Dr. Tawfik A. Khoja1 Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH,FRCP (UK) Director General - GCC Riyadh 11/1/1430H - 8/1/2009

Dr. Tawfik A. Khoja2 ” أَفَمَن يَمْشِي مُكِبًّا عَلَى وَجْهِهِ أَهْدَى أَمَّن يَمْشِي سَوِيًّا عَلَى صِرَاطٍ مُّسْتَقِيمٍ ” “ Is then one who Walks headlong, with his face Grovelling, better guided, Or one who walks Evenly on a Straight Way ? ” سورة الملك ( آية 22) Holy Quran

Dr. Tawfik A. Khoja3 SINCE the GCC States constitute one regional community in its Islamic religion, Arabic language, population, similarity in geography, and values history, traditions, economic sources, social and cultural circumstances. THEREFORE they had to unify their efforts in different fields of life to face the quick changes, and the overall development requirements.

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5 The Health Minister's Council for Cooperation Council States, was established in 1397 H (1976G. ) for coordination between the GCC States in the fields of health to join the common world efforts symbolizing one goal for better achievement of health and expectation for health. MISSION in the Gulf States based on these principles:- Common development & coordination between the Members States in the preventive, curative and rehabilitation fields.Common development & coordination between the Members States in the preventive, curative and rehabilitation fields.

Dr. Tawfik A. Khoja6 Identify the concepts and directions of the different health and scientific issues.Identify the concepts and directions of the different health and scientific issues. Unify and arranging the priorities as well as adopting the common executive programs in Gulf States.Unify and arranging the priorities as well as adopting the common executive programs in Gulf States. Assessment of the existing systems and strategies in the health fields and supporting the successful experiences in the Gulf States to exchange such achievements in other Member State.Assessment of the existing systems and strategies in the health fields and supporting the successful experiences in the Gulf States to exchange such achievements in other Member State.

Dr. Tawfik A. Khoja7 Since Alma Ata in 1978 Dramatic changes have occurred: *In the pattern of diseases. *In demographic profiles. In socioeconomic environment. Growing demand on health services. Rising costs. Public needs for better quality services. Which present new challenges to PHC. These changes are seen globally: For example: Increase in the prevalence of preventable risks In crease in the prevalence of chronic non- communicable disease.

Introduction The GCC is witnessing the last few years huge changes in the health needs of its population. MANY countries are suffering from the effects of the double burden due to infectious and non- communicable diseases (NCD). NCDs forms the main causes of premature deaths and disability where it forms around 60% of the overall mortality and 47% of the global burden of diseases. These two rates are expected to jump into 73% and 62% respectively by the year Dr. Tawfik A. M. Khoja8

The epidemiologic transition in the GCC : The quick ageing of the population the steadily increasing urbanization with consequent social and economic impact. Important behavioral factors related to the dietary pattern, physical inactivity leading to overweight and obesity and thus increasing rates of cardiovascular diseases, diabetes, hypertension, some types of cancer.. etc. The effects of this epidemiologic transition is far more than expected by the health policy makers. Dr. Tawfik A. M. Khoja9

10 The burden of NCD : Has major adverse effects on the quality of life of affected individuals; Causes premature death; Creates large adverse – and under appreciated – economic effects on families, communities and societies in general.

Dr. Tawfik A. Khoja11 CVD and diabetes are emerging as the single leading cause of mortality in the Gulf. The enormous burden caused, in terms of suffering and health costs is escalating. NCDs present mainly at the primary health care (PHC) level and will therefore need to be handled principally in these settings. Yet, most primary health care has developed in response to acute problems and the urgent needs of patients. Health care workers need the skills and practical tools to manage these chronic conditions and to ensure that patients receive comprehensive, coordinated care.

Dr. Tawfik A. Khoja12 Health care systems must guard against the fragmentation of services. Care for NCDs needs integration to ensure shared information across setting and providers, this means setting priorities for screening, early detection prioritising surveillance, and management to be applied and followed among Gulf area, through community - based programme as well as health team training on: Evidence-based, clinical management of chronic conditions. Organizational factors that support the provision of care for patients with chronic conditions. A proven methodology for accelerating health care improvement in PHC.

EMRO &NCD RISK FACTORS Diabetes in 10 Hypertension1 in 4 Smoking1 in 3 Obesity 1 in 2 Dyslipidaemia1 in 2 Physical Inactivity 8 in 10 13Dr. Tawfik A. M. Khoja

14 Prevalence of Physical Inactivity GCC mean of Physical inactivity is 71.4%

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Dr. Tawfik A. M. Khoja16 Global effect of Over weight & Obesity on developing NCDs In WHO analysis:  58% of Diabetes Mellitus  21% Ischemic heart diseases  4-42% of certain cancer Were attributable to BMI above 21 kg/m 2

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د. توفيق بن أحمد خوجة 18

Dr. Tawfik A. M. Khoja19 Current Situation in the GCC States The GCC countries lie in the center of these epidemiologic transitions. Statistical studies affirms that more than (40-50%) of the Gulf community are suffering high rates of overweight (which increases with age) in addition to the high prevalence of risk factors; namely high lipids and cholesterol in blood – smoking and others. The studies emphasized as well the aggravation of this health phenomenon and its consequent economic burden.

Dr. Tawfik A. Khoja20 Chronic conditions Among person aged 15 years and over, the percentage reported of have ever had specific chronic conditions confirmed by a doctor, by sex, GCC Family Health Survey

Dr. Tawfik A. Khoja 21 Many studies affirmed the high prevalence of the risk factors in the Gulf region for the age group 25-65, as follows: Risk factors in the GCC States - Smoking % - Hypertension % - Fats and lipids % - Physical Inactivity % -Diabetes % - Overweight and obesity 40-70%

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Dr. Tawfik A. M. Khoja % (age >15) Bacchus & Madkour % Fatani % AbuZaid % (age >14 years) Hazmi % (age >30 years) Nuaim % (age >30 years) Nozha % (age >30 years) MOH 2010??? Diabetes - an escalating problem in the Kingdom of Saudi Arabia

UAE 32.0% (DM 22.0% + IGT 10.0%) Bahrain DM 30% (age >40 years)… Mahroos Saudi Arabia 40% (DM % + IGT %) (age >30 years) Oman 19.0% (DM 10.0% + IGT9.0%) Kuwait 22.0% (DM 20.0% + IGT 12.0%) Qatar 30.0% (DM 10.0% + IGT 20.0%) Diabetes in the Gulf Region 24Dr. Tawfik A. Khoja

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Dr. Tawfik A. Khoja26 Control of Cardiovascular Diseases. Control of Diabetes. Cancer Control and Registration. Health Education and Information. School Health. Mental Health. Strengthening the Role of PHC in Prevention and Control. Hence, it became mandatory for the Health Ministers’ Council for the Cooperation council States to confront this problem, through a number of strategic directions: I- Establishing Specialized Consultative National Committees

Dr. Tawfik A. Khoja27 II- Strategic Resolutions by the Health Ministers’ Council for Cooperation Council States

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Dr. Tawfik A. Khoja29 Resolution # 3/50 (Kuwait, Shawwal 13-15, 1421H /Jan. 8-10, 2001). It decided the following: a: a: 1-Establish diabetes epidemiological screening program, collect information and prepare diabetes health indicators in the Gulf States. 1-Establish diabetes epidemiological screening program, collect information and prepare diabetes health indicators in the Gulf States. 2- Coordinate, follow-up and communicate in the field of dissemination of information and develop preventive, educational, and treatment programs to control this disease, and help individuals to lead a healthy life. 2- Coordinate, follow-up and communicate in the field of dissemination of information and develop preventive, educational, and treatment programs to control this disease, and help individuals to lead a healthy life. 3-Supervise the training programs and train workers in the field of healthcare for Diabetes mellitus. 3-Supervise the training programs and train workers in the field of healthcare for Diabetes mellitus.

Dr. Tawfik A. Khoja30 b. Adopt new methods in the health care service of diabetes,i.e. specialized primary healthcare clinics for diabetic patients, adoption of shared care for chronic diseases, and reinforce the referral system within the different levels of health care services. b. Adopt new methods in the health care service of diabetes,i.e. specialized primary healthcare clinics for diabetic patients, adoption of shared care for chronic diseases, and reinforce the referral system within the different levels of health care services. c.Adopt national diabetes registration system to register all the diabetes cases in each country of the Gulf States. It should possess very clear views and methodology to achieve each goal. c.Adopt national diabetes registration system to register all the diabetes cases in each country of the Gulf States. It should possess very clear views and methodology to achieve each goal.

Dr. Tawfik A. Khoja31 1- Approve the "Gulf Plan of Action" (2001 — 2002) which has been suggested by the referenced taskforce team, as a guiding plan for the rest of the Gulf countries. 1- Approve the "Gulf Plan of Action" (2001 — 2002) which has been suggested by the referenced taskforce team, as a guiding plan for the rest of the Gulf countries. 2-Take the initiative of forming the "National Committee for the Control of Diabetes" in member countries where these committees have not been formed yet. 2-Take the initiative of forming the "National Committee for the Control of Diabetes" in member countries where these committees have not been formed yet. 3- Incorporate diabetes control programs in the other programs that are related to chronic noncommunicable diseases i.e. high blood pressure (hypertension), obesity, etc… within the healthcare joint systems for chronic diseases, and the specialized clinics in the primary health care sector. 3- Incorporate diabetes control programs in the other programs that are related to chronic noncommunicable diseases i.e. high blood pressure (hypertension), obesity, etc… within the healthcare joint systems for chronic diseases, and the specialized clinics in the primary health care sector. Resolution # 2/51 (Geneva, Safar 1422H /May 2001) It affirmed the following:

Dr. Tawfik A. Khoja Member countries should submit their suggestions for the activation of the “Gulf Diabetes Control Plan”. These suggestions should indicate a phased goals plan, and a specific timetable, taking into consideration that special emphasis should be made on preventive measures in controlling diabetes. 1 - Member countries should submit their suggestions for the activation of the “Gulf Diabetes Control Plan”. These suggestions should indicate a phased goals plan, and a specific timetable, taking into consideration that special emphasis should be made on preventive measures in controlling diabetes. 2- Instruct the “Health Education and Information Committee” of the executive board, to prepare a special program to enhance positive healthy life style approach and encourage the change of individual attitudes and behavior to go alongside with this concept. 2- Instruct the “Health Education and Information Committee” of the executive board, to prepare a special program to enhance positive healthy life style approach and encourage the change of individual attitudes and behavior to go alongside with this concept. Resolution # 8/52 (Riyadh, Shawwal, 1422H / 8-9 Jan. 2002) It adopted the following:

Dr. Tawfik A. Khoja33 Resolution # 5, conference 58 HMC (Muscat, 5-6/1/1426 H – 14-15/2/2005) Which affirmed the following: A- Giving effect to the “global strategy on diet, physical activity and health” within the related programs and departments in the Ministries of Health.

Dr. Tawfik A. Khoja34 Resolution # 4 Conference 60 (Feb., 2006) A)Adopting new approaches to evaluate medical services for the care of patients of such diseases and giving effect to and developing the role of health centers in this respect (prevention, cure, and rehabilitation). B) Giving effect to the concept of health promotion within the Healthy Lifestyle, prevention and control of chronic and non-Infectious diseases. - Reaffirming the previous endorsed resolutions of the Council concerning the importance of supporting and promoting the role of control of non-communicable diseases and positioning the extended medical care as one of the priorities in the strategies of the ministries of health, with emphasis on: