Whitney Purdum
Last updated: 10 March, 2012

Comment: Rethinking Health in the Gulf

“The Gulf Cooperation Countries are rushing to repair one particular sector that has gotten little attention during the Arab Spring, but which is hugely important for the region’s burgeoning population. That is the health care sector”, writes Whitney Purdum.

The regimes that are still standing in the Arab world are scrambling to meet public demands and make amends for years of political repression. Cabinets have been sacked, term limits have been established and constitutions are being amended. Administrations can implement some of these reforms quickly, while others may take years. The Gulf Cooperation Countries are rushing to repair one particular sector that has gotten little attention during the Arab Spring, but which is hugely important for the region’s burgeoning population. That is the health care sector. Without massive restructuring and reform, a lack of adequate health care might be the next grievance that is aired on the streets.

Compared to the rest of the world, the population of the Gulf Cooperation Council countries is skyrocketing. Qatar’s population has doubled in the past decade. The United Arab Emirates has the highest population growth in the world – since 1961 its population has grown by 3,000%. Saudi Arabia’s average yearly population growth rate is 2.2% – four times higher than that of developed nations. On average, the GCC population is growing at 2.2% annually. At face value that number is not jaw dropping, but that is twice the average global rate of 1.1%. More people means a greater demand for health care services. The health care sector is expected to grow by 11% annually, and within three years it will be a $44 billion dollar industry for the GCC, with Saudi Arabia and UAE accounting for most of the growth.

It’s not just the issue of population growth that is daunting. The Gulf population suffers widely from medical conditions that require long-term, even life-long, care. As of 2008, 20% of UAE citizens had been diagnosed with diabetes, and that percentage rises to 40% for people aged 60 and over. In comparison, 5-7% of U.S. citizens have diabetes. The GCC has the highest obesity rate in the world – 40%. With obesity comes a plethora of other conditions like heart disease, cancer, and arthritis. Combine high birth rates with endemic chronic illnesses and the public demand for health care services is compounded. In the next 12 years, the demand for hospital beds will more than double.

As the health care industry expands, so will the need for qualified health care professionals. But even now some GCC countries have chronic shortages of health care professionals, partly because the field of medicine is not seen as an attractive or financially lucrative profession. As such, the medical profession in the United Arab Emirates relies heavily on foreign workers. This month the Dubai Health Authority announced that out of 3,000 nurses employed in the Emirate of Dubai, only 55 of them are Emiratis, and only one out of every 5 doctors are from the Emirates. GCC countries are crying out for specialists who can attend to the specific health problems that plague the region.

In order to meet the new demands that come with population growth, GCC governments are looking to the private sector to help modernize their facilities. Governments are pouring money into private health care developments to attract ‘health-care tourists’ from around the region. Health care tourism provides top-notch health care for a premium price. One may wonder why the government is diverting funds for high-price care when citizens at home are in dire need for public services, but the argument is that the money made from health care tourism is channeled back into state health care funds. It also keeps wealthier citizens from seeking treatment in other countries. This is a point of contention for medical professionals who work in the public health sector. Oman for example is spending $1 billion on a ‘medical city’ that will be the largest health facility in the country, providing state-of-the-art equipment and highly trained specialists. At the same time Omani doctors outside of the private health care system feel financially slighted and overworked. In March of 2011, doctors across Oman went on strike because of pay dissatisfaction and insufficient resources. Strikes have continued to occur periodically throughout Oman since January 2012. Medical professionals are demanding more hospitals and health care facilities, higher salaries and more specialists from ‘developed countries’ to serve as consultants.

With a growing demand for health care, GCC countries are rethinking how they are going to finance it. Almost all of the GCC countries are unique in that they are rentier states; most of their income comes from oil and gas exports, and as such they do not heavily tax their citizens. Reliance on public services like health care is high. Saudi Arabia, for example, shoulders 75% of its citizens’ health care costs. In 2009 the Saudi Arabian government allocated 4.5% of GDP to public health care, while the United Arab Emirates spent 2.7% of GDP on healthcare. These numbers are low in comparison to other developed countries; the United States for example allocates on average 16%. In an attempt to alleviate dependence on public health care, the Saudi government passed a law in 2006 stipulating that companies with 500 or more employees must provide a comprehensive company health insurance plan. At the time of that legislation, less than 10% of the population was covered by private insurance. While the global demand for oil will not wane significantly any time soon, GCC countries are looking for more economically sustainable and less government-oriented systems to provide access to health care.

With respect to the wider Middle East region, the GCC population explosion is not unique. Egypt, Syria, Yemen and most countries in North Africa have youth bulges in their population. Modernization of the health care system, and the role the government will play in providing health care, will have to be recalibrated. Newly dismantled regimes such as Tunisia and Egypt will be dependent on loans from foreign countries, the IMF and World Bank in order to restructure their economies and create a competitive job market for the young population; these loans will come with conditions, some of which will demand that government institutions and the role they play in social welfare be reformed. There is no doubt that their current health care systems and subsidy programs will be scrutinized for efficiency and effectiveness. Gulf countries are certainly in a better position financially than their neighbors to modernize and expand their health care system, but population growth and ailments related to lifestyle choices will not cease overnight. Solutions require educating the public on health and family planning and government consensus on the most effective way to do so. Looking forward, GCC leaders should ensure that health care solutions will be inclusive of all income levels and that the health care system is prepared to meet the challenges of the coming GCC generations.

This article was first published in Global Politics on 7 March and is reproduced here with the permission of the author. To see the original article, please click here.