James Hounsell, Co-Founder, Evolene
Over the past few months, I’ve spent more time working across the Middle East than ever before. It’s been a steep learning curve, in the best way.
Cultural differences are the obvious part, but the more meaningful differences are structural: how healthcare is organised, how decisions get made, what’s funded, and what’s prioritised. Last week’s WHX Dubai was the culmination of a lot of those conversations, and my first time attending the event.
Firstly, it was huge. Four aircraft hangars worth of exhibitors, hundreds of thousands of visitors, and enough new technology on display to make you feel as though you’ve quantum leapt. But for me, the biggest takeaway wasn’t about AI, robotics, or digital transformation. It was about preventative care, and metabolic disease.
Non-communicable diseases (NCDs) account for around 74% of deaths globally, a stat I was roughly aware of, but one I hadn’t truly internalised what it meant in practice, particularly in the Gulf.
Having lived and worked extensively across the US and Europe, I wrongly assumed metabolic disease was predominantly a “Western” issue. That assumption was completely wrong.
Across several Gulf countries, prevalence rates for obesity, diabetes, and related metabolic conditions are significantly higher than the US. This is not a slow-moving problem. It is a fast-growing, system-wide threat, and it sits underneath so much of what health systems are trying to manage: cardiovascular disease, neurodegeneration, kidney failure, liver disease, cancer, and a spiralling demand for care.
The more time I spend working in the region, the more I realise that public health leadership understands this. The problem is that understanding is not translating into spend, at least not yet.
Prevention is still a rounding error
One of the most sobering figures I heard in conversation last week was that less than 2% of health spending goes towards prevention. That number alone explains a lot.
It explains why health systems are world-class at treating illness once it becomes visible, but still struggle to intervene early, when treatments are more effective, less costly, and less disruptive to people’s lives.
It also explains why WHX felt, in many ways, like a mirror of the incentive structure of global healthcare.
A conference built around sickness, not prevention
WHX is not really a conference for education. The Connect Conference is a relatively tiny component compared to the scale of the exhibition. That said, the quality of content was strong, particularly in the public health stream.
But the overwhelming emphasis of the broader event was on solutions designed to manage sickness, not prevent it.
A friend and fellow attendee, Kevin Shah, joked that at WHX you could buy needles, MRIs, and hospitals, and everything in between. He wasn’t wrong.
There were thousands of exhibitors selling the tools of modern healthcare: devices, diagnostics, digital systems, clinical services, infrastructure, and AI in every imaginable form, and yet, there were surprisingly few solutions that felt genuinely preventative.
I had several conversations with large medical providers and health systems about metabolic disease, NCDs, and prevention. In more than one case, the response was a vacant look, as though I’d asked the wrong question.
Plenty of “innovation”, but not much that moves the needle
There was no shortage of impressive technology at WHX. AI nurses, AR headsets, ambient scribes, workflow automation, and futuristic clinical environments were everywhere. Many of these solutions are valuable. Some will meaningfully improve care delivery, workforce efficiency, and patient experience. However, it was hard to escape the feeling that much of what was being showcased was designed to optimise a system that is already broken.
In other words: making the sick-care machine run faster, rather than stopping people becoming unwell in the first place.
And with metabolic disease, that distinction matters, because the scale of demand that’s coming cannot be solved by incremental productivity improvements alone. Not in the Gulf. Not in the UK. Not anywhere.
A few bright spots, and a reminder of what’s possible
There were, however, some genuinely encouraging examples. One that stood out was a talk by Dr Howard Podolsky, CEO of Johns Hopkins Aramco Healthcare. He spoke candidly about the “tsunami” of NCDs (shout out to Roger Green for coining the term).
Dr Podolsky described efforts to reach patients earlier, before they deteriorate, and to use data and system design to shift care upstream. Conceptually, it felt aligned with the mission of our clients Predictive Health Intelligence, and with what many forward-thinking public health leaders are trying to achieve.
It was one of the few moments at WHX where prevention of NCDs took centre stage.
The uncomfortable truth: incentives are still misaligned
Ultimately, WHX Dubai reinforced something I already knew. The biggest barrier to better healthcare is not technology, it’s incentives.
Health systems, globally, are not structured to reward early intervention. They are structured to respond to illness once it becomes expensive, acute, and unavoidable, and while that remains true, the market will continue to favour solutions that address the visible symptoms of demand, rather than the causes.
To paraphrase Professor Duncan Selbie, while the marketing budget of an ice cream company outweighs the public health marketing budget of a nation, we are unlikely to make meaningful headway on the biggest killers.
That is a hard truth. But it’s also an important one.
Acknowledgements
My trip to WHX Dubai was supported by Predictive Health Intelligence, who we’re grateful to work with.
Predictive Health Intelligence has built a leading data-driven case-finding platform used to help health systems get ahead of metabolic disease, using existing clinical data already held in routine systems.
To learn more, visit predictivehealthintelligence.co.uk
This article has also appeared on Health Tech World.