[Engaging Books is a monthly series featuring new and forthcoming books in Middle East Studies from publishers around the globe. Each installment highlights a trending topic in the MENA publishing world and includes excerpts form the selected volumes. This installment involves a selection from Georgetown University Press on the theme of the Gulf States. Other publishers’ books will follow on a monthly basis.]
Table of Contents
By Allen J. Fromherz
About the Book
About the Author
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Crude Strategy: Rethinking the US Military Commitment to Defend Persian Gulf Oil
Edited by Charles L. Glaser and Rosemary A. Kelanic
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Critical Issues in Healthcare Policy and Politics in the Gulf Cooperation Council States
Edited by Ravinder Mamtani MD and Albert B. Lowenfels MD
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Qatar: A Modern History
Allen J. Fromherz
About the Book
What role does Qatar play in the Middle East, and how does it differ from the other Gulf states? How has the ruling al-Thani family shaped Qatar from a traditional tribal society and British protectorate to a modern state? How has Qatar become an economic superpower with one of the highest per-capita incomes in the world? What are the social, political, and economic consequences of Qatar’s extremely rapid development?
In this groundbreaking history of modern Qatar, Allen J. Fromherz analyzes the country’s crucial role in the Middle East and its growing regional influence within a broader historical context. Drawing on original sources in Arabic, English, and French as well as his own fieldwork in the Middle East, the author deftly traces the influence of the Ottoman and British Empires and Qatar’s Gulf neighbors prior to Qatar’s meteoric rise in the post-independence era.
Fromherz gives particular weight to the nation’s economic and social history, from its modest origins in the pearling and fishing industries to the considerable economic clout it exerts today, a clout that comes from having the region’s second-highest natural gas reserves. He also looks at what the future holds for Qatar’s economy as the country tries to diversify beyond oil and gas. The book further examines the paradox of Qatar where monarchy, traditional tribal culture, and conservative Islamic values appear to coexist with ultramodern development and a large population of foreign workers who outnumber Qatari citizens.
This book is as unique as the country it documents—a multifaceted picture of the political, cultural, religious, social, and economic makeup of modern Qatar and its significance within the Gulf Cooperation Council and the wider region.
About the Author
Allen J. Fromherz is Professor of History at Georgia State University, and previously Assistant Professor of Middle Eastern History at Qatar University. He received his PhD from the University of St Andrews in Scotland after graduating from Dartmouth College in New Hampshire and was awarded a Fulbright Research Scholarship to Morocco. In 2010 he was awarded the Gerda Henkel Stiftung fellowship to pursue research on the history of nationalism in the Middle East. In 2016 he was a senior fellow at the New York University Abu Dhabi Humanities Institute. He is also the author of The Almohads: The Rise of an Islamic Empire (I.B.Tauris, 2012) and Ibn Khaldun: Life and Times (2010) and The Near West: Medieval North Africa, Latin Europe and the Mediterranean in the Second Axial Age (2016).
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Praise for the first edition:
“Allen J. Fromherz has written an excellent book on Qatar based on a thorough knowledge of historical sources and enriched by his own experience in the country. This book will be essential reading to anyone interested in Qatar and useful to anyone interested more broadly in the dynamics of the Arab Gulf states.” —Jill Crystal, Professor of Political Science, Auburn University, and author of Oil and Politics in the Gulf: Rulers and Merchants of Kuwait and Qatar
“Qatar fills a major gap as it provides for the first time the necessary historical basis for understanding this Gulf state in all of its contradictions and importance.” —G. R. Garthwaite, Jane & Raphael Bernstein Professor Emeritus in Asian Studies and Professor Emeritus of History, Dartmouth College
“Allen Fromherz’s informed history of Qatar provides a much needed alternative to the often breezy and superficial descriptions of the country’s rise from its penniless pearl-diving past to its prosperous present.” —The National
“The combination of theoretical perspective and on-the-ground analysis paints a compelling picture of the diverging – and frequently contradictory – internal and external pressures that have shaped Qatar’s meteoric rise… important reading both for policymakers and general observers of international affairs.” —International Affairs
“Fromherz… suggests persuasively that the lasting power of the Al-Thani rulers of Qatar has been significantly underestimated. Highly recommended.” —Choice
“The best general history of Qatar so far.” —Bulletin of the British Foundation for the Study of Arabia
“Lucidly explains [Qatar’s] evolution as a meaningful global player… excellent.” —East Magazine
“An impressive account of the birth of a nation… Fromherz does an excellent job of explaining the condition of modern Qatar by putting events and actions in a historical context.” —Funds Global/Funds Europe
Table of Contents
Acknowledgements
Al-Thani Rulers and Princes
Maps of the Persian Gulf and Qatar
Preface to the New Edition
1. Qatar – A New Model of Modernity?
2. Qatar – Geography of a Near Frontier
3. The Origins of Qatar – between ‘Emergence’ and ‘Creation’
4. Creating Social Realities – Qatar and the British in the Twentieth Century
5. Sheikh Khalifa and the Enigma of Independence
6. Sheikh Hamad, Sheikh Tamim and the Future of Qatar
7. Qatar’s Political Economy – A Classic Rentier State?
8. The Emir and the Exercise of Authority in Qatar
9. Conclusions – Change or Continuity?
Timeline
Notes
Bibliography
Index
Preview
Qatar has emerged as a recognized location in the imagined geography of global opinion. In terms of its foreign policy, which for a small state is so crucial, it has changed from a relatively new power player to a country identified with specific interests and allies. It also plays an increasingly decisive role, and therefore also increasingly bears responsibility, for international events where it intervenes financially or, sometimes, militarily. Even if Qatar has left behind some of its reputation as a clean, neutral mediator, it remains a valuable ally for Western interests – especially the USA. Although known as a past supporter of the Muslim Brotherhood, Qatar’s fortunes have not necessarily fallen along with the brothers. Instead, Qatar continues to provide a way for the West and monarchies in the region to speak to and mediate with Islamist elements more generally – the use of Qatar as a base for Taliban negotiators is a case in point. . . .
Although there may be strong temptations to take sides, especially as the bloody conflict in Syria only seems to get worse, Qatar will only be able to maintain its recent success if it maintains a balanced approach. Qatar should hold on to its prestige as a mediator and as a rare island or a jazeera of relative freedom of expression. To prevent its brief period of spring in freedom from turning into a long, miserable summer, Qatar must avoid the temptation to silence dissident voices or different points of view. Also, the fact that there have been crackdowns on freedom of expression in Qatar, especially through the potent and traditional means of poetry, is also troubling. However, there are many reasons to be hopeful that Qatar will not fall into the trap of favoring too heavily any particular side. Major struggles for the future and soul of Islam in the aftermath of the Arab Spring are arising. It was a spring that Qatar’s Al-Jazeera, Qatar’s money and even Qatar’s military intervention helped to plant. Qatar reaped some of the fruit of these revolutions through favorable contracts, sovereign deals, and that intangible commodity – prestige. Nevertheless the drawn out ‘Arab Winter’ brewing in Syria and potentially spreading into the rest of the Middle East may dampen Qatar’s appetite for intervention, or it may draw it in too far and destroy Qatar’s reputation for mediation. . . .
It is perhaps worth reviewing the power and history of that original vision of peaceful mediation and relative openness in Qatar, a vision that, I believe, could be traced to the example of Muhammad the Prophet himself. It was a parable known to nearly every young Muslim: Muhammad the mediator. . . .
Sheikh Hamad bin Khalifa seems to have followed the example of the Prophet in his path from mediator to leader. In the process he has made Qatar, once a minor humble player in the region, one of the most important states in the Middle East and, arguably, the world. It is a great mistake to see Qatar as simply a product of vast amounts of money spent with abandon. Money has certainly made a difference, but it is the use of those resources that has made Qatar stand out. Since his rise to power in 1995 Sheikh Hamad has used the vast resources from the North Field, shared precariously with Iran, to make tiny Qatar the forum upon which the region’s major conflicts and contradictions could be placed, or at least discussed. Through this strategy Qatar has become, at times much more influential than neighboring countries, countries that appear more powerful in traditional measures of size, population and military prowess. At the same time, Qatar has learned that newfound powers also come with risks.
With success comes costs. Qatar’s Al-Jazeera the first open media outlet in the region was a coup for Qatar but also a source of resentment by Qatar’s allies. Education City provides a place for vibrant intellectual engagement but has also faced criticism abroad. The successful 2022 World Cup bid has led to investigations of Qatar’s treatment of migrant workers. Although Sheikh Hamad’s projects, and the projects of the royal family as a whole, may seem disparate or even flagrantly contradictory, they all follow that central strategy – to increase Qatar’s visibility and reputation as a place where the world’s most pressing conflicts and problems and ideas can be discussed. All of these international initiatives are even more extraordinary considering Qatar had almost no foreign policy to speak of before Hamad. Qatar’s transformation was more than a major polishing of its international image, however. Often overlooked by the international media is the fact that the mediator style of leadership was the bread and butter of Sheikh Hamad’s own rise within Qatari society domestically. He was a master resolver of disputes and issues within his own population and family, to such an extent that, despite constant coup rumors, divisions hardly saw the light of day. Secure in power, Hamad introduced the concept of nationalism and national loyalties to a citizenry that is still largely defined by blood ties. With nationalism, however, comes certain irreversible risks. The nationalism of Qataris, even if closely tied to the Al-Thani historical claims and stories, may not automatically correspond with the preferred nationalism of the rulers.
It never seemed Hamad bin Khalifa’s mission to be adored, or even to be the most visible person in Qatar. His public wife Sheikha Mozah has many more followers on social media and his prime minister, Hamad bin Jassim, has been the person seen flying around the world spreading Qatari largess. I met Sheikh Hamad one day briefly in 2008. He was sitting in the Four Season’s Doha lobby with minimal security. He had a manner that would not really distinguish him from other Qataris. Many who have met him remark that he prefers this humble approach. He has what Arabic speakers call hilm: a forbearing, stable, mild and reasoned approach toward leadership, leadership that listens before acting. Behind a relatively quiet public personality, however, is a man of great power who harnessed the influence of the mediator, the hakam, with stunning results for his country and the region, results that have still to play out. Tamim, who has kept a similarly low profile and has displayed many qualities of a haleem (somebody with hilm), was groomed to carry on a hefty legacy. One encouraging sign was the fact that Tamim opened ministry positions to a newly emerging elite of young, educated Qataris outside of Al-Thani or Al-Attiyah lineage groups. Hamad’s strategy transformed Qatar from a minor tribal state into a nation of world significance. It remains to be seen if Tamim will be haleem in both form and substance, whether he will maintain Qatar’s success even as many fundamental challenges lay ahead. Even as Qatar has been successful, Tamim and the new generation of Qatar’s leaders must never forget Qatar’s history and modest beginnings. This need for reasoned and balanced leadership remains especially true today. So many leaders, from those in the 2016 US presidential campaign to those engaged in war in Syria, have great deficits in hilm.
—Allen Fromherz, “Preface to the New Edition,” Qatar: A Modern History (2017)
© 2017 Georgetown University Press. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Crude Strategy: Rethinking the US Military Commitment
to Defend Persian Gulf Oil
Charles L. Glaser and Rosemary A. Kelanic, Editors
About the Book
Should the United States ask its military to guarantee the flow of oil from the Persian Gulf? If the US security commitment is in fact strategically sound, what posture should the military adopt to protect Persian Gulf oil?
Charles L. Glaser and Rosemary A. Kelanic present a collection of new essays from a multidisciplinary team of political scientists, historians, and economists that provide answers to these questions. Contributors delve into a range of vital economic and security issues: the economic costs of a petroleum supply disruption, whether or not an American withdrawal increases the chances of oil-related turmoil, the internal stability of Saudi Arabia, budgetary costs of the forward deployment of US forces, and the possibility of blunting the effects of disruptions with investment in alternative energy resources. The result is a series of bold arguments toward a much-needed revision of US policy toward the Persian Gulf during an era of profound change in oil markets and the balance of power in the Middle East.
About the Editors
Charles L. Glaser is a Professor in the Elliott School of International Affairs and Department of Political Science at George Washington University as well as director of the Elliott School’s Institute for Security and Conflict Studies. He is the author of several books, including Rational Theory of International Politics: The Logic of Competition and Cooperation.
Rosemary A. Kelanic is an Assistant Professor of Political Science at Williams College.
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Praise for Crude Strategy
“How and to what extent should America militarily defend Persian Gulf oil? With uncommon clarity, this book lays bare the questions and assumptions that lie at the heart of this timely issue. The analysis is essential reading for anyone seeking to understand continued US military presence in the region.” —Jeff Colgan, assistant professor of political science, Brown University
“This book makes a meaningful contribution to the ongoing debate on US policy in the Persian/Arab Gulf, as it challenges many of the cornerstones of US policy in the region. Among the book’s authors are some of the leading thinkers on US strategy and Middle East policy.” —Brenda Shaffer, visiting researcher and professor, CERES, Georgetown University
“Oil is one of the few natural resources the absence of which could constitute the achilles heel of great powers and an existential threat to the health of the global economy. Belief in petro-exceptionalism has led the United States to commit substantial military forces to the Persian Gulf. Glaser and Kelanic and their contributors judiciously weigh the threats to the continuing free flow of Persian Gulf oil and assess the various strategic options the United States has to respond to them. This volume will quickly become a vital intellectual resource on this important topic.” —Michael Desch, director, Notre Dame International Security Center
“This outstanding volume is a must read on Persian Gulf security and economic issues and how to reset U.S. strategy for the Gulf. It also serves as a superb example of how the gap between theory and practice can be bridged and of the excellent analytical work that serious scholars can, and should, provide practitioners.” —Andrew Ross, professor, Department of International Affairs; director, National Security Affairs Program; and senior fellow, Institute for Science, Technology and Public Policy, George H.W. Bush School of Government & Public Service, Texas A&M University
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Table of Contents
Introduction
Charles L. Glaser and Rosemary A. Kelanic
Part I: Background
1. The United States and the Persian Gulf: 1941 to the Present
Salim Yaqub
2. Assessing Current US Policies and Goals in the Persian Gulf
Daniel Byman
Part II: Key Questions
3. The Economic Costs of Persian Gulf Oil Supply Disruptions
Kenneth R. Vincent
4. Saudi Arabian Oil and US Interests
Thomas W. Lippman
5. After America: The Flow of Persian Gulf Oil in the Absence of the US Military Force
Joshua Rovner
6. US Spending on its Military Commitments to the Persian Gulf
Eugene Gholz
7. Resilience by Other Means: The Potential Benefits of Alternative Government Investments in US Energy Security
John S. Duffield
Part III: Conclusions and Policy Options
8. Should the United States Stay in the Gulf?
Charles L. Glaser and Rosemary A. Kelanic
9. The Future of US Force Posture in the Gulf: The Case for a Residual Forward Presence
Caitlin Talmadge
List of Contributors
Index
Preview
America has long defined the free flow of Persian Gulf oil as a key component of its grand strategy. Since the late 1970s US military force has increasingly become the instrument for achieving this end. The 1979 Iranian Revolution spurred plans to bolster American military power in the region, and the mission took on new urgency when the Soviet Union invaded Afghanistan by the end of the year. In the wake of Moscow’s surprising move, President Jimmy Carter warned in January 1980 that the flow of Persian Gulf oil was a vital US interest and that Washington would use “any means necessary, including military force,” to protect it. The statement became known as the Carter Doctrine, and in one form or another, it has underpinned US policy ever since. The Rapid Deployment Joint Task Force created in March 1980 enabled the United States to quickly project power into the region. Three years later the United States created Central Command as a unified, multiservice command responsible for South Asia and the Middle East. To support its military requirements in the Persian Gulf, the United States built up significant sealift and airlift capabilities, prepositioned matériel in the region, negotiated access to regional facilities, and improved its major military base at Diego Garcia in the Indian Ocean. The United States fought the Gulf War of 1991 to ensure that Iraq’s invasion of Kuwait was not the first step toward Saddam Hussein dominating the region’s oil supplies. US capabilities deployed in the region increased further following that war. The Iraq War of 2003, although not directly related to US oil interests, would likely not have occurred but for the long- standing oil- driven involvement of the United States in the region.1
The American objective of protecting Persian Gulf oil has generated little controversy among scholars and policymakers since the Gulf became a focus of US military deployments in 1980. The Persian Gulf has kept its central role in US grand strategy primarily because it accounts for a large fraction of global oil exports and proven reserves. This unquestioned focus on protecting Persian Gulf oil may seem unsurprising given the widely appreciated importance of oil to the American economy. The United States consumes roughly 19 million barrels of petroleum daily, accounting for nearly 20 percent of global consumption.2 Petroleum is the single largest source of energy in the United States, accounting for 36 percent of all US primary energy consumption, and it plays a special role in transportation, which relies on oil for 92 percent of its fuel.3 More broadly oil plays a critical role in the health of the global economy, which in turn influences the US economy.
Nevertheless, the US military commitment to the Gulf should be revisited. Since the United States established its commitment, quite dramatic changes have occurred in the regional balance of power, the nature of threats to US security, and global energy trends—all of which bear directly on US interests. This opens up the possibility that the United States should significantly revise its policy toward the Persian Gulf both in terms of how it defines its strategic interests in the region and in the means it uses to pursue them.
Motivated by these observations, this book analyzes two questions. First, and most basic, should the United States continue to rely on military capabilities to preserve the flow of Persian Gulf oil? To answer this question, we examine the key rationales driving current US policies, lay out the assumptions and conditions upon which they depend, and assess how strong the case for American involvement really is. If the threats to Persian Gulf oil have diminished, or if oil disruptions themselves have become less dangerous to the United States, an American security commitment to the region may no longer make sense. Yet even if the old assumptions hold and the United States should remain strategically engaged in the Gulf, questions remain about whether the current US military posture in the Gulf is the right one.
This observation naturally segues to our second question: If a US security commitment remains strategically sound, what military posture would be most appropriate for protecting Gulf oil from likely threats? For the past few decades, the United States has relied upon a forward- deployed military presence to support its regional strategy. Yet given political change in the region, whether this posture still suits US interests is unclear. Depending on the nature and severity of threats to Persian Gulf oil, the United States may wish to adopt an over- the- horizon stance that reduces the American military’s footprint in the Persian Gulf while preserving its ability to perform key missions.
Admittedly US interests in the Persian Gulf extend beyond oil to include preventing nuclear proliferation, fighting terrorism, and spreading democracy. Yet although our analysis of US policy for protecting the flow of oil constitutes a partial analysis of American strategy in the region, the potential implications are far reaching. Oil has been widely recognized as a critical driving force behind US policy in the Gulf since the Second World War. The presence of oil elevates the strategic importance of the entire region, raising the stakes across all US interests there. While the United States cares about nonproliferation, counterterrorism, and democracy promotion across many regions, such issues take on special significance in the Persian Gulf because of their potential ramifications for maintaining a steady flow of petroleum. . . .
Several factors, when combined, place the United States at a critical juncture for reevaluating its long-standing role as the military guarantor of Persian Gulf security. The explicit US commitment to protecting Gulf oil dates to the late 1970s, when the region and the globe looked very different than they do today. Across the intervening decades, a succession of geopolitical shifts reshuffled the threats. During the Cold War, the Soviet Union posed the greatest danger to American interests in the region—interests that included both US economic prosperity as well as US national security that required unimpeded access to Persian Gulf oil in the event of a conventional conflict in Europe. While the dissolution of the Soviet Union removed the direct security threat to US military power, prosperity threats remained. The Gulf War of 1991 greatly reduced the threat posed by Saddam Hussein’s Iraq; the US invasion of 2003 eliminated whatever Iraqi threat may have remained. The years since then have seen the region plagued by civil wars and insurgencies that have cast a shadow over the region’s ability to reliably produce oil. Volatile defense budgets also suggest that a reappraisal of US strategy may be necessary. The United States faces trade-offs between maintaining historical military commitments, including the protection of Persian Gulf oil, and adapting to new strategic priorities such as the challenges posed by a rising China—and all in a climate of fiscal uncertainty.
The current situation demands new analysis to determine whether a US military commitment to the region is still warranted and, if so, what military posture would be most appropriate. In this book we argue that four key questions must be addressed to evaluate US policy. First, how much damage would a Persian Gulf supply shock inflict on the American economy? The greater the damage, the more the United States should be willing to invest to lessen the risk of shocks through military or other means. Second, by how much would the risk of disruption increase if the United States terminated its military commitment? If the departure of American forces would significantly raise the likelihood of a shock occurring or make such a contingency more difficult to reverse, the United States might gain the most by staying put. Third, how much does the United States spend to meet its military commitments in the Gulf? Holding all else equal and assuming US forces actually do reduce the probability of disruptions, the lower the military price, the more inclined the United States should be to pay it. Finally, could nonmilitary investments offer better protection to the US economy for an equal or lesser investment than military forces? If government policies—including those that would increase transportation fuel efficiency, support alternative fuels, and enlarge the strategic petroleum reserve—can substantially increase US resilience to oil disruptions, nonmilitary options may represent a better strategy than continued reliance on US military power to tamp down potential threats to the flow of Persian Gulf oil. The following chapters offer fresh perspectives on these questions. Based upon these analyses, we conclude that a major change to US grand strategy is much closer to being desirable than the widely accepted conventional wisdom suggests.
Notes:
- John S. Duffield, Over a Barrel: The Costs of U.S. Foreign Oil Dependence (Stanford: Stanford University Press, 2008), chap. 6; Michael T. Klare, Resource Wars: The New Landscape of Global Conflict (New York: Henry Holt, 2001), 58–78; and Charles A. Kupchan, The Persian Gulf and the West: The Dilemmas of Security (Boston: Allen and Unwin, 1987).
- BP, BP Statistical Review of World Energy, June 2015, 9, https://www.bp.com/content /dam/bp/pdf/energy- economics/statistical- review- 2015/bp- statistical- review- of – world- energy- 2015- full- report.pdf.
- Ibid., 41. Natural gas, the second- largest source, provides 30 percent of all energy consumed in the United States. The third- largest source, coal, provides 20 percent. Stacy C. Davis, Susan W. Diegel, and Robert G. Boundy, Transportation Energy Data Book: Edition 33 (Oak Ridge TN: Oak Ridge National Laboratory, 2014), 2–4, table 2.2.
—Charles L. Glaser and Rosemary A. Kelanic, “Introduction,” Crude Strategy
© 2016 Georgetown University Press. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Critical Issues in Healthcare Policy and Politics in the Gulf Cooperation Council States
Ravinder Mamtani MD and Albert B. Lowenfels MD, Editors
About the Book
This is the first book to examine challenges in the healthcare sector in the six Gulf Cooperation Council (GCC) countries (Saudi Arabia, Oman, the United Arab Emirates, Qatar, Kuwait, and Bahrain). These countries experienced remarkably swift transformations from small fishing and pearling communities at the beginning of the twentieth century to wealthy petro-states today. Their healthcare systems, however, are only now beginning to catch up.
Rapid changes to the population and lifestyles of the GCC states have completely changed—and challenged—the region’s health profile and infrastructure. While major successes in combatting infectious diseases and improving standards of primary healthcare are reflected in key health indicators, new trends have developed; increasingly “lifestyle” or “wealthy country” diseases, such as diabetes, heart disease, and cancer, have replaced the old maladies. To meet these emerging healthcare needs, GCC states require highly trained and skilled healthcare workers, an environment that supports local training, state-of-the-art diagnostic laboratories and hospitals, research production and dissemination, and knowledge acquisition. They face shortages in most if not all of these areas. This book provides a comprehensive study of the rapidly changing health profile of the region, the existing conditions of healthcare systems, and the challenges posed to healthcare management across the six states of the GCC.
About the Authors
Ravinder Mamtani, MD, is Professor of Healthcare Policy and Research, Professor of Integrative Medicine, and Associate Dean for Global and Public Health at Weill Cornell Medicine-Qatar. He is a specialist in occupational and general preventive medicine, public health, and integrative medicine.
Albert B. Lowenfels, MD, has been associated with New York Medical College as Professor of Surgery and also as Professor of Community and Preventive Medicine.
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Praise for Critical Issues in Healthcare Policy and Politics in the Gulf Cooperation Council States
“A brilliant mapping of our shared world’s health care challenges, sharpened with keen insights from nations most impacted by the tsunami of epidemics of obesity, diabetes and modern lifestyle ills. A considered call for synthesising good science with new thinking in better prevention, better care and better self-care to create a road out of our well-being impasse.” —David Reilly, FRCP, MRCGP, DSc, director of TheWEL and WELWorld programmes
“An essential contribution to the literature on healthcare policy in the context of the Gulf Cooperation Council states. Comprehensive and rigorously researched, the contributors shed much light on hitherto understudied topics ranging from mental health to substance abuse in the Arab Gulf states. Editors Ravinder Mamtani and Albert B. Lowenfels should be congratulated for such a sterling effort.”—Christopher Davidson, Reader in Middle East Politics, Durham University, School of International Affairs
Table of Contents
Foreword
Javaid Sheikh
Acknowledgements
Introduction
Ravinder Mamtani and Albert B. Lowenfels
1. A Historical Overview of Healthcare in the Gulf Cooperation Council States
Nabil M. Kronfol
2. The Politics of Healthcare in the Gulf Cooperation Council States
Dionysis Markakis
3. Human Resources for Healthcare in the Gulf Cooperation Council States
Mohamad Alameddine, Nour Kik, Rami Yassoub, and Yara Mourad
4. Mental Health in the Gulf Cooperation Council States
Suhaila Ghuloum and Hassen Al-Amin
5. Substance Abuse in the Gulf Cooperation Council States
Samir Al-Adawi
6. A Chronic Disease Profile of the Gulf Cooperation Council States
Cother Hajat
7. Lifestyle Diseases in the Gulf Cooperation Council States
Albert B. Lowenfels and Ravinder Mamtani
Conclusion
Ravinder Mamtani, Albert B. Lowenfels, and Sohaila Cheema
List of Contributors
Index
Preview
About fifty million people live in the Gulf Cooperation Council (GCC) states of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The GCC’s critical geographic location between Europe and Asia has resulted in an increase in both inhabitants and visitors, in what was once a relatively remote region. Geographically contiguous—and located just 25 degrees north of the equator—the region has a desert climate marked by excessive summer heat, minimal rainfall, and an increased likelihood of dust storms.1 These geographic factors play a deterministic role in the overall health of the region’s inhabitants.
Within the GCC, population and economic growth over the past several decades has been rapid, as has been the region’s integration into the global economy.2 These factors have led to a substantial increased demand for a mod ern, capable healthcare system to satisfy the needs of the population. This rapid, unprecedented demand for healthcare has resulted in the majority of services and professionals being sourced from outside the region. Before the unprecedented growth of the energy industry within the GCC, healthcare was limited to individuals mostly practicing traditional medicine, and to very small hospitals staffed by a handful of health professionals. If this level of healthcare had persisted, it would have severely limited regional growth. Many of the healthcare workers in the GCC have been trained outside the region, emphasizing the need to increase training capacity for the nationals in each country.
Beginning at the end of the twentieth century and continuing until the present, the Gulf region’s countries have devoted considerable efforts to boosting the healthcare sector. Although estimates vary greatly between different sources, healthcare-related costs are increasing rapidly, and are projected to reach $60 billion by 2025. Despite this considerable financial investment, the region still does not match other developed nations in infrastructure and capacity. Rapid changes to the environment and lifestyle of the Gulf region over the course of only a few decades have completely changed the region’s health profile.
Until now, healthcare costs for citizens of the GCC have been primarily borne by their respective governments, and this has become a major challenge for the state. Despite the availability of free medical care, many citizens of wealthier states, such as Qatar and the United Arab Emirates, prefer to receive medical treatment abroad instead of relying on the national healthcare system. In most cases the additional costs for overseas treatment are funded by the state, substantially increasing the burden of healthcare costs. . . .
In the Gulf states the healthcare field is currently dominated by expatriate expertise. Public health professionals have drawn attention to the critical need for the GCC to develop national and regional expertise in healthcare management. Many regional states have recently established state-of-the-art medical teaching and training programs, specifically designed to build a national cadre of health professionals. . . .
It is also essential to build national expertise in the management of health care. Medical technology and population health remain key determinants of strong healthcare systems, so additional areas—such as research, information technology, and healthcare management—are pivotal to strengthen the new strategies developed by the states.
Major successes in combating infectious diseases and improving standards of primary healthcare have been reflected in key health indicators—such as the decreasing levels of infant and maternal mortality rates and dramatic increases in life expectancy. Life expectancy is a simple measure of improvement of the healthcare system over time. As a result of several factors, life expectancy improved in all the GCC states during the twenty-three-year period from 1990 to 2013, with an average gain of about four to eight years. Table I.2 summarizes recent basic health statistics for each of the six GCC states. The life expectancy in the GCC . . . is comparable to those of other high-income countries.
As the overall health of the region’s population has improved, new patterns and trends in healthcare have emerged that pose different and yet significant challenges. For example, diseases related to the lifestyle of wealthy countries, such as diabetes, hypertension, and heart disease—which were once rare—are now common. These new challenges require highly trained and expertly skilled healthcare workers; an environment that supports local training, state-of-the-art diagnostic laboratories, research production, and dissemination; and knowledge acquisition to meet emerging healthcare needs.
Managing the healthcare needs of the region also requires accurate, up-to date statistics. Such information is not always available in the GCC, which limits the ability to allocate resources. Thus, though the industry is rapidly evolving, critical decision making pertaining to healthcare issues is hampered by the limited availability of information, which underscores the need for additional research in the area. This volume discusses critical, pressing healthcare politics and policy issues in the GCC states. Specifically, it examines the GCC’s rapidly changing health profile, the existing conditions of its healthcare systems, and the challenges posed to healthcare management across its six countries. . . .
The seven chapters in this book each cover a different topic, but there are several common overlapping themes. A special problem in the region relates to the large proportion of guest workers or expatriates—amounting to about half the total population. In some countries, such as Qatar, noncitizens constitute almost 80 percent of the population. Healthcare statistics generally are drawn from the native population, and thus only partially reflect the overall levels of health in the population. Also, the small size of the native population restricts the pool of native healthcare workers, resulting in a sustained need for foreign healthcare workers to satisfy the needs of the region.
Another problem dealt with in several chapters concerns the relative youth of the population. In many of the world’s wealthy countries, birthrates are low and older persons form a majority of the population. The GCC states still have relatively youthful populations, with the result that conditions such as cancer and Alzheimer’s disease are uncommon. Preparing for the transition from a younger to an older population will be a challenge facing each of the GCC states.
A major concern for the GCC is its preparation for the management of health care when its currently abundant energy resources are depleted. Recognizing this, the region is now focusing on educating the local population to assume the tasks that are now carried out by expatriates. New hospitals, such as the modern Sidra Medical and Research Center in Qatar, are under construction, and the region now has numerous medical schools whose aim is to train productive healthcare professionals who will remain within the region after completing their training. Nevertheless, it will require a strenuous effort for the region to be able to sustain a healthcare system without the help of foreign manpower.
The situation of healthcare in the GCC states continues to evolve. The emergence of lifestyle diseases, mental health conditions, the aging population, healthcare costs, health coverage, and a shortage of healthcare workforce personnel pose considerable challenges. Factors that are likely to shape and drive healthcare delivery in the years ahead include information and medical technology, regional and global partnerships, self-care, patient safety efforts, growing health awareness, government and hospital regulations, changing societal values and needs, and the changing face of the expatriate population. An interest in women’s health, the adoption of new health technology, and the changing face of healthcare professionals’ education are also receiving attention and are likely to influence the healthcare landscape in the GCC states.
The GCC’s rapid economic growth has dramatically changed its healthcare systems and situation. Life expectancy, the human development index, and other health indicators have significantly improved. It took many decades for high income European and North American nations, with their stable and growing economies, to enable their healthcare systems to mature. From this perspective, the GCC states have performed quite well in the health sector, in consideration of the comparatively very recent onset of economic development. The contents of this book remind us that a clear healthcare policy, with a focus on efficiency and equal access to resources, will be required to maintain and further improve the health and quality of life of the GCC’s population.
Notes:
- Economist Intelligence Unit, “The GCC in 2020: Resources for the Future,” The Economist, 2010, http://graphics.eiu.com/upload/eb/GCC_in_2020_Resources_WEB.pdf
- See Mehran Kamrava, ed., The Political Economy of the Persian Gulf (New York: Oxford University Press, 2012).
—Ravinder Mamtani and Albert B. Lowenfels, “Introduction,” Critical Issues in Healthcare Policy and Politics in the Gulf Cooperation Council States
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