The Healthy People federal initiative has experienced moderate success in the United States by identifying and addressing various issues in public health that affect the population and health system. Healthcare has taken a leading spot in the UAE National Agenda for 2021, and there is an increased surge of health awareness amongst residents and private organizations. There is an increased demand for the government to implement a similar Healthy People initiative in the UAE for the 2020-2030 years. The following plan will address public health domains including diabetes morbidity, quality of hospital services, and lifestyle-related diseases.
As countries undergo economic development, the prevalence of diseases shifts from infectious to non-communicable. Lifestyle diseases are a group of conditions associated with the health behaviors of individuals in their daily life. These causative factors include the use of drugs, tobacco, and alcohol, unhealthy eating habits, and inappropriate levels of physical activity. A wide range of diseases is associated with lifestyle, encompassing obesity, heart disease, and diabetes. The UAE has seen a tremendous increase in the prevalence of such conditions, responsible for 65 percent of fatalities. Furthermore, the issue is impacting increasingly younger generations with a 19 percent chance of death from lifestyle-related diseases between the ages of 30 and 70 (Jones, 2015). Heart disease is the leading cause of death in a metropolis such as Abu Dhabi, encompassing 37 percent of total deaths (Al Nowais, 2017). This rate is alarming and epidemic, signifying concerns of a demographic crisis that may occur due to disease.
The problem of chronic lifestyle-related diseases has become a focus of government programs relatively recently. Since the World Health Organization identified non-communicable diseases as the primary threat to human health and development a decade ago, the country has begun to address numerous issues in its healthcare delivery system. Some of the progress made includes providing wider availability of infrastructure, more medical personnel per population, and enrollment of adults into screening programs. For example, approximately 94 percent of Abu Dhabi residents have been recruited into a screening program known as ‘Weqaya’ (translated as “prevention”) which is essential for early identification and treatment of lifestyle-related diseases (Hajat, Harrison, & Shather, 2012). However, the program identified that as many as 71 percent of citizens are experiencing at least one health risk factor for lifestyle-related conditions such as heart disease (Al Nowais, 2017). Most individuals are unaware of and not seeking treatment for the potential risk factor or attempting to change prevalent modifiable behavior.
Challenges include the personal, occupational, and environmental factors that drive UAE residents into an unhealthy lifestyle. Sedentary lifestyles occur due to modern work schedules that leave little to no time for physical activity. Meanwhile, high caloric food intake is causing exponential increases in obesity. (Ann, 2016). There is a lack of awareness or healthy habits amongst the general population. This may be due to poor health education and a cultural perspective that values sedentary activities and comfort. Solutions require reforms to the socio-cultural norms of daily life and an initiative to increase public health education.
An indicator is a general summary of a priority topic regarding population health. For this domain, a proper recommended indicator would be the proportion of the population engaged in healthy behaviors. Lifestyle-related diseases are directly correlated with healthy day-to-day behaviors, significantly influencing physical and mental health. The described conditions are preventable, even when genetic factors are involved. Healthy behaviors include adequate exercise, sleep, and diet with no substance and alcohol abuse as well (Farhud, 2015). Therefore, interventions that increase healthy behaviors generally result in improved health outcomes amongst the population by slowing health deterioration.
An objective-based on this indicator would be to increase the percentage of adults meeting current physical activity guidelines for both aerobic and muscle-strengthening exercise. An adequate amount of physical exercise to gain health benefits for adults requires 150 minutes of moderate-intensity activity and 75 minutes of vigorous-intensity activity per week. Muscle-strengthening physical exercise should be done 2 or more days per week and include all muscle groups to achieve a health benefit. Generally, experts recommend 30-60 minutes of any physical activity per day (Centers for Disease Control and Prevention, 2018). It is important to note that any physical activity is better than none at all. Therefore, adults should not avoid an exercise session simply due to time constraints.
The UAE, similarly to other countries in the region, has a relatively inactive population. The number of adults engaging in regular physical activity is approximately 41.9 percent and does not exceed 45 percent (Carroll, 2014). An appropriate target to achieve by 2030, would be a 15 percent improvement. It would be realistic to expect 55 percent of the population to meet the established guidelines. The proportion of adults engaging in strength training is typically lower. Although there is no available data from the UAE, a target in the United States for a similar objective is 24 percent. Although these statistics are lower than necessary to resolve the issue of lifestyle-related diseases, achieving the target can have long-lasting effects.
Diabetes mellitus is a heterogeneous metabolic disease, characterized by abnormal blood glucose levels. If untreated or not properly managed, it can lead to several severe complications, ranging from blindness to stroke and heart disease. Commonly, Type II diabetes is a co-morbidity of obesity and is correlated with decreased life expectancy. It is a prevalent and threatening public health concern worldwide and in the UAE in the 21st century. UAE maintains one of the highest prevalence of diabetes in the world with 19 percent of adults affected, and potentially 450,000 undiagnosed. Diabetes is a primary risk factor for cardiovascular disease which is the leading cause of death in the country, as the fatality rate has increased by 61.2 percent from 2005 to 2015 (Zaman, 2017). It is estimated that by 2020, 32 percent of the adult population may be diagnosed with Type II diabetes or the prediabetes condition, resulting in $8.52 billion in expenses to the country over the next decade (Razzak, Harbi, Shelpai, & Qawas, 2017). Obesity is a critical factor in the formation of diabetes, as 34.5 percent of UAE residents are medically obese and over 70.6 percent are overweight (Rizvi, 2016).
The UAE has made diabetes prevention one of the primary focuses of its health policy in recent years. National-level policy, interventions, and guidelines were developed for a better understanding and management of the condition. Furthermore, significant resources have been invested in medical research on the causes and treatment of Type II diabetes to reverse it in the population. Efforts are made to screen and educate the population, particularly attempting to reach almost half a million citizens that may be undiagnosed (Swan, 2017). The health plan has seen beneficial results, with most recent statistics indicating a fall of diagnoses from 19 percent to as low as 11.8 percent (“UAE’s health plan pays off,” 2018). One of the biggest challenges is creating change at both individual and policy levels. The government must regulate unhealthy foods by limiting commercial companies while promoting healthy lifestyles in the community.
An indicator for this domain would be the proportion of the population with an A1c value greater than 9 percent, indicating the diagnosis of type II diabetes. The World Health Organization indicator for diabetes consists of an age-standardized prevalence of fasting blood glucose of 7.0 mmol/l (126 mg/dl) in adults (World Health Organization, n.d.). The indicator is commonly measured by the cumulative number of patients diagnosed at the end of the calendar year as well as the prevalence rate per 100 people. This is an objective value that is commonly used for the diagnosis of the condition and determines whether an individual is diabetic. It can be easily tracked and measured amongst the population through competent health surveillance and monitoring tools.
An objective in this domain would be to reduce the annual number of newly diagnosed cases of diabetes in the general adult population. As a disease, diabetes is difficult to reverse and eliminate. However, the diagnosis of new cases should be reduced as it demonstrates the effectiveness of both preventive care and lifestyle changes. Surveillance data should be utilized in collaborative efforts amongst multi-sector partnerships to advance policies and practices that support diabetes prevention, self-management, and eliminating risk factors. This includes access to diabetes and dietary education, access to screening and quality care, and public policy which promotes health equity and communication regarding the disease.
By recent statistics of 11.8 percent diagnosis rate, the number of cases should be reduced to 8 percent by 2030 (“UAE’s health plan pays off,” 2018). This is an ambitious, but realistically achievable target if proper actions are taken at the population level. It is important to lower the amount of newly diagnosed patients so that the condition is no longer considered an epidemic. It is critical to ensure that the majority of the population can adequately control A1C indicators (Laiteerapong, John, Nathan, & Huang, 2013). Glycemic control is critical for both, residents with a diabetes diagnosis and those without. Therefore, a downward shift of the national distribution of A1C levels can be achieved, improving diabetes outcomes such as co-morbidities and mortality that this domain is meant to investigate.
Quality of Hospital Services
The quality of hospital services is an important domain in the promotion of a healthy population. Healthcare received at hospitals directly affects the trust of the population in the national health system as well as the effectiveness of any treatment or intervention on health outcomes. Quality is determined through various frameworks, one of which is promoted by the U.S. Department of Health and Human Services. It emphasizes that a healthcare system should have the following aspects: safety, effectiveness, patient-centered, timely, efficient, and equitable (Agency for Healthcare Research and Quality, 2016). Another measure of quality for healthcare is patient satisfaction, based on service quality dimensions: tangibles, reliability, responsiveness, assurance, and empathy. Satisfaction is ultimately a dimension that encompasses the fact that the patient needs and wants are met by healthcare organizations (Al-Neyadi, Abdallah, & Malik, 2016). The quality of healthcare services greatly depends on public opinion and satisfaction from the experience. These measures focus on providing the population with an optimal environment and excellent quality of care while avoiding waste and eliminating disparities.
As the UAE government aspires to establish a world-class health system, significant measures have been taken to improve the quality of healthcare and facilities for the population to use. Various reforms have been implemented in a range of areas in the system over the last decade. In terms of hospital quality, health infrastructure has contributed to improving these services. This included doubling the amount of bed space and a five-fold increase in the number of medical professionals. The overall number of hospitals, both public and private, has increased. Quality measures such as the decrease of clinical adverse events increased accreditation of facilities, and standardized assessment of patients with diabetes was also witnessed as part of the reform (Koornneef, Robben, & Blair, 2017). The biggest challenge for this domain remains excessive costs of practically all aspects of healthcare, requiring resource investment for projects that may not produce results for years. Another challenge can be considered regulatory fragmentation that is unable to maintain adequate control or promote competition in the sector.
An indicator for this domain would be a proportion of the population receiving appropriate preventive services, including but not limited to vaccinations and screening services. Residents are more likely to receive preventive services when the quality of hospital healthcare delivery and assessment systems can identify and direct individuals towards these interventions. Health care utilization and expenditure provide an overview of program efficacy. The highest quality hospitals and preventive programs attempt to deliver personalized interventions, focusing on lifestyle modifications and access to a network of healthcare delivery for primary health. National quality indicators are directly correlated to variations in population health. Therefore, receiving preventive care is a reliable clinical indicator of hospital quality.
In line with the indicator, the objective for this domain would be to increase the percentage of the population receiving preventive age-appropriate preventive services. Preventive services are critical for leading a healthy lifestyle as well as receiving quality and necessary treatment promptly if the need for the population arises. A clinical setting such as a hospital or health provider must administer adequate health and wellness promotions. Furthermore, a reduction of illnesses demonstrates that clinical care organizations can communicate and collaborate to coordinate such measures of preventive healthcare in the population. Vaccinations are one of the fundamental preventive care health services that serve as the cornerstone of an efficient and sustainable health system. Vaccines not only prevent diseases but contribute to the reduction of resource utilization and optimal distribution of medical services to the most vital issues of concern for the country.
Vaccination rates need to be at a high level to maintain herd immunity. Meanwhile, screenings should be commonplace as well to remain effective and timely in determining the presence of any diseases. Currently, vaccination rates vary depending on the infection. Some vaccines such as measles or rubella maintain a seroprevalence rate of above 90 percent, while others such as pertussis are as low as 39 percent (Al-Mekaini et al., 2016). A target rate for this objective would be to reach a 90 percent seroprevalence rate for all critical vaccines. A similar rate would be desired for preventive screenings as well.
The Healthy People initiative is an effective method to identify, track, and address public health concerns. This report identified three domains of lifestyle-related diseases, diabetes morbidity and mortality, and quality of hospital care that require resolution. It is vital to use the selected indicators to achieve the necessary objectives and targets so that the country, its population, and health system can continue to experience sustainable growth and prosperity.
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