Gluttony costs

They call Type Two Diabetes the silent killer. But there’s nothing hushed about the effect it is having on GCC economies.
Diabetes in the region is the result of a sedentary lifestyle and popular Western fast food diet.
By Karen Leigh
Wed 26 Jan 2011 02:07 PM

The Oman Diabetes Association headquarters in Muscat is located in what everyone there refers to as “the Pizza Hut building.”

The location is symbolic of the fight Oman and the rest of the Gulf states are waging against type two diabetes, a disease which some experts estimate affects thirteen percent of adult Omanis and up to 20-25 percent of those in the UAE and Saudi Arabia. The epidemic is largely the result of a new sedentary lifestyle and Western diet introduced by decades of economic development.

As the rich get richer, the rich get lazier. They get drivers and chefs. They sit in office cubicles at computer screens instead of hoeing fields. They graze on staple junk food like candy bars and crisps all day. They drink soda.

Their sugar balance spins out of control. They become diabetic. Many of them go undiagnosed. If it goes untreated long enough, they end up with severe, acute illness — anything from kidney failure to, in a small number of cases, blindness.

Diabetes is one of the greatest healthcare challenges facing MENA countries. There are 26.6 million people in the region impacted by diabetes. The number is set to almost double to 51.7 million by 2030. Curtailing the diabetes epidemic is critical to the health of MENA’s  people — and its economy.

Governments in the GCC are stepping up their education and awareness platforms. The UAE itself hosted the MENA Diabetes Leadership Forum in December, welcoming top medical experts from around the world and even Denmark’s Crown Prince Frederik and former US president Bill Clinton, reborn as a health advocate.

The government’s motives here would be economic, at heart — estimates of how much diabetes could end up costing them in healthcare costs have varied wildly, but the consensus is firm. Hundreds of millions of dollars by the year 2030.

The UAE government currently spends an estimated $500m on diabetes annually.

But are officials’ efforts enough to combat a physically-lazy fast-food culture enjoyed
by millions?

“Given the impression I got when we were [in Dubai], there’s a high level of understanding at the political levels of the potential devastating effect of diabetes in the region in terms of lifestyle and the emerging obesity epidemic,” says Lars Sorenson, president and CEO of Copenhagen-based healthcare company and global diabetes researcher Novo Nordisk. But “they’re impacted by the culture of individual people, and it’s very hard to change culture.”

Officials have called for unity across MENA, and particularly the GCC, in establishing a plan to both stop the number from growing and help those who already have diabetes to get the cheapest, most effective healthcare possible — as soon as possible.

“This is a public health challenge,” Dr Mohmood Fikree, undersecretary for the UAE Ministry of Health, says at a forum panel discussion. “We have engaged all together for a national strategy for prevention of type two diabetes and the promotion of diabetes research.”

Some 530 doctors have been trained in diabetes management in the last two years, he said.

The higher the income level per country, the greater the risk of diabetes.

“Economic growth is unfavourable to health. We see a change in lifestyle where people move from the countryside to the city, where they’re just walking from room to room,” Sorenson explains during our first meeting, in December at the Dubai forum. “For people to eat differently and exercise is counterintuitive — we prefer to eat sweet stuff and do nothing.”

In the Gulf, this propensity means that Yemen — one of the poorest, least Westernised economies in the world, home to a traditional healthier diet and less sedentary farming lifestyle – is in the safest position against diabetes.

“The MENA region is nitrogenous, so there are countries where it’s not as much of a problem,” he says. “Yemen has lowest income per capita, so people are living rural hard lives and that means that the prevalence of diabetes is much less.”

But Iraq, which has been waging war against terrorism and insurgency, might soon find itself in the thick of another battle.

“You even have to be concerned about Iraq going forward,” Sorenson says. “The war has stopped and income levels are going up again so lifestyles will be impacted.”

Countries in the throes of economic transition are the most vulnerable to an epidemic like diabetes. Their governments are focused on the minutiae of growth — road building, developing a basic infrastructure — and its native population finds itself working most of the day, taking advantage of new economic opportunity.

Then — and the Gulf is perhaps the best example — expats bring their high-fat Western diet to a region, and a perfect health storm begins brewing.

The real hurdle for the GCC states is education of its native population about the dangers of this new lifestyle, and ensuring that those who already have diabetes are properly diagnosed and begin treatment before they contract life-threatening complications that are expensive to treat.

“The general public awareness is similar to other countries of the same income background,” Sorenson says. “So unfortunately it is a problem of a lack of public awareness, and it’s important that [healthcare professionals] get a chance to meet politicians and people from Treasury who aren’t working on public health issues all the time… but need to know about the topic to prevent it from becoming a challenge.”

Though the UAE and Saudi — the stereotypically flashier, large-living countries — boast the highest rates of occurrence, he said Oman, Qatar and Bahrain followed the same pattern and could soon close the gap.

In the next few decades, the economy will take the brunt of the epidemic, with soaring healthcare costs.

“While it may not be a major issue at this point in time, it’s likely to become one,” Sorenson says. The UAE and Saudi’s 20 percent rate means that there’s “one in every family. So it is likely to change the public perception of diabetes because it’ll be less stigmatised when people all know someone who has it.”

Experience in the US and Europe has taught researchers that diabetes is one of the most costly diseases to a healthcare system. Still, the disease itself — if caught early — is inexpensive when treated on an individual basis.

“The [early] medicines are affordable — it’s when they’re not getting proper treatment and we get very serious health issues like kidney failure, strokes, cardiovascular disease, the amputations and blindess,” he says. “These all stem from diabetes, and are likely to be one of the biggest public health costs to any public country.”

Most Gulf countries have underestimated the illness’s impact.

“It’s often countries in transition economically, and they’re dealing with trying to build infrastructure, trying to build schools and social security… most have underestimated how difficult it is to get politicians to understand that this needs to be addressed,” he said. “The UAE [government] seems to understand the issue and I think there’s reason to be optimistic that opportunities will emerge from this.”

But the impact of culture on diet and lifestyle remains key — “so the middle income countries will get worse before they get better. In the meantime the main issue is to insure there’s healthcare capacity to treat diabetes.”

Sorenson said it would take 30 to 50 years before the number of UAE residents being diagnosed with diabetes plateaus.

In the meantime, at the Dubai Mall food court and in shopping centres and drive-thrus across the Gulf, residents will go on driving and eating their burgers and fries — perhaps unaware that this very cheap food could take a helping from their finances (and their health) in short order.

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