Oman beating NCDs at the souk, the restaurant and the bakery doors

August 2017

People in Oman celebrating in Nizwa
Launch of a new health promotion project in the Omani city of Nizwa
WHO

From smoke-free souks to low-salt bread, businesses and communities in the Sultanate of Oman are leading the charge against noncommunicable diseases, like heart and lung diseases, cancer, and diabetes.

Guided by the country’s Nizwa Healthy Lifestyle Project (NHLP), Oman’s oldest community-based health promotion project founded in 1999, many layers of society – from the national consumer protection authority and municipal authorities to various businesses – have joined forces to reduce risks that causes NCDs and, in turn, improve health.

Nizwa, located about 175 kilometres from Muscat, Oman’s capital, is one of the country’s oldest cities and most popular tourist destinations.

"All going well, we will set a goal to disseminate these initiatives and put in place more examples all over Oman," says Dr Zahir Al Anqoudi, head of the NCDs section at Oman’s Ministry of Health and a member of the Oman Anti-Tobacco Society.

Earlier this year, the Nizwa project launched two new innovative health promotion activities: the "Tobacco-free souk" in Muscat’s open-air traditional market, and the Healthy Restaurants Initiative.

Oman is one of several countries selected by WHO to receive integrated support to fast-track progress on achieving nine global targets to prevent and control NCDs, including reducing premature death from NCDs by 25% by 2025, and the NCD-related targets in the 2030 Agenda for Sustainable Development.

A unique recipe for success

WHO’s support has been key in Oman’s progress in reducing salt consumption, regulating alcohol sales and marketing and promoting physical activity. The Organization also helped to lay foundations for the five strategic priorities for NCD prevention and control Oman is working towards: tobacco control, healthy diet, physical activity, healthy territories, and integration of NCDs into primary health care.

Uniting people and leaders from different sectors behind a common goal to intensify action to improve the health of everyday Omanis has also been part of WHO's work.

Such collaboration has resulted in significant reductions of salt consumption, for example. Reducing salt content in food was a measure supported by many local food producers, particularly Oman’s main bakeries, who supply 90% of all bread products. As a result, the Omani government is now committed to additional legislation to regulate fats and sugars.

Taking it to the streets

In Oman, popular community centres are often places of worship, restaurants, or markets. Recognising this, Oman’s Ministry of Health is focusing in on such areas to tackle two big NCD risk factors: diet and tobacco.

In Nizwa, establishing a tobacco-free souk was the next big step in tobacco control following its indoor smoking ban issued in 2010. A survey conducted by local volunteers in 2016 found near unanimous support for the smoking ban by community members, business owners, local visitors and international tourists alike.

The Healthy Restaurants Initiative is a first for Oman and one of the few of its kind in the Eastern Mediterranean Region. Three restaurants have volunteered to pilot locally developed guidelines for healthy food options on their menus that are low in salt, fat and sugar. Classes on healthy food preparations are also on offer for staff.

"We will make sure that the implementation of the initiatives will happen gradually through proper awareness raising and training," says Mr Yarub Al Yahyaee, director of the Municipality of Nizwa.

The case for change

Targeting risk factors like diet and tobacco that are closely related to cancers, heart disease and stroke, diabetes and chronic respiratory diseases is vital in Oman.

More than 50% of Omani men and women are overweight or obese, more than 40% have hypertension, and 12% have been diagnosed with diabetes. One in five Omanis die before their 70th birthday, most from largely preventable cardiovascular diseases.

Like many other countries in WHO’s Eastern Mediterranean Region, the estimated average intake of salt consumption for people in Oman is close to 10 grams per person per day. This is double WHO recommendations.

This is why the United Nations Interagency Taskforce on NCDS (UNIATF) and the WHO GCM/NCD Integrated Country Support team work in strong collaboration with Oman to ensure factors like salt reduction can be implemented from end-to-end, starting with monitoring and surveillance of population-wide salt consumption.

Achieving results

Since 2015, Oman has been successful in achieving a 10% reduction of salt content in bread items within main bakeries. In 2016, this initiative established a more ambitious objective of 20% salt reduction in breads and broadened its focus to cheese as well.

Oman’s Ministry of Health has also established a national monitoring team to control the progress in salt and fat reduction in Omani food products.

It is hoped that this will help establish a base-line measure of salt consumption in the population, usually measured from a 24 hour urine sample, so that progress can be tracked and more easily linked to changes in health outcomes.

To ensure these measures reach Oman’s youth, the government has incorporated health education in all school curriculums. This recognizes that youth can act as powerful agents of change but also benefit greatly from health promotion messages.

A further proposal for reducing saturated fat, especially palm oil, in Omani foods is being considered by the government.

Giving everyone a seat at the table

Continued success in Oman in the fight against NCDs will depend on strong leadership and a cross-sectoral approach including all levels of society, authorities state. It will also require patience and support to ensure scale-up from pilot projects can happen at the right pace.

"It’s encouraging to see such genuine commitment from the food and beverage industry in Oman to try to work towards making a change for the betterment of health," says Dr Asmus Hammerich, director of NCDs in WHO’s Eastern Mediterranean Regional Office.