Why the UAE’s healthcare model is actually a ‘sick care’ model

When do you think about healthcare?

If you’re like most people in the UAE and across the world, it probably only crosses your mind when you’re sick. Here’s the problem: This isn’t a workable model for the future.

The fact of the matter is that it’s our lifestyles that are very often making us unwell and it’s only by making changes at this level that we can see real health benefits for individuals and dramatic savings for businesses.

Need more convincing? Well, the World Health Organisation (WHO) spells it out pretty clearly:

“A large percentage of NCDs (that’s non-communicable diseases such as cancer, diabetes, respiratory disease, obesity and cardiovascular disease) are preventable through the reduction of their four main behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet.”

So there we have it: Smoking, not taking enough exercise, drinking to excess, and poor food choices. If those are so vital to our good health, shouldn’t our healthcare reflect that?

Steering the UAE healthcare model in the right direction

In the Global Burden of Disease report (by the Institute for Health Metrics and Evaluation) the warning signs for the Gulf region are clear. The research showed that in 2013, it was “alcohol and drug use, high body-mass index, and dietary risks” that were the leading risk factors for lost years from disability, ill health or death.

So shouldn’t we be addressing these areas as a major priority, rather than taking the usual hands-off approach and turning up at the 11th hour to try and cure our ailments?

The improvements to a population’s health would be dramatic. Take diabetes as a key example: According to the most comprehensive study of its kind in recent years, the American Diabetes Association estimates the cost to the American healthcare system in 2012 was $245bn. Now let’s take Diabetes UK’s estimate that some 58 per cent of type 2 diabetes cases could be prevented through lifestyle changes.

Make those changes, then see the health benefits and the business savings.

Understanding the “sickcare” framework

So it’s clear change is needed. But what exactly does that change look like?

The very philosophy of our current healthcare model does not lend itself to a prevention mentality. We are stuck in the belief that we only need to worry about our health when we become sick, and that most medical conditions are either genetic or simply bad luck.

The reason for this common belief comes down to lack of education around lifestyle and disease.

Because while it’s true that some medical conditions are bad luck or related to genetics (or a mix of the two), the common NCDs that plague Western society and the UAE such as cancer, diabetes and heart disease are much more strongly linked to how we live our lives. These and many other common health problems can be either prevented, lessened or reversed to some degree if addressed early enough.

Early. That’s the key word. And we’ll return to it.

So if the link between lifestyle and poor health is so clear, why do so many of us fail to act on the evidence? Well, it’s because we have become used to the “sick care” model: We simply live as we like then when we get sick we go to the doctor who diagnoses us and prescribes a course of treatment.

The problem is the medicine is doing nothing to improve our overall health – it is simply treating the symptoms of the illness. We then continue with the lifestyle that was making us sick in the first place and… well, you can see where this is going. It becomes a vicious circle.

From doctors to the healthcare industry: What needs to change

So how do we make the move to a healthcare model that truly focuses on health? Responsibilities for this fall onto individuals, doctors, businesses, and the medical health insurance industry.

As individuals, we need to be aware of just how much our lifestyles damage our health. Beyond that, we need to take more responsibility for knowing just how healthy we are. How do we assess our own health – is it just because we happen to feel okay at any given time?

What if I then told you that many grave medical conditions start to impact on health for months or even years before the first symptoms appear? Damaged cancer cells can take years to develop, while pre-diabetes is often evident in sufferers up to a decade before it presents itself as full-blow type 2 diabetes.

The only way for us to know about these dormant conditions is through regular and comprehensive health screenings. This isn’t the traditional annual corporate health check-up, I’m talking about a modern and thorough medical screening that tests across the broadest possible spectrum of health biomarkers. This enables doctors to spot potential illnesses early and use test results to help the individual achieve and maintain an acceptable level of health.

And this is where doctors in fact need to play a far greater role. Of course they must treat the sick. But medical professionals also need to be proactive in protecting the wellbeing of the healthy as well.

Firstly, by encouraging their patients to come for consultations rather than just waiting for them to show up sick. Secondly, making sure that when patients do present themselves with signs of illness, time is taken to help them understand the root causes and what can be done in terms of lifestyle to manage or even reverse the situation.

The health insurance industry has a case to answer here as well. While many now offer coverage for health screening and other preventive initiatives, how many are doing enough to promote the use of these?

How many emphasise all the points we have been discussing in terms of reducing the controllable factors that lead to serious health issues?
Let’s not forget corporations either. They need to look at how they build a working healthcare model, providing wellness programs to educate staff and incentivise health screening and nutritional and fitness regimes.

So everyone needs to contribute.

Change in healthcare: A real-world example

If this seems like too much of an upheaval for a “sick care” model that has existed for far too long, take heart from the fact that the proactive model I am describing already exists and is seeing great results. And you may be surprised by the country example we are going to use to highlight the point.

In Cuba, doctors pay regular visits to the homes of their patients. As well as performing a number of tests – blood pressure, heart rate and other vital signs – they also discuss lifestyle and take note of anything in the home that could be hazardous to health. After these regular consultations, physicians put patients into categories: If you are in perfect health then an annual check-up may be enough; if you are displaying any early signs of sickness you will be seen much more regularly and advised on lifestyle changes that could improve overall health.

It works. The Cuban health services outperforms the majority of low- to medium- income countries as well as a good number of richer ones too. In fact, Cuba ranks 39th on the WHO World Health Service index, just two places below the US and above countries such as South Korea and New Zealand.

Even more compelling is the fact that, despite spending just $431 per head on healthcare, Cuba has a lower infant mortality rate and similar life expectancy to the US (which spends around $8,553 per person.)

Better health, better quality of life: At a fraction of the cost

As the Cuban model shows, a lot can be achieved with a little money as long as the focus is on health rather than sickness. Imagine if each of us from childhood were aware of the responsibility of looking after our own health; if the consequences of our lifestyles weren’t mentioned after the fact but instilled from the start. The job of the physician then changes – not to one who heals the sick, but to one who helps to analyse and optimise our mental, physical and emotional health.

However, we should also acknowledge some potential pitfalls that would come with the adoption of a real healthcare model.

For one, we are all imperfect and there is an awful lot around to tempt us – especially in the UAE. What’s more, many of the lifestyle factors that impact our health, such as smoking and sugary foods, are highly addictive. Assuming they could be instantly eradicated from everyone’s lives isn’t practical.

It also requires proactivity on the part of the individual. For example, at Willis our findings suggest that people are often not proactive about their healthcare even when given the opportunity: Wellness engagements numbers are falling. So more employees than ever before are being offered health screenings and preventative regimes but they are simply not making use of them.

So where does that leave us now? Well, it gives us a mountain to climb – but not an impossible one if the right education is brought in early enough. We know the “sick care” model is not fit for purpose: It’s not keeping us healthy and it’s astonishingly expensive. But the worst part of all, it’s entirely of our own making. So rather than lament its shortcomings, let’s focus our attention on building a better model.

One that truly works for us all.

Stephen Maclaren is head of regional sales employee benefits at Al Futtaim Willis