75% of Indian workers lack health insurance

DUBAI // Three-quarters of Indians, other Asians and Arab expatriates in Dubai have no health insurance, the most comprehensive health survey of the emirate has found. The first Dubai Household Health Survey also found that high blood pressure is more than eight times more common in nationals than among expatriates, and twice as many Emiratis as expatriates suffer from diabetes.

The Dubai Health Authority (DHA) carried out the study of more than 5,000 people in conjunction with the Dubai Statistics Centre. Laila al Jassmi, the chief executive of policy and strategy at the DHA, said the figures on access to health care would be among the most useful in shaping policy. They showed that only 23 per cent of the bottom fifth of wage-earners - who earned an average of Dh2,273 a month - had health insurance, although the income brackets were not specified. She said once the analysis was completed, the authority would "know exactly what is going on".

"Initially," she said, "the survey has shown there is quite a large percentage of people not covered by health insurance. "People need at least a minimum coverage." Dr Eldaw Suliman, the head of research in the DHA policy and strategy sector, said the differences between nationalities were "striking". The overwhelming majority of nationals and western expatriates, but only a third of Filipinos, had some form of health insurance.

Of the 2,416 expatriates surveyed, it is not clear how many were from each nationality grouping. "The most important thing here is to get a baseline," said Dr Suliman. "Breaking it down into ethnicities allows us, very clearly, to see where the gaps are." Dubai planned to introduce universal health coverage in January 2009, requiring every employer to pay a set fee to the Government for each employee. This money would have been used to provide employees with "free access to basic health care".

This scheme, however, has yet to be introduced. In April this year, Dr Haidar al Yousuf, head of funding, said the DHA was considering instead a scheme similar to Abu Dhabi's mandatory health insurance. He said the original plan had been delayed because the extra cost to employers would have led to job losses during the financial crisis. Mrs Jassmi said the DHA was "still looking" into different models to ensure everybody had access to health care. The new figures stressed the need for a comprehensive policy, she said.

The survey's preliminary results also highlighted the growing problem of chronic diseases. Diabetes affects 16 per cent of UAE nationals and eight per cent of expatriates. Figures from the World Health Organisation have previously suggested that one in four nationals has the disease. Dr Suliman said he believed "strongly in the results". Emiratis are also far more likely to suffer from high blood pressure, a major risk factor of heart disease. Around 22 per cent of nationals have the condition, compared with just 2.75 per cent of expatriates. However, the figures are not corrected for age, a major factor in blood pressure. Dr Malek Makarem, a family medicine consultant in the capital, pointed out that the expatriate population is much younger than the local population, making comparison difficult.

"We cannot assume anything without understanding the details of the study, the age groups interviewed, the methodology and so on," said Dr Makarem. The DHA has not released any details on the demographics of those surveyed. Dr Huda al Shamsi, a family medicine specialist at Neima Clinic in Al Ain, said there was no single reason behind the higher prevalence of diabetes and hypertension among Emiratis compared with people of other nationalities. "It is multifactoral," she said, "Diet, lifestyle, lack of exercise and family history all play a role in diabetes prevalence.

"Diabetes and hypertension go hand in hand with one another, the numbers are not surprising." The figures on smoking showed a higher prevalence among expatriates than nationals - 12.7 per cent compared with 8.6 per cent. However, previous studies have found that men - especially Arab men - are far more likely to smoke than women. Men also make up a much larger proportion of the expatriate population, potentially skewing the results.

The DHA said it planned to create a number of "policy briefs" based on the results over the next 18 months. These will include fertility levels and patterns, psychological symptoms and distress in adults, health expenditure and traffic injuries. [e-mail] * With additional reporting by Hala Khalaf