Strong oil prices have bankrolled an affluent lifestyle in the Middle East’s Gulf region, with deadly consequences. Rich foods, decreased physical activity and high smoking rates have exacerbated a genetic predisposition to diabetes, fuelling an epidemic responsible for 10 percent of all adult deaths and sucking up a major chunk of the region’s healthcare budget.  Five of the six Gulf countries are now listed among the top 10 worst afflicted places in the world, according to International Diabetes Federation data, with the United Arab Emirates at number two, behind the small island state of Nauru.

Healthy eating, exercise and stress management can dramatically reduce obesity and the chance of developing diabetes, but convincing the region’s patients and those at-risk to make the lifestyle change is proving difficult. 

“The solution can only be found in creating awareness and behavioural change from an early age, ” Dr Mazin Jawad Al Khabouri, senior consultant at Oman’s ENT Al Nadha Hospital and adviser to Oman’s Health Ministry, told INSEAD Knowledge outside an INSEAD Innovators for Community Wellness programme in Abu Dhabi recently.

“That’s not easy. Because everyone’s obese here, it’s not considered a major problem but there is no doubt that non-communicative diseases like diabetes are the biggest issue facing the Gulf. Up to 20-24 percent of the Gulf’s national population has diabetes, and because it’s related to many chronic heart, kidney and eye diseases, if we can control diabetes we can control these other diseases as well.”

A new approach

Since late last century, governments in the region have been monitoring and developing strategies to reduce the problem, providing accessible screening opportunities and training more health professionals. But results have been limited and diabetic numbers continue to climb.

A recent focus group for diabetes self-management in Oman found patients still hold many misconceptions; turning to herbal medicines, or overindulging in dates and mangoes, even eating honey in the belief that being “natural” it won’t affect blood sugar levels.

“Oman like other Gulf countries is in a transitional period, people have faith in the medical system but we have to convince people it’s not medication but the patients themselves who can make the difference,” Dr Fatma Ajmi, director general of health services in the Omani governorate of Muscat told INSEAD Knowledge on the sidelines of the Wellness programme.

To this end, Gulf countries are pouring resources into primary care services bolstering the relationship between care-giver and patient. This is where the marketing techniques come in. “We’re still learning how to communicate with people, how to empower them to manage their disease,” Ajmi says.

Easier to take a pill

The solution is in finding innovative techniques to engage specific groups within the population, says Markus Christen, INSEAD Associate Professor of Marketing.

“From a purely medical point of view we have good knowledge of what’s going wrong. The people have a comfortable life and don’t want to give it up. They prefer to get a magical pill from the pharmacy which allows them to continue to engage in this behaviour. It’s easier than going to the gym.

“We need to break these habits and create new ones. Marketing is a powerful way to do this. The most successful brands are thriving because they’ve got us into certain habits, now we want them to use the same methods to help break habits. It’s not a matter of being forceful and saying this is what people need to do, because they will resist that.”

While previous campaigns have been aimed at blanket coverage, targeted approaches give better results, Christen says. And different targets need different approaches. Smoking, for example, because of its addictive nature, has a medical as well as a social component to address, while many eating habits are attached to the region’s culture.

“Within the family or community structure there are often traditional influences that are detrimental to what you are trying to accomplish,” notes Christen. “They are often very entrenched and extremely difficult to change.

“This is where we need new ideas and innovation. Perhaps it’s a matter of encouraging employers to give employees free time to look after themselves, maybe go to the gym.”

Deep pockets have limits

Nation-wide gym membership may be an expensive proposition but the alternative is even more so.

As patient numbers rise, technology advances and treatments for chronic disease get more expensive, healthcare costs in the region are skyrocketing to an expected US$60 billion by 2025 from US$12 billion today, according to McKinsey & Company estimates.

Stephen Chick, INSEAD Professor of Technology and Operations Management and director of the school’s Middle East Health Leadership Programme, says the challenge of rising health costs is forcing health care systems around the world to make this shift away from acute care to a combination of acute and primary care - put simply, away from disease and into wellness.

“Innovation management and systems thinking are sometimes not the focus of medical schools or nursing schools, but I think poor processes, poor engagements or poor marketing can be deadly if it’s not done well,” Chick told INSEAD Knowledge.  “As people age, different disease categories become more prevalent. This chronic disease challenge is absolutely essential to resolve to ensure we have a sustainable healthcare system. The question is: can we think differently and come up with a system rapidly that will adapt?”

Al Khabouri says the answer must be yes.

“The costs to governments are very, very high and because of the exponential factor there will come a time when nobody can afford it,” says Al Khabouri.  “We need new and innovative ways of thinking, we can’t buy our way out of this.”

Stephen Chick is Professor of Technology and Operations Management, Novartis Chaired Professor of Healthcare Management, Technology and Operations Management Area Chair, Academic Director, Healthcare Management Initiative. He is also the Director for two Executive Education programmes: the Middle East Health Leadership and Innovators for Community Wellness.

Markus Christen is Associate Professor of Marketing at INSEAD.

The Innovators for Community Wellness was an Executive Education programme held at the INSEAD Abu Dhabi campus April 21-26, 2012.

Middle East Health Leadership Programme

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