Noncommunicable diseases are the leading cause of death and disability worldwide, accounting for 74 percent of all deaths and more than three out of four years lived with a disability. These chronic conditions – which cannot be transmitted from person to person and often require long-term or lifelong care – include cancers, cardiovascular disease, strokes, chronic respiratory diseases, diabetes, mental health and neurological conditions, as well as chronic kidney disease among many others.
Despite Saudi Arabia having a relatively young population (it boasts the fifth youngest median age in the G20 and half of its population is below the age of 35), the burden of NCDs in the country is particularly strongly felt. As a 2023 UNDP report points out, NCDs cost the Saudi Arabian economy USD 18.6 billion annually (around three percent of GDP), with a further USD 6.8 billion lost on diminished productive capacities due to premature mortality, disability, and other factors. NCDs account for over 73 percent of all deaths – over 83,100 every year – in the country and their wider economic, social, and health impact cannot be understated.
Prevention Needed
NCDs therefore already pose a significant threat to the Saudi population, a threat that will only increase in prominence as this population ages in the coming years. However, the good news is that 80 percent of NCDs are preventable and risk factors can be significantly diminished by reducing tobacco use, eating a healthy diet, engaging in physical exercise, drinking less alcohol, and lowering exposure to air pollution.
While excessive alcohol consumption is not a major concern in the predominantly Islamic Kingdom, there has been a concerted effort on the part of the Saudi government to address these other risk factors and catch NCDs much earlier. Boosting public health and disease prevention is, for example, a fundamental focus of Vision 2030. The Vision includes initiatives around comprehensive screening programs, increased access via digital services, and public health awareness and education campaigns.
A dense network of international management consultants is engaged with the Saudi leadership on how best to work through these issues, including Walid Tohme, a partner for the Middle East at PwC’s consulting arm, Strategy&. “Looking ahead, the demographic shift towards an aging population, along with the prevalence of NCDs necessitates proactive healthcare planning,” says Tohme, who advocates for greater levels of healthcare spending. “Currently, Saudi Arabia allocates approximately seven to eight percent of its GDP to healthcare, a figure that surpasses many regional counterparts but falls short of global averages of around ten to 11 percent. The overarching goal is to transition from a predominantly curative healthcare model to one focused on prevention, thereby enhancing health outcomes nationwide.”
“NCDs such as diabetes, hypertension, and obesity are on the rise in the region,” adds fellow consultant Samar Nassar, managing director for Accenture’s healthcare practise across the Middle East. “Addressing the NCD burden will require comprehensive public health interventions for prevention, early detection, and management,” she adds.
The fact that Saudi Arabia’s population is so young presents “a significant opportunity for proactive healthcare intervention” in the eyes of Dr Ahmad Hersi, CEO of King Saud University Medical City (KSUMC). He notes that, “The government’s efforts to improve infrastructure for sports and physical activities create a foundation for the health sector to heighten public awareness and promote lifestyle changes. By shifting the focus of care upstream, our goal is to prevent diseases rather than solely treating them, thereby ultimately cultivating a healthier society in the long term.”
Obesity and Diabetes
One of the most talked about NCDs today is diabetes, especially in terms of its intersection with obesity. This is a particularly pointed topic in Saudi Arabia, where one in five people have diabetes and obesity is estimated to affect a full 30 percent of the population.
Obesity is not just a risk factor in diabetes, but a chronic, progressive, and relapsing disease in itself with serious downstream complications. It affects over a billion people worldwide and is associated with numerous health risks, including type 2 diabetes, cardiovascular diseases, non-alcoholic fatty liver disease, certain cancers, and sleep apnoea.
The sources of the diabetes and obesity epidemic among the Saudi population are varied – from rapid urbanisation to a lack of physical exercise, dietary issues, and insufficient awareness – although for Fars Alanazi, CEO of the Saudi National Institute for Health (Saudi NIH), a lack of region-specific research into diabetes is another major issue.
“Diabetes, a complex condition with various types and factors, has prompted us to convene councils that prioritize critical questions raised by healthcare providers, hospitals, societies, and regulators,” explains Alanazi. “For example, questions have arisen about the optimal insulin regimen for fasting patients during Ramadan. These inquiries, sourced directly from the field, inform our grant opportunities. Through these grants, we invite researchers, in collaboration with those from international centres, to propose innovative solutions. Upon funding promising proposals, we translate research findings into actionable outcomes, whether through policy development, guidelines or products of health-researchers.”
On the commercial side, Eli Lilly is prioritising education, destigmatisation, and access to medicines as the three pillars of its response to the diabetes and obesity epidemic in Saudi. The US-headquartered giant was the first company to commercialise insulin over 100 years ago and is today a leading industry sponsor of headline-generating semaglutide-based treatments.
“Lilly has been and will always be committed to innovations and advancements in diabetes and recently in the field of obesity,” says Felipe Borges dos Reis, general manager of the company’s Saudi Arabia RHQ. “Addressing the rising prevalence of obesity in Saudi Arabia is urgent, especially considering its serious health implications. It’s crucial to dispel myths and misconceptions surrounding obesity, such as the notion that it’s solely a matter of individual choice. This misconception contributes to stigma and can hinder individuals from seeking proper care and treatment for obesity as a chronic disease.”
He continues, “Therefore, one of our main priorities is education and awareness to eradicate the stigma associated with obesity. We aim to foster open and supportive conversations between patients and healthcare providers, encouraging individuals to seek the help they need without fear of judgment.”
“Another key priority is ensuring access to highly effective interventions for obesity management. Over the past decade, significant advancements have been made in understanding the pathophysiology of obesity and developing interventions that can yield impressive outcomes. We have obtained regulatory approval for these innovations, and our focus now is on making them widely accessible to those who need them.”
Cardiovascular Disease
Cardiovascular diseases are another key concern in Saudi Arabia, where they account for over 45 percent of all deaths. Additionally, as a recent paper from the Journal of the Saudi Heart Association shows, the economic impact of CVDs in Saudi Arabia is significant, with costs expected to almost triple from USD 3.5 billion in 2016 to 9.8 billion by 2035. Atrial fibrillation (AF) for example (a type of arrhythmia characterised by an irregular and often abnormally fast heart rate which can impair the heart’s ability to pump blood efficiently, leading to various health complications) has seen a 30 percent global surge in incidence over the past 20 years, with numbers even higher in the Middle East and Saudi Arabia.
As Trad Alkhelaiwi, senior director and general manager of Johnson & Johnson’s Saudi affiliate points out, “The risk factors for AF in Saudi Arabia are critical. The often-silent disease is increasingly becoming a serious health problem, with incidences expected to double over the next three decades globally, and at a higher rate in the Middle East, specifically in KSA. There needs to be an urgent call for action in Saudi Arabia. KSA’s rapidly growing and ageing population combined with a high burden of chronic disease increases the urgency for the Kingdom to act now to deter the growing tide of AF.”
Of course, as a leading player in the cardiovascular space, J&J has commercial skin in the game in terms of addressing AF, but Alkhelaiwi is calling for a more holistic approach beyond selling medicines alone. “The need for guidelines around screening, referral and management of AF in Saudi Arabia is dire,” he says. “Streamlining the care of patients with AF in daily clinical practice is a challenging but essential requirement for the effective management of the condition. AF clinics or Centres of Excellence that bring together multidisciplinary teams to address all aspects of AF can improve health outcomes and the patient experience.”
Basel Al-Qahtani of leading medtech group Boston Scientific is keen to highlight the progress that has already been made in AF in Saudi and the contribution that his company has made. “AF is a cardiac arrythmia condition that is often underdiagnosed or undertreated due to limited access to skilled physicians, challenges in referral pathways, and technological limitations,” notes Al-Qahtani. “Boston Scientific has introduced innovative technologies for AF management, such as our pulsed field ablation system, which has transformed patient care in this space. We are also exploring ways to improve the entire patient pathway for AF, including early detection and intervention, to better address the needs of patients and healthcare providers.”
Cancer
Cancer is the second leading cause of NCD deaths in Saudi Arabia, accounting for 12% of total national mortality. Efforts to control hepatitis B and C have helped reduce liver cancer risk, but other factors like obesity continue to drive cancer prevalence.
There is also the issue that the way that cancer presents in Middle-Eastern populations can differ significantly from counterparts in other regions. As J&J’s Alkhelaiwi posits, “Colorectal cancer, for example, often presents at later stages in younger Saudi patients, which significantly impacts prognosis and treatment outcomes. Our surgical solutions are positioned to support the country in diagnosing and treating these patients at earlier stages, where curative rates are higher.”
There does seem to be an openness on the part of the Saudi state to innovative solutions to the country’s cancer crisis. When interviewed earlier this year, Farrukh Rehan of GSK noted that “Currently, a team of eight top GSK R&D scientists specialising in oncology and genomics are engaging with officials from the Ministry of Health and leading research institutes in Saudi Arabia. This underscores both GSK’s commitment to the region and Saudi Arabia’s openness to innovative partnerships. The exchange of insights and data could pave the way for mutually beneficial collaborations, particularly in tailoring oncology therapies to the specific genetic profiles of Saudi and Middle Eastern populations.”
Innovation also comes in delivery forms. King Saud University Medical City for example, which recently received an award for being the best performing hospital in Saudi Arabia in terms of prevention and innovation in oncology care, has been moving into the homecare space. “One of our unique initiatives includes providing chemotherapy at home, which ensures safe and efficient treatment for our patients,” explains CEO Hersi. “This initiative, along with our broader home healthcare services, reflects our commitment to pushing the boundaries of patient care and delivering innovative healthcare solutions.”
Finally, there have been important reorganizational efforts of the country’s regulatory framework to allow earlier access to cutting-edge oncology therapies. “Saudi Arabia demonstrates a commendable commitment to innovation and modernization, particularly in healthcare,” beams Rehan. “The regulatory environment, spearheaded by the Saudi FDA’s robust processes, is conducive to the introduction of new medicines and vaccines. Notably, government agencies exhibit proactive support, as evidenced by requests to expedite the availability of certain oncology products, although the process of ensuring widespread access to these innovations may sometimes encounter delays.”
