Views & Reviews Outside the Box

The business of health

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39496.665891.59 (Published 21 February 2008) Cite this as: BMJ 2008;336:450
  1. Trisha Greenhalgh, professor of primary health care, University College London
  1. p.greenhalgh{at}pcps.ucl.ac.uk

    Arrivals lounge in Dubai airport. To our right, a huge banner ad stretching the width of the building: “The city that puts health as its first priority.” Outside, we join a taxi queue on a crowded pavement and inch past an unofficial bazaar of merchants, touts, and beggars. The night air is thick with tobacco smoke. Every other person seems morbidly obese. Some are leaning precariously backwards to balance their paunches. We are ankle deep in fast food wrappings. The taxis are going nowhere since traffic is gridlocked in every direction, but it would be unthinkable to walk and too dangerous to cycle. The man who offers to be our driver displays that most ironic and telling of behaviours—smoking two cigarettes at once. Presumably, we will be doubly impressed with his lifestyle choices.

    I am irritated. “I thought they said health was their first priority.”

    My husband knows about business. “They don’t mean this sort of health.”

    “Well, what sort of health do they mean?”

    “Building hospitals. Health tourism. That kind of thing. Stuff that brings in revenue.”

    Later, we are treated to a presentation from a strategic manager in a leading US medical school that has invested heavily in a prime piece of real estate called “Health Care City.” There are, she pointed out, a billion people in the Middle East and neighbouring regions, all of whom are likely to get sick at some stage. Many of these currently seek health care farther afield and could be diverted locally. To that end, the medical school is building a state-of-the-art hospital. She shows outline financial figures.

    “Just a minute,” I asked. “If this is a presentation about the strategic direction of the medical school, could you give me an idea of the health needs of the region?”

    “Oh, I don’t have exact figures, but we know the demand’s there for sure. Diabetes, heart disease, breast cancer. Lots of all those. Same kind of thing as the USA really, but there aren’t the same facilities for dealing with it yet.”

    Twenty-five percent of the adult population here has diabetes. Around 40% of men also smoke. Plenty of work, then, for the vascular surgeons. And if the focus is on when patients with diabetes “get sick”, presumably the gleaming new eye hospital won’t be short of customers for vitreo-retinal surgery. Which I guess is better than opening a shop selling white sticks.