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Rich and Sick

Why do wealthy Middle East countries struggle with public health?

By Gary Gately

Wealth alone doesn't guarantee good health care. Bloomberg School researchers found this borne out by the broken public health systems of two oil-rich Middle East states.

Just off an 18-month study of public health systems and health care in Saudi Arabia and Qatar, 10 Bloomberg School and Ernst & Young health researchers found chronic disease rampant in both nations. “They’ve got all the riches, but they have very poor public health systems,” says David Celentano, ScD ’77, MHS ’75, Epidemiology chair.

Among the findings:

  • In Saudi Arabia, three of four people never get routine physicals for early detection of diabetes, cancers, cardiovascular disease and high cholesterol, and many Saudis are sedentary while subsisting on fast food. National health care, most of which is paid for by the government, is disjointed, with little coordination among five competing systems.
  • Qatar has no central public health agency analogous to the U.S. Centers for Disease Control and Prevention so surveillance of chronic diseases is practically nonexistent.

The information void has far-reaching implications. The tiny country classifies roughly 30 percent of its causes of death as unknown (compared with 7 percent unknown or ill-defined in the U.S.), thwarting efforts to target resources to prevent diseases.

Bloomberg School researchers recommended better coordination among Saudi health agencies. The Saudi government might improve screening rates and quality by linking routine physicals to receiving required national identification cards, suggested Aruna Chandran, MD, MPH ’04, an associate scientist.

The team recommended that Qatar establish a public health oversight organization to upgrade data collection and disease surveillance. Both countries, the researchers added, should boost patient education and outreach through social media campaigns and events at health centers, schools and mosques.

Health patterns discerned in the past decade attracted the researchers’ attention, Celentano says: “People in all Gulf countries are dying almost exclusively from noncommunicable diseases such as diabetes, cardiovascular disease and cancer. So when we saw this huge spike in chronic diseases in the Middle East, that’s when we got interested. We want to know what’s going on. There’s a huge need there.”