Population-Wide Interventions to Prevent NCDs | 129
is likely to reduce smoking substantially. In a survey of Jeddah residents by Alghamdi et al. (2020), 22.6 percent of respondents said they smoked less after the tax went into effect. Findings from the 2019 World Health Survey in Saudi Arabia (MOH 2020) indicate that some smokers reduced their consumption in response to the tax and other interventions, with the prevalence of smoking in Saudi Arabia declining by 0.6 percentage point between 2013 and 2019.
Diet interventions There is a strong link between unhealthy diet and NCDs. It is well established that an unhealthy diet—particularly excess consumption of highly processed foods, fast food, and sugar-sweetened beverages (SSBs) and inadequate intake of fiber—cause weight gain (Hall 2019), obesity (Mendonça et al. 2016), and numerous NCDs, including diabetes mellitus (Malik et al. 2010; Nseir, Nassar, and Assy 2010), metabolic disease (Malik et al. 2010), coronary heart disease (Mente et al. 2009; Mozaffarian et al. 2006), nonalcoholic fatty liver disease (Nseir, Nassar, and Assy 2010), stroke (Spence 2019), and several cancers (Fiolet et al. 2018). Excessive dietary sodium can lead to high blood pressure (Takase et al. 2015). Prepackaged foods, fast food, and SSBs are available in virtually every community in Saudi Arabia. Combined with aggressive marketing of these products, this availability has reduced the quality of the population’s diet (ALFaris et al. 2015; Khabaz et al. 2017). Saudi Arabia has already implemented or proposed many interventions to steer consumers toward healthier dietary choices (table 7.2). A multitiered VAT is imposed on beverages, including a 100 percent tax on energy drinks and a 50 percent tax on all SSBs. Saudi Arabia also introduced added-sugar labeling on the back of food and beverage packaging. A front-of-package traffic light labeling system for food and beverages has been proposed; this labeling would use red, amber, and green lights to depict high, medium, and low levels of designated nutrients of concern. Some jurisdictions require restaurants or fast food outlets (or both) to show the calories of meals on their menus. Saudi Arabia also has nutrition standards governing what foods and beverages may be served in
TABLE 7.2 Implemented
and proposed diet-related interventions to reduce NCDs in Saudi Arabia
INTERVENTION
DESCRIPTION
Excise taxes
• 100% VAT on energy drinks • 50% VAT on some SSBs
Nutrition labels
• Packaging {{ Added sugar displayed on back-of-package nutrition facts label a {{ Front-of-package traffic light nutrition labels • Restaurants and cafes {{ Mandated calorie menu labeling
Nutrition standards
• • • •
Limits on what foods and beverages schools can provide in their canteens Ban on energy and soft drink sales in hospitals and public health facilities Restrictions on advertisements for unhealthy food and drinksa directed at children Public awareness campaigns
Source: Original compilation for this publication. Note: NCDs = noncommunicable diseases. SSB = sugar-sweetened beverages. VAT = value added tax. a. Proposed interventions.
