When visualising modern Arabia, images of sand dunes, camels, skyscrapers and expensive cars spring to mind. Not cardiovascular disease, obesity, diabetes and general poor health. Diabetes may not be the most glamorous of global health topics but it is a serious and ongoing issue, related not only to wealth but also to poverty. The discussion around diabetes mellitus – coined the ‘silent epidemic’ – must be heard loud and clear. Characterised by the leading to uncontrollable blood sugar levels, diabetes can lead to a multitude of illnesses and possible death if left untreated. Diabetes is categorised into type 1, type 2, secondary and gestational. Type 1 is currently unpreventable and usually indicates , in which the patient will have to inject themselves 2-4 times a day, depending on what they eat and their level of activity. Type 2 diabetes – normally brought on by obesity and a sedentary lifestyle – can initially be controlled by diet, frequent exercise and oral hypoglycaemicagents, but may eventually have to be controlled with insulin. Global incidence is rapidly increasing, coinciding with the worldwide obesity pandemic. Currently are living with diabetes worldwide, and considering 1 in 2 people with diabetes are unaware that they have the condition, this number is likely to be far higher. In the Middle East, reported rates of diabetes are on par with the United States (9.3%) and United Kingdom (6.2%), illustrating that diabetes mellitus is not limited to industrialised nations, and is increasingly becoming a challenge for lower income countries. However, if we remove the West from the equation, the Gulf region sticks out like a sore thumb in terms of diabetes prevalence. In Oman, the diagnosed prevalence of diabetes is an with type 2 making up roughly 90% of these cases. So what is happening in the Middle East, and specifically Oman, to cause this rampant epidemic? The surge in obesity is thought to be attributable largely to the ready availability ofenergy-dense food. One possible general explanation for the rise of diabetes in Oman then, is the rapid increase in its GDP, leading to universal improvements in socioeconomic conditions. Mainly down to the discovery and exportation of oil in the 1960s, this increase in GDP allowed Oman to develop rapidly. Historically, the Omani diet relied heavily on subsistence farming due to the Bedouin heritage of the country. A harsh agricultural environment, water scarcity and newfound funds with which to import food all lead to the sudden inundating of the modern Omani diet with all food types. So what is being done to tackle the scourge of diabetes in Oman? Firstly, it’s important to understand Oman’s modern health system – one of the best in the world – and how this battle could be made less problematic. , Oman had only 2 hospitals, based in Muscat; a total of 12 beds and 13 physicians for the whole country. The average life expectancy in 1970 was 49.3 years, and infant mortality wasstaggeringly high with one in every five children dying before their fifth birthday. Malaria, Pulmonary Tuberculosis and Trachoma were endemic, exerting heavy burdens on health with high rates of morbidity and mortality. The situation was unacceptable for a newly wealthy country, and in 1971 the Ministry of Health (MoH) was established under the auspices of His Royal Majesty (HRM) Sultan Qaboos, and was accountable for the organisation and development of Oman’s national health service. HRM Sultan Qaboos granted free at the point of service healthcare as a fundamental right for all Omani citizens through a system of Primary Health Care. Several years before Alma Ata, the Omani health authorities used Five Year Development Plans to achieve their goal of universal free healthcare, with decentralisation at the heart of the project’s success. Oman’s health system is now ranked by the World Health Organization, and yet diabetes remains a blight on the country’s public health. And the problemwill only get worse; public health experts have warned that the Middle East is forecast to endure by 2030, yet the region’s governments are simply not doing enough to tackle the issue. Health systems and staff will become increasingly overburdened, and morbidity and premature deaths will continue to rise. Oman and many other Middle Eastern countries – particularly the wealthier Gulf States – do have the resources to be able to cope, and yet Oman has only partially implemented non-communicable disease (NCD) initiatives. The ever-worsening rise of obesity and NCDs will test Oman’s national heath service. The mangement of first obesity, and then diabetes, is a complex issue that includes a wide variety of cultural and psychosocial factors. Therefore every individual with diabetes should receive personal diabetic care and advice from phyicians, and patient autonomy should be at the heart of this. Middle Eastern governments must recreate policy to include all the major risks and how theycan be tackled. Featured image: Baklawa © Michelle Muirhead Aoife Bulmaín is an Irish UCL graduate, living and working most recently in Oman. She studied Social Science as an undergraduate, with an interest in societal issues at large. After volunteering in Kenya in 2010, she shifted her path to international development and undertook an MSc in Global Health & Development at UCL. Aoife has a keen interest in child health.
