In many developed Western economies, age-old commitments to state health and welfare, free at the point of use for all, are becoming increasingly unsustainable. Poor planning, shifting demographics, and the trend of elderly citizens living longer and demanding more complex care are all contributing to the significant burdens facing already failing healthcare and welfare systems. In some jurisdictions, those systems are reaching breaking point.
The GCC has much to learn from Western economies when it comes to planning and running retirement, care and social-welfare systems, in the sense that they can teach us how not to do things. In some respects, given the relatively young average age of Gulf populations, time is on our side. But the region needs to safeguard against the dangers of complacency, and there’s also an urgency to getting the demographic analysis, planning and execution right, as well as addressing the health and dependency issues unique to the region.
Legacy systems in Western economies: the background
Ageing involves mental and physical deterioration, creating a growing cohort of elderly and vulnerable patients. Countries such as the US are ill-prepared for this, with the proportion of over-65s set to jump to 23% of the population by the 2050s. And the number of people living to 100 or more will quadruple in that time.
Simultaneously, the US is experiencing rising care costs and a chronic shortage of care workers. In 2023, a private room in an American care or nursing home cost an average of USD 120,000 per annum, while at-home social care and welfare averaged around USD 75,000 per patient. State and federal funds in the US are under increasing pressure as more and more elderly and vulnerable patients are forced into social care-funded nursing homes within the US Medicaid or Medicare systems when they run out of cash.
More worryingly, some healthcare and community organisations in the US are warning of an imminent spike in the number of elderly patients with dementia or mental illness becoming homeless. As an indication of how dire the Medicare and Medicaid public insurance systems are in the US, around 65% of US citizens have private health insurance, whether through employer-sponsored or privately paid coverage, yet public healthcare is struggling. And the current US administration has recently passed legislation to cut the Medicaid and Medicare budgets by more than USD 910 billion.
Elsewhere, retirement, welfare and social care systems, especially for the vulnerable, have failed to seize the opportunity to reform. In the UK, for example, quality care beds for patients with dementia or learning difficulties are disappearing at alarming rates. And that’s partly because private and charity care homes that previously catered for patients with complex needs had effectively been subsidising local-government commissioning authorities that lacked adequate funding to pay for those care beds.
Despite a doubling of the UK’s healthcare budget in real terms between 1997 and 2009, the state-funded National Health Service (NHS), with its growing waiting lists and worsening health outcomes, is on the verge of collapse. It’s clear that, despite generous increases in funding and staffing – it now employs 1.7 million people and accounts for over 14% of all government spending – the UK’s NHS is poorly equipped to deal with additional healthcare burdens. And yet it is now beginning to bear the brunt of increasing numbers of vulnerable, chronically frail and elderly patients requiring extremely complex levels of care and support, and for whom there are a diminishing number of suitable care-home beds.
With acute beds in the NHS continuously occupied by patients who should be treated in nursing and care homes, it’s only a matter of time before this creaking system reaches breaking point. Approximately 1.5 million people, equivalent to around 2% of the UK population, have some form of learning disability or other conditions that demand high levels of support to enable them to cope with everyday life, and that figure is closer to 2.5% for children in the UK. Future demand for care is such that, when coupled with the growing demographic of elderly patients with dementia or increasing frailty, the mathematics of sustainability within the social-care system simply doesn’t add up.
Care and welfare in the GCC: how can we plan for a better future?
While systemic and structural failures in the US and UK serve as lessons for the GCC and the wider MENA region, we also face unique challenges that need to be addressed within policy and planning frameworks. The relatively low average age of populations in the GCC, around 34, gives us some breathing space before those demographic pressures start to exert themselves. Yet, some of our unique challenges need to be addressed more urgently – in the GCC, the ratio of individuals living with some form of learning disability equates to 10% of the population. Substantially caused by consanguinity, people suffering from these genetic issues are, for cultural and policy reasons, primarily cared for at home by their families. And where outside care is available, there’s very little coordinated training, little regulation and a lack of regulatory oversight.
That’s not to say these challenges are being ignored – there is a growing recognition that People of Determination have the same human rights as any other citizen and deserve increased levels of support. And while it’s true that basic care is still unavailable to most and that few carers are trained in Professional Behavioural Support, organisations are emerging to help address these issues. The Zayed Higher Organization for People of Determination, for example, has set its mission to establish equal rights to “increase happiness and social empowerment” for people with disabilities. Its dual focus is on helping People of Determination live their fullest possible lives, as well as providing training for caregivers.
At the same time, a new Ministry of Family is addressing these challenges and establishing a framework to integrate international best practice into UAE policy. Established to help people with disabilities and special needs integrate more easily into society under an overarching National Policy For Empowering People Of Determination, the Ministry recently celebrated the graduation of 50 students with special needs from centres that offer targeted education, training and rehabilitation for People of Determination aged 4 to 18. As the Ministry itself noted, “young people can transition into vocational roles, develop life skills, take on project-based work, or join the wider job market”. But there is still a long way to go.
Where do we go from here?
Recognising their advantage over many developed nations, the GCC and broader MENA regions must adopt a bold vision, one that blends careful consideration and consultation to strike the correct balance between urgency and deliberate action.
The traditional model of families caring for their elderly, frail or disabled relatives may be evolving, as younger generations are becoming more internationally mobile and therefore not always available to provide that care. And in the case of certain types of dementia, family members aren’t ordinarily qualified to provide the specialised care dementia patients require. Future care provision must be underpinned by robust regulation and training as the sector develops a new vision for assisted living. This vision should integrate optimal communities, housing, and technology to ensure effective delivery.
Although we have a clean slate to create and develop these plans, there’s still an urgency to put in place practical, scalable systems that learn from the failures of Western economies.
