Belaila. "So we will see more people suffering from NCDs. We want all people to live and age healthily."