An analysis of the health status of the United Arab Emirates: the 'Big 4' public health issues

Abstract

Background: The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population.

Methods: A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals.

Results: The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010.

Conclusion: The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases.

ORIGINAL ARTICLE

An analysis of the health status of the United Arab Emirates: the 'Big 4' public health issues

Tom Loney1*, Tar-Ching Aw1, Daniel G. Handysides1,2, Raghib Ali1, Iain Blair1, Michal Grivna1, Syed M. Shah1, Mohamud Sheek-Hussein1, Mohamed El-Sadig1, Amer A. Sharif1,3 and Yusra El-Obaid1

1Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; 2School of Public Health, Loma Linda University, California, United States; 3Dubai Health Authority, Dubai, United Arab Emirates

Abstract

Background : The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population.

Methods : A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals.

Results : The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010.

Conclusion : The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases.

Keywords: globalisation of public health; non-communicable disease; United Arab Emirates

To access the supplementary material to this article please see Supplementary files under Article Tools online.

Received: 16 November 2012; Revised: 8 January 2013; Accepted: 9 January 2013; Published: 5 February 2013

Glob Health Action 2013. © 2013 Tom Loney et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Glob Health Action 2013, 6 : 20100 - http://dx.doi.org/10.3402/gha.v6i0.20100

The United Arab Emirates (UAE) is a country composed of seven emirates (Abu Dhabi, Ajman, Dubai, Fujairah, Ras Al Khaimah, Sharjah, and Umm Al-Quwain), formed in 1971, and is located in the southeast of the Arabian Peninsula (1). Since the discovery of oil, the UAE has experienced significant economic and industrial growth, particularly in the petroleum, aviation, maritime, construction, and health care industries (2). Several mega-projects exemplify the industrial progress over the past 10 years, including the construction of the world's tallest building (Burj Khalifa) and largest shopping complex (Dubai Mall), Jebel Ali Port and Free Zone, Dubai International Airport, and numerous artificial islands: Yas Island, Palm Dubai, and a man-made archipelago called The World. In addition, the UAE has an expanding manufacturing base with aluminium, steel, iron, and textiles contributing significantly to exports.

Population growth and demographics of the UAE

Population growth is the product of natural growth (births minus deaths) and growth from net migration (3). Migrant workers are recruited from all over the world to satisfy the manpower demands of the fast-paced economic and industrial developments in the UAE (4). Consequently, the UAE population has increased substantially over the past four decades, and this is primarily due to the high net inward migration of expatriate workers (population estimates: 287,000 in 1971, 4.1 million in 2005, 8.3 million in 2010) (5). Indeed, mass recruitment of migrant workers has created an unusual population structure, with the total UAE population composed of approximately 11% (950,000) Emiratis, and the rest expatriates of varying nationalities (6). Similarly, the total population of Abu Dhabi (the largest emirate in the UAE) is estimated to be 2.3 million, with over half of the population being expatriate males aged 20-59 years (6).

As a result of expatriate workforce recruitment for industrial projects, males outnumber females 3:1 in the overall UAE population (nationals and non-nationals); however, there are approximately equal numbers of male and female UAE nationals (3). Among non-nationals, the ratio of males to females is 3.7:1 due to the imbalance between the number of expatriate males employed in construction compared with migrant females working in hospitality, health care, or domestic service (3). Principally, there is an apparent distribution of migrant workers by nationality; construction workers and manual labourers tend to be from the Indian subcontinent; middle managers and health care workers from the Philippines, India, and neighbouring Arab countries; and senior management and consultants from the UAE, Europe, North America, and Australasia. As such, the UAE is composed of a multinational population, with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies.

The primary aim of this article was to utilise secondary data from existing peer-reviewed journal publications and reports of government agencies and related health organisations to comment on the key public health issues in the UAE.

Materials and methods

The following method was used to obtain secondary data from existing peer-reviewed journal articles and reports of government agencies and related health organisations:

1. systematic search of the published literature, using defined keywords;

2. through personal contact with senior health officers at health authorities, government agencies, and local hospitals; and

3. from publications/reports by health authorities, government agencies, and local hospitals.

Literature search strategy

A systematic literature search was conducted to retrieve peer-reviewed scientific and medical journal articles on health in the UAE. Electronic databases (MEDLINE [accessed by PubMed], EMBASE, PsycINFO) were searched covering the period from 1950 to January 2012, utilising a combination of the following MESH terms, free-text words, and entry terms - 'health, public health, morbidity, mortality, diabetes, overweight, obesity, population, United Arab Emirates' (see Supplementary Material File 1 for an example of search syntax used for PubMed). The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (7), which stipulate the components (e.g. multiple data sources, unpublished) associated with a high-sensitivity search strategy. In addition, references of published studies were searched manually for pertinent articles and national/local health authorities (e.g. Health Authority Abu Dhabi) were contacted for annual statistics and data. Sources of unpublished data included personal communication with senior health officers at the Health Authorities of Dubai and Abu Dhabi, the UAE Ministry of Health, publications produced by local hospitals (e.g. the cancer registry of Tawam hospital in Al-Ain, Abu Dhabi), and in-house data collected from various on-going faculty, staff, and student research projects.

Eligibility criteria

Eligible studies included only empirical research papers that were relevant to the health status of the UAE. Exclusion criteria were:

1. studies that highlighted the UAE in the abstract but subsequently pooled data to produce estimates for the Gulf Region or the Gulf Cooperation Council (GCC) states (i.e. Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE);

2. articles that were not available in English; and

3. duplicate publications or sub-studies of included articles. The systematic literature search yielded a total of 185 citations and 179 abstracts. Table 1 summarises the findings from the literature retrieval.

[Table omitted -see PDF.]

*Ranking defined by total number of cases.

Public health priority area 4: respiratory disorders

Respiratory illness can be acquired following exposure to gases, dusts, and fumes (as in occupational settings), from infectious agents, or as a result of poor ambient air quality. Occupational and environmental exposures can lead to obstructive (asthma, chronic bronchitis, and emphysema) or restrictive (pulmonary fibrosis) lung disease, or lung cancer. The UAE population is at a high risk of such exposures due to increased urbanisation, reliance on motorised transportation and traffic congestion, adverse weather conditions such as dust/sand storms, and the rapid expansion of the construction and manufacturing sectors emitting air-borne pollutants. Respiratory infections were the second most common non-life threatening condition in the UAE in 2010, accounting for almost 15% of all encounters across all healthcare facilities (10).

The major airports in Abu Dhabi, Dubai, and Sharjah serve as important stop-over locations for individuals travelling all over the world and receive a high-volume of travellers throughout the year. In view that contact between large numbers of people increases the risk of infection transmission, the UAE population is at potential risk from 'new' respiratory infections, such as 'avian' flu and SARS (severe acute respiratory syndrome) (22). Outbreaks of the 'traditional' respiratory infections, such as tuberculosis, are also possible, although this may be less likely with the national immunisation program and the visa screening requirement for all expatriate workers in the UAE.

Recommendations

Surveillance and monitoring

Reliable and valid longitudinal data are essential for planning population-based public health programs. As such, several areas have been identified where improvements in coordination and cooperation between different agencies of the seven emirates in the UAE will produce national datasets permitting the analysis of the magnitude and trends in occurrence of specific diseases. In addition, the establishment and continuation of several public health initiatives in the UAE should be resourced adequately. Examples include:

1. a National Cancer Registry accredited by the International Agency for Research on Cancer;

2. a cross-emirates Injury Registry and Surveillance Scheme;

3. a National Genetic Disorders Registry;

4. notification of Communicable Diseases with data from microbiology laboratories;

5. improvements in death certification and registration of births; and

6. development of laboratories to aid the recognition of specific diseases, and the analysis of environmental and/or biological samples for exposure to workplace or environmental hazards.

Research

Research funding should be directed toward investigating the association between lifestyle and personal risk factors that are prevalent in the UAE (namely physical inactivity, unhealthy dietary practices, smoking, obesity, vitamin D deficiency, and parental consanguinity) and the development of chronic disease, such as diabetes, cardiovascular disease, and cancer. High-quality epidemiological research will provide the foundations for the development of experimental studies and clinical trials investigating the efficacy and effectiveness of various public health interventions on reducing the risk factors associated with chronic disease. Community- and school-based intervention programs focusing on increasing physical activity, improving dietary practices, increasing safety restraint use, and reducing tobacco consumption are urgently required to slow the trajectory of the estimated mortality rates due to cardiovascular disease, injury and cancer, particularly in the young population ranges.

Training, education, and federal legislation

Training

Sufficient numbers of trained health professionals are required to improve the health status of the UAE. At present, there is a shortage of specialist physicians in fields, such as histopathology, oncology, occupational medicine, and infectious diseases, which hamper efforts for improving the health status of the UAE population. There are already developments in place by universities and health organisations to facilitate and improve the training of clinical and public health specialists in the UAE. The key personnel are not necessarily restricted to those directly involved in curative care or prevention. For example, engineers may be better placed to improve road safety, and reduce occupational and environmental hazards. Similarly, health education and health promotion specialists are essential for campaigns focussing on the adoption of healthy lifestyles.

Education

Increased focus should be placed upon improving population health through primary prevention involving health education and awareness programs. Examples include health education activities for the reduction or cessation of tobacco use, promotion of safe driving, and compliance with safe systems of work. Currently, there is a lack of workplace health and safety programs focusing on health education, safety awareness, and training. Such programs have the potential to reduce occupational-related morbidity and mortality when supported by UAE federal legislation and regulations. Finally, encouraging full uptake of immunisation is another specific health protection measure that will further enhance the health status of the UAE population.

Federal legislation

Legislation and standards for compliance to public health measures should be reviewed and revised periodically. Some aspects of UAE law and ministerial orders (e.g. requirements for health screening for new workers to the UAE, labour law) may benefit from cyclical reviews to ensure they are aligned with current concerns and international standards. Finally, a dual-pronged approach encompassing educational efforts coupled with federal legislation and enforcement should be adopted for certain public health issues, such as mandatory seat belt use for rear seat passengers, child safety restraints, and maximum working hours for professional drivers, to reduce the mortality attributable to traffic-related deaths.

Conclusion

A number of public health issues, particularly non-communicable diseases, significantly contribute to morbidity, mortality, and economic losses in the UAE. In view of the population demographics of the UAE, future national population-based public health initiatives should consider the sociocultural, religious, ethnic, and educational diversity of the UAE in the design, development, and implementation of campaigns, interventions, and strategies. The major public health challenges posed by certain personal, lifestyle, occupational, and environmental factors associated with the development of chronic diseases are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action.

Acknowledgements

The authors would like to thank the National Research Foundation in the United Arab Emirates for funding this research project.

Conflict of interest and funding

The authors have not received any funding or benefits from industry to conduct this study. This research project was funded by the National Research Foundation in the United Arab Emirates.

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*Tom Loney

Institute of Public Health

College of Medicine and Health Sciences

United Arab Emirates University

PO Box 17666, Al Ain

United Arab Emirates

Tel: [phone]

Fax: [phone]

E-mail: [email protected]