Health has improved dramatically in the United Arab Emirate (UAE) in the past 50 years. The under-5 mortality rate has fallen dramatically from 223 (per 1000 live births) in 1960, to 84 in 1970, 30 in 1980, 17 in 1990, 11 in 2000 and 7 in 2009. For under-5 mortality, UAE is currently ranked 39th amongst the world's 196 countries. This decline in death amongst children has resulted in life expectancy increasing over the same period from 53 years in 1960 to 78 years in 2009.
These improvements in health have been possible because of visionary leadership and the wise investment of oil revenues to improve the social conditions of the population3. Investment in hospital services, public health infrastructure, preventative services, immunization, services for children and women and female education have transformed the UAE from a small, mostly nomadic and seafaring economy to a major industrial nation within a generation, a rate of development unprecedented in human history.
While these changes have been taking place new health challenges have emerged. These include rapid growth of the population in which expatriate workers make up more than 80%; lifestyle changes that are leading to increasing levels of chronic diseases such as diabetes, heart disease, stroke and cancer; and high levels of the factors that cause these conditions namely obesity, inactivity, poor diets and tobacco use. The UAE also has high rates of injury on the roads, at work and in the home.
Over the past 40 years in the UAE, the hospital sector has developed strongly and facilities are now among the best in the world but again this development has brought problems and as in many other countries, the UAE health system is now facing the twin challenges of how to maintain quality while controlling costs. Also, the current and future health needs of the population are complex and may not be properly served by the continued expansion of hospital capacity. For example, rising levels of morbidity amongst nationals will require the development of chronic disease management programs that support screening, prevention and self-care and community based generalist services may be more effective than hospital based specialist services. The expatriate population also has unique health needs. This population has lower morbidity so that ambulatory care, occupational health and preventative services offer the greatest benefits.
In the next 5-10 years careful planning by health authorities, continued investment in services and programs and the regulated expansion of the private sector should allow the health needs of nationals, expatriates and medical tourists alike to be satisfactorily met by the development of a comprehensive range of modern, high-quality health services and public health programs.
However at the same time, lifestyle changes on a population scale are urgently needed to reduce obesity, diabetes and heart disease and to reduce the effect of these diseases on health services and improve health related quality of life. Unlike most western countries, in the UAE, alcohol, drugs and HIV infection are less important public health determinants but obesogenic lifestyles (inactivity coupled with overconsumption of energy-dense foods), smoking, road crashes and mental health are all important.
How can these twin tracks of health systems strengthening and lifestyle modification be achieved?
The key requirement is high quality decision making, planning, policy development, implementation and evaluation by our public leaders not only in the health field but also in those areas that affect health, namely environment, education, social services and economics.
Future decision making and planning must be based on the best possible information and evidence. Health can only be improved if interventions and programs are effective and there has been an accurate assessment of health need.
Currently our decision takers and policy makers lack support. In most other countries they would be supported by at least one policy and research agency or institution. In the UAE there is no such entity. However it is proposed that the newly established Zayed Center for Health Sciences will develop to fill this essential role in the UAE.
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