The Health of Kuwait – A Wake up Call (Part I)

Health is neither a luxury nor a commodity; it is an unquestionable right of every human being. Governments must strive to provide the best possible care to their people. The public must be informed of advances in health care and have access to a scope of quality services. In an altruistic realm this could probably stand as a moral statement. Truth be told, health must also be looked upon as an investment as a healthier population is a more productive one. Illness impedes on the socioeconomic progress of our nation by reducing productivity through the lack of manpower. This may seem to be a moot point knowing that Kuwait’s economic expansion has been unprecedented in the last couple of years. Thanks to our desirable resource, we have achieved a growth of close to 20% in 2004 alone, continuing to fair well to this day. So, what is the point you may wonder? Well, with health being the third largest budget, you would expect our health services to flourish accordingly. They do not. People in the business will tell you that, in the recent decades, the quality of services has been steadily declining. Can we objectify this? Standard markers of a population’s health such as infant and maternal mortality rates or life expectancy can be deceiving as they do not adequately highlight certain deficiencies in primary, secondary or tertiary prevention throughout life creating a false sense of well-being despite a high prevalence of chronic diseases with worsening courses and trauma-related injuries in the country. The reasonable life expectancy underscores a trend in our disease profile, also seen in the rest of the industrialized world, towards more chronic conditions such as heart disease or diabetes from the more acute, life-limiting infections previously observed in our young and middle-aged populations. A caveat to keep in mind is that devastating infectious disease crises remain plausible if entities such as HIV continue to be neglected and prevention programs for threats like the Avian Flu or, worse, the deadly XDR-TB (the newly discovered untreatable tuberculosis) remain weak. Such life expectancies are not representative of the quality of life of patients with such life-long ailments. When comparing patients, the average Kuwaiti will be more limited by his or her disease than one from a nation with stronger prevention programs where systems are in place to tightly control those disorders. When focusing on trauma-related injuries, the major cause of death in our productive age group, recent statistics from the Department of Motor Vehicles have shown that road traffic injuries are on the rise. During the first eleven months of 2005, 403 deaths have been reported averaging 1.2 deaths per day. This compares to 398 during the entire year of 2004 and 372 in 2003.

A recent article published by the KUNA emphasizes the low death rate of our State. Statistics from the World Health Organization (WHO) do indicate that we rank among the nations with the lowest overall death rates. However, information like this, in the setting of an obvious crisis, must be taken with a grain of salt. Death rates do not necessarily predict the quality of health services, particularly in our region. A number of factors can explain this. First, Kuwait’s population is young with only 2.7% being in the elderly age group (over 65 years of age) which contrasts with over 12% in countries like the United States, the United Kingdom or France. Second, the bulk of our workforce is a working age expatriate population that is thoroughly screened upon entry into the country, making them more likely to be healthy. Furthermore, it is common practice for such foreigners to return to their home country or, in certain instances, be deported after being diagnosed with a life-threatening or communicable illness. Third, depending on their socioeconomic status or political influence, many citizens have access to health care services abroad, thus improving their health outside our system. One cannot make assumptions on the status of a system based on a general figure. The death rate adjusted by cause of death, details not reported in the article, provide a more defined picture of the true health problems plaguing our system. Moreover, there is very little awareness within the population and effective health campaigns have been scarce, if at all existent, in our recent history. To demonstrate this, the average patient is often incapable of providing a list of his or her medical problems, current medications or drug allergies, information that is vital to clinics and emergency departments in an environment that lacks the most basic information system infrastructures. Other gauges of the nation’s health status are studies conducted by organizations such as the WHO. As previously mentioned, its 2000 World Health Report has placed our health care system in the 45th position of 191 member nations and last within the GCC. The message needing to be relayed is that funding is only part of the issue. What weighs more in the balance is its appropriate use. The right minds need to think in the right way.

“Improved health contributes to economic growth in four ways: it reduces production losses caused by worker illness; it permits the use of natural resources that had been totally or nearly inaccessible because of disease; it increases the enrollment of children in school and makes them better able to learn; and it frees for alternative uses resources that would otherwise have to be spent on treating illness.”
World Bank (1993), World development report 1993. New York (Oxford University Press)