IPM Take
MENA’s cardiometabolic crisis is a political stress test. Cardiovascular disease and diabetes are not only clinical outcomes; they are signals of whether states can deliver basic prevention, affordable medicines, functioning primary care and trust in public services. Conflict still matters. But focusing only on conflict misses the slower emergency: preventable disease is eroding household security, public budgets and social contracts. A region that invests in hospitals but underinvests in prevention is not building resilience. It is financing the consequences of delay.
Executive Summary
Atlantic Council commentary argues that cardiovascular disease, diabetes and related cardiometabolic conditions should be treated as a strategic crisis in the Middle East and North Africa. The article frames unhealthy diets and physical inactivity as socially contagious risk factors that spread through families, communities, cities, digital environments and work patterns.
The regional burden is substantial. The World Heart Federation reports that cardiovascular disease is the leading cause of death in the Middle East and North Africa, responsible for around 1.4 million deaths every year. The International Diabetes Federation estimates that 84.7 million adults aged 20-79 were living with diabetes in its MENA region in 2024, with 32 million undiagnosed. By 2050, that number is projected to reach 162.6 million.
The burden is also economically and socially destabilising. IDF estimates diabetes-related health expenditure in MENA at USD 35 billion in 2024, while broader modelling has projected very large long-term costs if prevention and care do not improve. For the Gulf Cooperation Council, WHO, UNDP and partners estimated that scaling up NCD prevention and control interventions across six GCC countries over 15 years would avert 290,000 premature deaths and return nearly USD 5 for every USD 1 invested.
The article’s central policy message is clear: cardiometabolic disease in MENA should not be treated as a private lifestyle problem. It is a regional resilience issue requiring prevention policy, surveillance, urban planning, school and food reform, primary care strengthening, medicine access and global health diplomacy.
Why it matters
- Policymakers and public authorities: Cardiometabolic prevention should be treated as part of national resilience, not as a secondary health ministry file. Food policy, city planning, transport, schools, labour policy and healthcare financing all shape risk.
- Payers and HTA bodies: The economic case for prevention is strong. Delaying investment means paying later for dialysis, stroke, heart failure, amputations, disability and lost productivity.
- Clinicians and providers: MENA health systems need earlier detection of hypertension, diabetes, obesity, kidney disease and cardiovascular risk, especially through primary care, pharmacies and community-based services.
- Patients and advocates: The crisis cannot be reduced to personal responsibility. Many patients are living inside environments that make healthy food, physical activity, continuity of care and affordable medicines difficult.
- Industry and innovation partners: Medicines, diagnostics, devices and digital tools may help, but they must be embedded in equitable care pathways. Commercial innovation cannot substitute for prevention policy.
The Middle East and North Africa is often discussed through conflict, energy, migration and geopolitics. But one of the region’s deadliest forces does not look like a security threat.
It looks like untreated hypertension. Undiagnosed diabetes. Ultra-processed food. Heat-stressed cities. Long sedentary workdays. Car-dependent urban design. Weak prevention. Late diagnosis. Expensive lifelong care.
An Atlantic Council commentary by Daniel E. Zoughbie makes that argument sharply: MENA’s greatest killer is not what most people think. Cardiovascular disease and diabetes are already taking a staggering toll, and the drivers are spreading through social, commercial and built environments.
The numbers justify the alarm. The World Heart Federation says cardiovascular disease is the leading cause of death in the Middle East and North Africa, responsible for around one third of all deaths and approximately 1.4 million deaths every year. IDF estimates that 84.7 million adults aged 20-79 in its MENA region were living with diabetes in 2024. One in three adults with diabetes is undiagnosed. By 2050, the number of adults with diabetes in the region is projected to reach 162.6 million.
That is not only a medical problem. It is a governance problem.
The region’s cardiometabolic burden sits at the intersection of biology and politics. Obesity, diabetes and cardiovascular risk are shaped by food prices, marketing, school meals, walkability, heat exposure, gender norms, working conditions, primary care access, medicine affordability and conflict. Calling this a lifestyle crisis is politically convenient. It pushes responsibility onto individuals while leaving the system untouched.
The Atlantic Council commentary uses a provocative frame: cardiometabolic risk factors may be “socially contagious”. The point is not that diabetes spreads like a virus. It does not. The point is that behaviours, norms and exposures linked to diet, physical activity and metabolic risk move through social networks, families, schools, workplaces, cities and digital platforms. If unhealthy patterns can propagate, prevention has to be designed for propagation too.
That is where the policy imagination has been too small.
Public health systems know how to mobilise around outbreaks. They build surveillance systems, track spread, identify high-risk groups, coordinate across borders and treat prevention as urgent. For cardiometabolic disease, the response is slower, more fragmented and too often clinical rather than structural.
But MENA cannot afford that delay.
The economic case is already visible. IDF estimates diabetes-related expenditure in MENA at USD 35 billion in 2024, despite the region accounting for a much larger share of global diabetes cases than of global diabetes spending. In the GCC, WHO, UNDP and partners estimated that NCDs cost around USD 50 billion each year, equivalent to 3.3% of 2019 GDP across GCC countries. They also estimated that scaling up cost-effective NCD interventions over 15 years would avert 290,000 premature deaths and return nearly USD 5 for every USD 1 invested.
This is the brutal arithmetic of prevention: governments can pay early for healthier food environments, screening, hypertension control, diabetes care, physical activity and medicines access, or pay later for heart attacks, kidney failure, stroke, amputations, disability and lost productivity.
Conflict makes the equation worse. In humanitarian settings, chronic disease care is usually the first thing to collapse and one of the last things to recover. Trauma care rightly dominates the emergency phase, but people with diabetes still need insulin, people with hypertension still need medicines, and people with heart failure still need monitoring. When supply chains break and clinicians flee, manageable disease becomes lethal.
This is why cardiometabolic disease should be part of resilience planning. A health system that cannot maintain chronic care during crisis is not resilient. It is just good at reacting to visible emergencies.
The household impact is even more politically sensitive. Cardiometabolic disease often arrives slowly, then financially all at once. A late diagnosis can mean repeated clinic visits, medicines, complications, reduced work capacity and catastrophic health spending. When a working-age adult develops severe diabetes, kidney disease or cardiovascular disease, the entire household absorbs the shock.
This is especially relevant for MENA because IDF reports that the region has the highest percentage of diabetes-related deaths among people of working age under 60. That means the disease burden is not confined to older age. It is hitting families during their earning years, when unemployment, inflation and political frustration are already intense in parts of the region.
No serious policy analysis should claim that cardiometabolic disease alone drives instability. That would be too simple. But it can deepen the conditions that make societies brittle: household insecurity, distrust in public services, economic pressure, youth frustration and weak confidence in institutions.
Healthcare is part of the social contract. When citizens watch preventable disease go undetected, untreated or unaffordable, they do not experience it as an abstract NCD burden. They experience it as state failure.
So what should change?
First, MENA governments need serious cardiometabolic surveillance. Many countries still lack strong real-time data on obesity, hypertension, diabetes, kidney risk, lipid control, treatment access and complications. Without surveillance, policy is guessing.
Second, primary care must become the front line of cardiometabolic prevention. Blood pressure measurement, HbA1c or glucose testing, lipid assessment, kidney function testing and risk stratification should be routine, affordable and connected to follow-up. Screening without treatment is theatre. Diagnosis without access is abandonment.
Third, the region needs food and urban policy, not just clinic policy. Salt reduction, sugar-sweetened beverage taxes, front-of-pack labelling, school nutrition standards, restrictions on marketing unhealthy foods to children, walkable neighbourhoods, heat-adapted physical activity infrastructure and active transport all belong in cardiometabolic strategy.
Fourth, medicine access must be protected. Essential antihypertensives, statins, insulin, metformin and other diabetes medicines are the backbone of prevention and control. Newer therapies, including GLP-1 receptor agonists and SGLT2 inhibitors, may have major cardiometabolic value for selected patients, but they will widen inequality if they arrive without reimbursement strategy, supply planning and criteria for clinical use.
Fifth, prevention has to use social networks. The Atlantic Council article is right to point to social propagation. Family-based programmes, school-based interventions, workplace health, faith and community networks, refugee-clinic models and peer support can help shift norms faster than one-to-one counselling alone.
Sixth, MENA should treat cardiometabolic disease as a field for regional cooperation. Data sharing, pooled procurement, cross-border clinical training, regional registries, harmonised screening standards and joint investment cases could turn fragmented national responses into a regional health security agenda.
This is where global health diplomacy matters. Infectious disease diplomacy has built institutions, funding platforms and rapid-response norms. Cardiometabolic disease has not received the same diplomatic seriousness, despite killing far more people over time.
The comparison is uncomfortable. The world built global coalitions for HIV, tuberculosis, malaria and pandemic preparedness. It still treats hypertension and diabetes as routine domestic problems, even when they are draining economies and destabilising households across entire regions.
MENA should not wait for crisis language to become polite.
The cardiometabolic emergency is already here. It is visible in dialysis units, cardiology wards, amputations, stroke disability, family debt and younger adults dying before their time.
War destroys health systems violently. Cardiometabolic disease can hollow them out quietly.
Both deserve political attention. Only one is still being treated as background noise.
