Dubai: In January 2015, His Highness Shaikh Mohammad Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, launched a seven-year UAE National Agenda leading to the UAE Vision 2021 which will coincide with the UAE’s 50th National Day.
The UAE National Agenda, developed by over 300 officials from 90 federal and local government entities, includes a set of national indicators in the sectors of education, health care, economy, police and security, housing, infrastructure and government services, which are long term and will measure performance outcomes in each of the national priorities, and evaluate UAE’s achievements in these area against global benchmarks.
The National Health Agenda 2021 aims to provide world-class health care with definite health goals to be reached in a period of seven years in the country. Community awareness, education, specific strategies to meet goals, augmenting medical staff and international accreditation for international benchmarking are some of the tools to achieve excellence in all aspects of public health.
Gulf News takes a look at some major Key Performance Indicators (KPIs) the UAE has set for itself to meet the National Health Agenda 2021 and ask
health experts what can be done to help the UAE progress as per its vision.
International accreditation
What: This follows the national health agenda target and the emphasis is on international benchmarking from international bodies such as Joint Commission International (JCI). All hospitals and clinical laboratories in Dubai must be internationally accredited and periodically reaccredited thereafter.
Why: The regulation is in place to ensure provision of a high quality of health services and patient safety. At a later stage, the Dubai Health Authority (DHA) aims to extend this mandate to all other health facilities as well. As part of the health-care system of the country, the DHA has been on an international accreditation drive since 2007, Eisa Al Maidour, Director-General of DHA, said. “Eighty per cent of our private hospitals have received international accreditation, keeping the health excellence standards in mind. Of the 25 private hospitals, 20 have got international accreditation.”
Dr Layla Al Marzouqi, Director of Health Regulation and the Dubai Medical Tourism Project, said: “New facilities are being given a grace period of 18 months from the date of establishment after which they will need to get accredited by an international accreditation agency that is recognised by the International Society for Quality in Health care.”
UAE’s National Health Agenda 2021 and KPIs
Key Performance Indicator (KPI): Cardiovascular Disease (CVD)
This indicator measures the deaths from cardiovascular disease per 100,000 population.
Current statistics: As per the World Health Organisation, it is 211 (2008 figures published in 2013).
Target 2021: 158.2 deaths per 100,000 population. (To reduce the current number by 25 per cent).
What can be done?
Cardiovascular health is multifactorial and is like a lock that can be opened by the combined effort of many health keys. “By keeping many bad health habits in check, the risk for CVD naturally goes down,” said Dr Fahd Baslaib, Consultant and head of cardiology at Rashid Hospital.
Community awareness on improving lifestyle is the key to controlling CVD. People can cut the risk of CVD by:
1. Stop smoking completely
2. Change sedentary lifestyle and introduce regular exercise
3. Eliminate refined carbohydrates and choose wholegrains and proteins, cutting down on saturated fats
4. Reduce salt and sugar
5. Keep weight in check
6. Controlling the onset of other diseases such as diabetes, high cholesterol
7. Going in for regular screening. Those with a family history of CVD need to go in for annual screening from the age of 30 while others can do it once a year after 40
“We have been conducting regular community campaigns where a team of heart physicians and dietitians have been holding camps, distributing brochures and also educating primary health doctors who are the first point of contact for all CVD patients. We have also been targeting schools and educating the younger generation on the dangers of obesity that can easily lead to early onset of CVD. We have been also running antismoking campaigns for teenagers as smoking negates all efforts at good health.”
A sustained combat approach that covers all these fronts adopted by all private and public health care providers will help the community achieve the best cardiovascular health, Dr Baslaib is confident.
Key Performance Indicator: Diabetes
Definition: This indicator measures the number of people between the age of 20 and 79 with diabetes in the UAE, as a proportion of the total population. This age group is aligned with the age group used by the International Diabetes Federation (IDF).
Current statistic: The IDF figures of 2013 indicate 19 per cent of the UAE population suffers from Type II diabetes.
Target 2021: To reduce the incidence to 16.3 per cent of the population (to reduce the current value by 14 per cent).
What can we do?
According to Dr Hamed Farooqi, head of DHA’s Dubai Diabetes Centre, a sustained education campaign for the community that highlights the combined benefits of balanced diet and exercise can help make people aware of small lifestyle changes that can help them. Currently, a large section of the population is either pre-diabetic or not even aware about the onset of the disease. Dr Farooqi thinks both endocrinologists and people must know a few basic facts that will go a long way in combating the disease:
• Testing to detect Type 2 diabetes and pre-diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at the age of 45.
Risk factors include being overweight or obese, having a sedentary lifestyle, diagnosed with high blood pressure or abnormal cholesterol/triglyceride levels, with a strong family history or ethnic background (such as South Asians). In case of women, those with polycystic ovaries or diabetes during pregnancy also have a high risk of developing diabetes.
• A simple fasting blood glucose level is generally enough for screening purposes. It has to be repeated to confirm the diagnosis.
• A healthy diet leading to a weight loss of around seven per cent and regular exercise of 150 minutes a week of moderate activity such as walking are effective to prevent or delay the onset of diabetes in high-risk individuals by nearly 60 per cent.
• Limit the amount of time spent being sedentary by breaking up extended amounts of time spent sitting. In other words, don’t sit for longer than 90 minutes at one time.
• E-cigarettes are not an alternative to smoking or to facilitate smoking cessation.
• The American Diabetes Association now recommends a pre-meal blood glucose target of 80—130 mg/dl, rather than 70—130 mg/dl
• Those at high risk for foot complications, such as all patients with insensate feet, foot deformities, or a history of foot ulcers should have their feet examined at every visit.
Key Performance Indicator: Childhood Obesity
Current statistic: According to the WHO report of 2012, 14.4 per cent children in the UAE were found to be obese.
Target 2021: Reduce the number to 12 per cent (to reduce the current value by 17 per cent).
Obesity in children is defined as follows:
Children aged 5 to 12: The proportion of children with a BMI greater than 2 standard deviations above the growth standard median.
Children aged above 12: The proportion of children with a BMI greater than 30.
What can we do?
According to Dr Wafa Aish, Director of the Clinical Nutrition Department of the DHA, reduction of obesity is achievable in the UAE and their department is working in tandem with other health agencies by launching a sustained campaign in schools. “As part of our strategy, the clinical nutrition department has launched its health campaign in schools working closely with the Dubai Municipality and Ministry of Education to issue healthy eating guidelines and emphasise on the importance of physical activity for students.
“We have been holding workshops for parents and schoolteachers on healthy eating options, importance of fibre, fresh fruits and vegetables and lean meat in the diets of kids. We have been working tirelessly on our part,” she said.
The Dubai Municipality on its part is conducting regular inspections of school canteens and levying penalties on those who stock unhealthy food with high sugar and refined carbohydrates.
Dr Aish feels a sustained health campaign targeting schoolchildren with education of parents and education providers will yield a positive impact as children are able to absorb the message quickly and can be moulded to choose a healthier lifestyle.
Key Performance Indicator: Cancer
The number of deaths from cancers in per 100,000 of the population. This indicator measures the deaths from malignant tumours per 100,000 of the total population.
According to the 2013 figures provided by the WHO, cancers claim 78 deaths per 100,000 of the total population (2008 figure published in the 2013 report).
Target 2021: 64.2 deaths per 100,000 population. (To reduce the current number by 18 per cent)
“The top three cancers currently in the UAE are breast, colorectal and prostate,” said Dr Mohammad Diab, Consultant Oncologist at NMC Speciality Hospital. “The most important step towards cancer control is early screening. According to international standards, nearly 30 per cent of the cancers can be detected or pre-empted at this stage. We have begun collaboration with certain pharmaceuticals to initiate free cancer screening. Many people agree about periodic screening. But when they see that it can cost anything between Dh400-Dh1,000, they are discouraged by the burden of expense. We are able to counter that at our oncology clinic by providing this free,” he said.
What can we do?
There were many other mindsets that required to be changed, both by the patients afflicted with cancers and the oncology teams treating them, Dr Diab said. A few are given below:
1. Convincing cancer patients not to opt for bio-similar drugs which mimic the original drug. That treatment may be cheaper but the potency of the original formulation is always more effective said Dr Diab.
2. Diet plays an important role as certain foods such as meat done rare or raw, refined carbohydrates, canned food with chemicals, etc, are known to increase the risk of cancer, especially colorectal cancer. Dr Diab feels the community must as a matter of habit opt for healthy choices of wholegrains, legumes, beans, nuts, fresh fruits and vegetables, and cut out extra salt, sugar and oil from their diet to reduce the risk of cancers.
3. The oncologist surgeon, physician, radiologist, dietitian and therapist must realise that treating cancer is not a one-man show any more. Every single case requires collaborative effort. “At our hospital, we hold a tumour board meeting every week which is a multidisciplinary conference where every new case is discussed threadbare and the treatment protocol is decided for best results. The battle against cancer is a collective fight where every hospital and health-care specialist related with it must join hands to bring down the incidence.”
KPI: Prevalence of smoking any tobacco product
This indicator measures the daily consumption of cigarettes and tobacco products among different segments of society.
Current statistic: According to WHO, 19 per cent of men and two per cent of women in the UAE are smokers. (2009 figures published in the 2013 report)
Target 2021: To reduce the current rates by 15 per cent as follows: 16 per cent among men, 1.7 per cent among women.
The Ministry of Health has been very proactive in this area and passed an anti-tobacco law in January 2014 to make the UAE a smoke-free environment. This law prohibits smoking in all public places that include hospitals, educational and sports institutions, malls, public transport, nightclubs, hotels, bars and health and religious establishments.
“While the incidence of smokers in the population is comparable to the West, what we need to fight against is teen smoking and third-hand or passive smoking that harms the non-smoking population, especially children,” said Dr Sreekumar Sreedharan, Internal Medicine specialist at Aster Medical Centre, Al Karama, and an active antismoking campaigner.
The UAE has a high incidence of lung cancer, according to the National Cancer registry. Smoking can trigger CVD as it changes the lipid profile of a patient, it can cause different respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Dr Sreedharan lists the obvious negative fallouts of smoking.
1. Cancer — lung and oral cavity cancers
2. Erectile dysfunction as it constricts blood flow
3. Aggravates diabetes
4. Triggers hypertension by constricting blood vessels and causing plaque build-up
5. Increases metabolic rate and accelerates ageing
6. Tar coating destroys dental and oral health.
“What is really vital is all the health fallouts of smoking can be completely reversed by stopping smoking. The risk of cardiovascular disease falls to that of any non-smoker’s risk within a year of quitting smoking. All respiratory and lifestyle diseases register a very effective improvement within a month of quitting,” said Dr Sreedharan.
What can we do?
1. Adults must be motivated to be role models for teens and young adults through sustained community campaigns.
2. Graphic pictorial representation on cigarette packs (as followed in Brazil and China) of the kind of oral cancers that smoking causes, will be an effective deterrent at the point of sale where a person can make a split second decision.
3. Smoking needs to have similar support groups as Alcoholics Anonymous as it is as addictive as alcohol, with nicotine having a very negative impact on health.
4. More extensive and generalised forms of education. If community health centres have diabetic education, they must also have non-smoking education.
5. More random tests like blowing into a spirometer must be introduce for people to be aware if they have weak breathing capacity.
6. Stronger regulation for teens and young adults to not be able to procure cigarettes or tobacco.
7. Ban on electronic cigarettes which contains vapours of nicotine. If people have to quit completely. the e-cigarette will not help as it keeps the urge to smoke alive in the mind.
KPI: Average healthy life expectancy
Definition: This indicator measures the average number of years that a person can expect to live in full health.
Current statistic: According to WHO, 67 years (2012 figure published in the 2014 report).
Target 2021: 73 years.
The life expectancy figures of UAE are similar to the worldwide figures. One of the most important factors to take into consideration while looking at the average life expectancy is the Global Burden of Disease (GBD) which has changed since 1990.
1990
Top five diseases that caused death were:
Ischemic heart disease (5.7 million deaths worldwide)
Stroke (4.5 million)
Pneumonia (3.4 million)
Diarrhoea (2.5 million) and
COPD (2.5) million.
2013
However, the December 2013 figures indicate the GBD has shifted. Annual fatalities worldwide due to stroke are now 8.1 million,
Heart disease 6.4 million,
COPD 2.9 million,
Pneumonia 2.6 million and
Alzheimer’s 1.6 million.
(The Lancet)
Commenting on the shift, Dr Atul Aundhekar, CEO of iCare Clinics in Dubai, said, “While the GBD for heart disease and stroke has multiplied, certain diseases like diarrhoea have fallen off the radar and new conditions like Alzheimer’s have been added. It also indicates that there is not much difference between the disease patterns of developing countries like Nepal, Niger and Bolivia as compared to the developed nations as the average death rate in both was 59.3 per cent and life expectancy was 67 years in 2013.”
What is happening around the world is reflected in the UAE community too where CVD tops the list of diseases. However, Dr Aundhekar thinks that although there is no direct link established between exercise, nutrition and better life expectancy, these are issues that give us a regular biofeedback on good health. “I think four to five parameters for good health that can be identified are nutrition, regular medication, exercise, mental well-being [reducing stress in life] and regular health screening can be identified as definite strategies towards increasing life expectancy.”
