Choosing life: How Maldives is promoting healthy lifestyle choices to reverse the NCD burden

Ministry of Health, Maldives

For Ali Mohammad, a 33-year-old property management worker who began smoking in his teens, the saying ‘health is wealth’ has special significance.

After Maldives hiked import duties on tobacco products to 60% of retail price in May 2017, Ali made a potentially life-saving decision. “My health and pocket was suffering,” he explains. “Obviously, this was becoming a more and more costly habit for me. I decided to quit.”

That is exactly the response Maldives’ Ministry of Health set out to encourage. As Health Minister Abdulla Nazim Ibrahim emphasized on World No Tobacco Day, “Smoking brings nothing but harm to everyone,” costing Maldives an estimated USD 17.1 million annually and killing 11.3% and 7.1% of men and women in the country respectively.

Tobacco consumers are not the only ones being encouraged to add years to their life: In March, Maldives increased import duties on energy and soft drinks by a massive 58% ― the single largest increase anywhere in the world. The sale of energy drinks in all schools and health facilities has also been restricted. Both interventions will decrease consumption of these products, reducing the prevalence of a range of life-threatening noncommunicable diseases (NCDs), including diabetes and heart disease.

As WHO Representative to Maldives Dr Arvind Mathur explains, demand-reduction measures such as increased taxation and point-of-sale restrictions will help Maldives negotiate a difficult disease transition, with NCDs now accounting for 81% of all deaths in the country.

“Maldives is a high middle-income country where lifestyle choices are resulting in a significant NCD burden, whether from consumption of tobacco or sugary beverages, or other unhealthy habits. For the country’s health, as well as its economy, evidence-based action is needed,” he says. “When included as part of a comprehensive plan to change consumer behavior and encourage healthy lifestyles, fiscal interventions have significant impact.”

For tobacco specifically, and NCDs more broadly, increased taxation and sales restrictions are part of a package of best practices outlined in Maldives’ Multisectoral Action Plan for the Prevention and Control of NCDs 2016-2020. As Health Minister Ibrahim has noted, graphic health warnings, legislation against smoking in public places, and banning the sale of single cigarettes are now on the cards, while campaigns to encourage healthy eating and increase physical activity will continue to be rolled out country-wide.

Maldives’ targets are well-defined: By 2025, the country aims to achieve a 25% relative reduction in overall mortality from cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases; a 30% reduction in the prevalence of tobacco use in persons aged over 15 years; and to halt the rise in obesity and diabetes. These targets are aligned with the South-East Asia Region’s 2025 NCD goals, as well as the Sustainable Development Goal target of a one-third reduction in premature deaths caused by NCDs by 2030.

Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, says Maldives is charting a bold and necessary course.

“Tackling the NCD burden requires technical proficiency and steely resolve. Key interventions include creating cultural change via health promotion and fiscal interventions such as increased taxation, implementing the WHO Package for Essential NCD interventions at the primary level, and making urban spaces more amenable to physical activity,” she says. “Maldives has been active in pursuing these and other interventions, making it a regional – and indeed global – leader in NCD prevention and care. Maldives is demonstrating that real change is possible.”

Amid this wider push, Ali Mohammad’s decision to quit smoking is a small but important victory – not only for his health and wellbeing, but for the policies that inspired it and which can help reverse the NCD burden across the South-East Asia Region.

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