When prevention is our best medicine

An Indian tuberculosis (TB) patient sits at a Free Tuberculosis Hospital run by the Kolkata Corporation on the outskirts of Kolkata on World Health Day.

In the UAE's attempts to introduce more effective primary care for its residents, preventive strategies have become a formidable weapon. Medical screening and educational programmes are nothing new, but the scale of what the UAE plans to put in place and what it seeks to accomplish are what make this public health strategy so ambitious. At a recent press conference, the UAE Ministry of Health unveiled what it hoped would become a national cervical cancer screening campaign. Cervical cancer is the second most fatal type of cancer for women worldwide and the picture in the UAE is no different.

The ministry and the Emirates Medical Association are collaborating to create an organisation that raises awareness of the disease, and the main function of the Emirates Cervicare Network is to encourage women and, in particular, Emirati women, to have an annual cervical smear test. There is also discussion regarding an information campaign promoting vaccination in young women against Human pappilloma virus (HPV), a virus that increases the risk of cervical cancer.

Eventually, the health ministry could use mobile screening units to visit outlying areas. Such units have already been used to combat the main cause of cancer deaths in women: breast cancer. One of the leading hospitals in the UAE has been running a campaign for about a year where mobile units have visited small villages and towns. It's already proving to be a success, with treatment being given to many women who might not have received it, and women being diagnosed with breast cancers that might have been overlooked, or diagnosed at a later, more deadly stage of development.

This week a proposal for a comprehensive national cancer centre was unveiled. Although part of its role will be to offer treatment, its real focus will be on prevention, with screening featuring heavily in the programme. Although they are often muted, there are cultural barriers to overcome in achieving these goals, but there is a growing awareness that these problems can be tackled. Whether it is vaccinating young women against papilloma virus or encouraging women to have smears carried out, the issues surrounding social stigmas can at times be blown out of proportion. It's often less about overcoming cultural barriers than it is about education.

After all, how many men are screened for testicular or prostate cancer? There are fewer men who are screened than there should be, but is this because of cultural taboos - or a lack of education? As public awareness increases, we will witness a rise in the acceptability of these types of screening programmes. Moreover, screening isn't being limited to cancer. The UAE has long had a range of health-screening protocols. These include premarital screening programmes for Emiratis and the screening of the expatriate workforce for HIV and tuberculosis.

The latter comes in for criticism now and again because any expatriate found to have either disease is deported, but the UAE can capitalise on the strength of the screening programmes it runs already to galvanise greater and more comprehensive preventive efforts in the country. Perhaps the greatest stigma associated with screening has revolved around HIV since its discovery in the 1980s. This stigma is not just found in the UAE, however.

In the UK there has been an outcry over the treatment of children with HIV being ejected from schools as a direct consequence of their illness. However, the system the UAE has in place to screen expatriates before issuing work visas is different. The UAE isn't responsible for the health of people who arrive from foreign lands who wish to work here. While it is not pleasant to be ejected from a country because of a health condition, many other countries do the same thing.

It might not be popular but, right or wrong, it's a system that has been running successfully for many years. Its preventive benefits should be expanded and the screening process could be broadened to other diseases and other segments of the population. The data collected from all types of screening programmes should be gathered in a central database that could be used for epidemiological studies. Statisticians from across the globe would be interested in visiting the country for this type of information and the UAE could become a centre of excellence for tracking public health trends in everything from cancer and infectious disease to joint replacement.

Of course, it's a massive undertaking, but the foundations are already in place. The money, resources and the will needed to expand preventive programmes are present in the UAE, more so than in many other nations. Private-sector hospitals and clinics could also be included. Health screening is a crucial aspect of preventive medicine and the UAE has a head start in developing a comprehensive model of treatment. However, there has to be a high level of confidentiality and those being encouraged to be screened need to understand why.

When this happens the UAE's battle against cancer and other diseases can truly begin. Peter Donnelly is science correspondent for the Life Science Division and IIR Middle East