Non-communicable diseases (NCDs) account for around 75% of deaths worldwide, while Tajikistan faces a mixed picture: the incidence of cardiovascular diseases is declining, but cancer, diabetes and metabolic risk factors are on the rise. Experts discussed these challenges and approaches to prevention at an international scientific session in Dushanbe on October 15.
The session, titled “Global Health in the 21st Century: Managing Risk Factors and Modern Strategies for the Prevention of Non-Communicable Diseases,” brought together representatives of government agencies, the medical community, professional associations and civil society organizations from Tajikistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Belarus and France.
According to the World Health Organization (WHO), NCDs cause more than 43 million deaths annually, accounting for approximately 75% of all deaths worldwide. Around 18 million people die prematurely from these diseases before the age of 70, with 82% of such deaths occurring in low- and middle-income countries.
The main risk factors include tobacco and alcohol use, unhealthy diets, physical inactivity and air pollution. Experts also highlighted chronic stress and sleep disorders as factors associated with the development of chronic diseases.
The event was organized by the National Academy of Sciences of Tajikistan, with support from the Majlisi Namoyandagon, the lower chamber of parliament, and the public organization Right to Health.
Tajikistan faces a mixed picture
Opening the session, Deputy Speaker of the Majlisi Namoyandagon (Tajikistan’s lower chamber of parliament) Mavsuma Muini said Tajikistan had adopted a Population Health Protection Strategy through 2030, aimed at achieving universal health coverage and advancing the country’s commitments under the Sustainable Development Goals.
She also noted that several sectoral programs and concepts for preventing and treating NCDs had been developed and approved, alongside efforts to improve medical services in cooperation with international partners.
However, the health indicators presented at the session pointed to persistent challenges.
Adolat Narzullayeva, head of the Cardiology Department at the Institute of Postgraduate Healthcare Education and the Health Ministry’s chief non-staff cardiology specialist, said the incidence of cardiovascular diseases in Tajikistan was declining across major categories, including hypertension and ischemic heart disease.
At the same time, she said, the country was seeing increases in the incidence and mortality of cancer, as well as in newly diagnosed cases of diabetes.
Narzullayeva described this as a “dynamics paradox,” in which improvements in some health indicators coexist with worsening trends in other areas.
She cited an epidemiological study conducted using WHO methodology, which reportedly found improvements in dietary habits and a 3% decline in alcohol consumption. Yet the prevalence of overweight and obesity, elevated cholesterol and high blood glucose had increased.
“Half the population in Tajikistan is affected by overweight and obesity,” she said, adding that the share of people with this risk factor had risen by nearly three percentage points.
According to Narzullayeva, the findings suggest that improvements in some behavioral risk factors have not yet translated into better metabolic health across the population.
She also highlighted differences in health-related behavior between men and women. According to the figures she presented, 83% of men with hypertension receive no treatment, while men also face high mortality from heart attacks. Women, meanwhile, more frequently experience obesity and tooth loss, although they tend to approach treatment more responsibly, she said.
Narzullayeva noted that Tajikistan was using the FINDRISC tool to assess the risk of developing type 2 diabetes and taking other measures to strengthen the prevention of cardiovascular diseases.
Why restrictions may not be enough
A central theme of the session was how to reduce health risks when people do not respond to warnings or are unwilling to give up harmful habits.
Dmitry Ruzanov, deputy director for research at the Republican Scientific and Practical Centre for Pulmonology and Phthisiology in Belarus and a professor at Belarusian State Medical University, said that providing information about health risks did not always lead to behavioral change.
“We know the risk factors; we essentially have a ‘silver bullet’ that we can use to improve public health. But people do not always accept information about risks, and they do not always give up harmful habits,” he said.
Ruzanov pointed to cultural influences, social environments and marketing as factors that can shape people’s choices.
Participants also discussed the unintended consequences of restrictions on vaping products. According to examples cited at the session, bans in Estonia and Australia had contributed to the emergence or expansion of illicit markets.
These examples formed part of a broader discussion about whether restrictions alone can effectively address risky behavior and what complementary measures might be needed.
Can international experience offer lessons?
Sweden was cited during the discussion as an example of a country with a low smoking rate. Advocates of tobacco harm reduction attribute part of this outcome to policies that regulate certain nicotine products rather than prohibit all alternatives to conventional cigarettes.
Tajikistan has banned nicotine pouches since 2023. Asia-Plus asked participants whether approaches used in other countries could offer lessons for Tajikistan.
Talgat Nurgozhin, a professor and academician of the National Academy of Sciences of Kazakhstan and chairman of the council of the Densaulyk National Association for Harm Reduction of Health Risk Factors, argued that policies should consider alternatives for people who do not quit smoking.
“Nicotine is addictive, but unlike tobacco smoke it causes significantly less harm to the body. That is why Sweden’s approach is being studied and increasingly supported in many European countries,” he said.
Nurgozhin also referred to Japan and China when discussing international approaches to tobacco-related harm.
Saida Umarzoda, a professor at the oncology department of Tajik State Medical University, head of the Right to Health NGO and a doctor of medical sciences, likewise argued that alternatives could play a role when people are unable or unwilling to abandon harmful habits.
“In the case of smoking, these are heated tobacco systems, which do not burn tobacco and do not produce smoke, and therefore contain significantly fewer harmful substances. The impact on those around the user is also reduced,” she said.
However, claims about the relative risks of nicotine products and the effectiveness of particular harm-reduction policies remain important public-health questions. The statements at the session reflect the views of the experts who presented them and should not be interpreted as establishing that alternative nicotine products are safe.
Prevention and support among the priorities
Participants concluded that preventing NCDs requires more than informing people about risks or imposing restrictions. They highlighted the importance of psychological support, preventive health checks and counseling to help people change their behavior.
The recommendations developed during the session included strengthening preventive examinations, expanding behavioral-change counseling, supporting initiatives to reduce harmful habits and improving coordination between sectors involved in NCD prevention.
The discussion also emphasized the need to make prevention more accessible and to help people adopt healthier behaviors before risk factors develop into chronic diseases.
On 15 October, Dushanbe hosted the International Scientific Session “Global Health in the 21st Century: Managing Risk Factors and Modern Strategies for the Prevention of Non-Communicable Diseases”.
Experts from various countries gathered to discuss approaches to preventing non-communicable diseases (NCDs) and international experience in this field.
More than 40 million deaths from NCDs
According to the latest WHO data, non-communicable diseases (NCDs) cause more than 43 million deaths annually, accounting for around 75% of all deaths worldwide.
Around 18 million people die prematurely before the age of 70, with 82% of such cases occurring in low- and middle-income countries, experts note.
The main risk factors include tobacco and alcohol use, unhealthy diet, insufficient physical activity and air pollution. Chronic stress and sleep disorders also play a significant role in the development of NCDs, contributing to an increased risk of cardiovascular and other chronic diseases.
In this context, experts at the scientific session discussed modern approaches to promoting a healthy lifestyle and protecting public health, effective NCD prevention strategies, and measures to reduce the impact of the key risk factors driving the global burden of these diseases.
The event brought together representatives of government bodies, the medical community, professional associations and civil society organisations from Tajikistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Belarus and France.
The session was organised by the National Academy of Sciences of Tajikistan with the support of the Majlisi Namoyandagon of the Majlisi Oli of the Republic of Tajikistan and the public organisation “Right to Health”.
Goals and pathways
Opening the event, Deputy Speaker of the Majlisi Namoyandagon of the Majlisi Oli Mavsuma Muini noted that a number of important measures have been taken in the country’s healthcare sector.
“The Population Health Protection Strategy for the period up to 2030 has been adopted, with the goal of achieving universal health coverage and integrating international commitments under the Sustainable Development Goals (SDGs).
Work is under way in cooperation with international partners to improve prevention and reduce the impact of NCD risk factors among the population.
In recent years, a number of sectoral programmes and concepts for the prevention and treatment of NCDs have been developed and approved in Tajikistan,” she said.
Among other things, Muini noted positive changes in the delivery of medical care, including the introduction of new treatment methods for cardiovascular diseases, improved services for patients with oncological diseases, eye diseases, and acute liver and kidney diseases.
She also mentioned the ratification of the UN Convention on the Rights of Persons with Disabilities. Members of the Majlisi Namoyandagon ratified the Convention at the first sitting of the third session of the seventh convocation. The event marked an important step in protecting the rights of persons with disabilities in Tajikistan.
“At the round table on 13 October, participants discussed the importance of identifying priority tasks and measures for implementing the Convention’s provisions in Tajikistan, as well as ways to strengthen coordination among relevant bodies and ensure fulfilment of the obligations placed on the republic under the Convention,” Mavsuma Muini added.
“The dynamics paradox”
Adolat Narzullaeva, Head of the Cardiology Department at the Institute of Postgraduate Healthcare Education, Chief Non-Staff Specialist in Cardiology at the country’s Ministry of Health, and Candidate of Medical Sciences and Associate Professor, noted that NCD mortality is rising worldwide, and that the situation with NCDs in Tajikistan shows both improvements and negative trends.
“In Tajikistan, primary incidence of cardiovascular diseases is declining across all major nosological categories — including arterial hypertension and ischaemic heart disease. However, this success does not reassure us cardiologists, because at the same time the country is seeing rising incidence and mortality from oncological diseases, as well as a rise in primary incidence of diabetes mellitus,” she said.
She also noted what she described as the so-called dynamics paradox.
“That is, a decline in overall mortality masks a sharp rise in metabolic and oncological morbidity. And given the shared risk factors for NCDs, this is leading to increased incidence and mortality from diabetes and cancer,” she explained.
According to the expert, an epidemiological study conducted in the country using WHO methodology showed that the population has been adhering more closely to a healthy diet and consuming 3% less alcohol. At the same time, figures for the prevalence of overweight and obesity are rising.
“In Tajikistan, half the population is affected by overweight and obesity. The share of people with this risk factor has grown by nearly 3%. In addition, a 3% increase in the prevalence of hypercholesterolaemia has been observed, and levels of hyperglycaemia have also risen.
It turns out that our population is reducing behavioural risk factors and behaviour is improving, yet the metabolic component of risk factor prevalence has grown. Having analysed this data, we assume that this may be a delayed effect of behavioural risk factors that have influenced the growth of metabolic factors,” Adolat Narzullaeva explained.
According to her, measures are being taken in the country to improve the situation: for example, the FindRISC tool is being actively used to assess the risk of developing diabetes mellitus, primary prevention indicators for cardiovascular diseases have improved, and more.
In addition, Adolat Narzullaeva raised the important topic of attitudes towards health among men and women in the country. It emerged that men measure their blood pressure less frequently: 83% of men with hypertension receive no treatment, and they also show high mortality from heart attacks.
Women, meanwhile, more frequently suffer from obesity and tooth loss, despite approaching treatment more responsibly than men.
Alternatives instead of prohibitions
Almost every specialist stressed in their remarks that prohibitions and restrictions are ineffective when working with patients. Instead, patients should be offered alternative pathways that help reduce risk and preserve health, or enable them to give up harmful habits altogether.
This was also addressed in a presentation by Dmitry Ruzanov, Deputy Director for Research at the Republican Scientific and Practical Centre for Pulmonology and Phthisiology and Professor at the Department of Cardiology and Internal Medicine at Belarusian State Medical University.
“We know the risk factors; we essentially have a ‘silver bullet’ that we can use to improve public health. But people do not always accept information about risks, and they do not always give up harmful habits.
Of course, we would like people who have been told what is harmful and what is beneficial to avoid those risks and improve their health. But the reality is that, more often than not, this does not happen,” the specialist said.
He noted that cultural factors, the social environment, and marketing that makes products more appealing to consumers also play an important role. And this is only part of the problems raised.
Each speaker gave different examples of NCD prevention in their own countries, as well as the experience of other countries around the world — which, unfortunately, has not always proved successful.
In Estonia, for instance, after vapes were banned in 2020, people began purchasing them on the black market. In Australia, where the sale of vapes was also banned, the black market is already estimated to be worth $2 billion. This too was discussed during the scientific session.
How can international experience help Tajikistan?
The foreign press frequently cites Sweden as an example — a country with the lowest smoking rate in the European Union and one of the lowest rates of lung cancer incidence. Harm-reduction advocates attribute this to the country’s approach of regulating certain categories of nicotine products rather than banning them outright.
In Tajikistan, nicotine pouches have been banned since 2023. Asia-Plus asked experts to explain whether the Swedish experience could be of benefit to the country.
Talgat Nurgozhin — Professor, Doctor of Medical Sciences, Academician of the National Academy of Sciences of Kazakhstan, and Chairman of the Council of the National Association for Harm Reduction of Health Risk Factors “Densaulyk” — answered this question during the panel discussion.
“The harm-reduction approach is a state policy aimed at preserving quality of life in society. Sweden is one of the leading developed European countries, where the share of smokers is below 10%. Today, the main carcinogen is tobacco smoke, which causes cancer — not nicotine. Sweden has placed its bet on combustion-free products, in which nicotine is consumed without tobacco smoke. Nicotine is addictive, but unlike tobacco smoke it causes significantly less harm to the body. That is why Sweden’s approach is being studied and increasingly supported in many European countries,” Talgat Nurgozhin explained.
He also cited Asian countries — Japan and China — where the harm-reduction principle is applied. As a result, tobacco use in Japan has fallen by nearly 30%, while China has concluded that tobacco consumption causes more harm than nicotine itself.
The concept of harm reduction and the search for alternatives was also endorsed by Saida Umarzoda, Professor at the Department of Oncology at TSMU, head of the NGO “Right to Health,” and Doctor of Medical Sciences.
“If a person does not give up harmful habits, it is necessary to look for alternatives in order to reduce harm to the body. In the case of smoking, these are heated tobacco systems, which do not burn tobacco and do not produce smoke, and therefore contain significantly fewer harmful substances. The impact on those around the user is also reduced,” she said.
During the discussion, the specialists reached another conclusion — it is important to introduce psychological support for patients and to improve NCD prevention. A set of recommendations was developed, including strengthening the system of preventive health checks, behavioural change counselling, support for initiatives aimed at reducing harmful behaviour, improvement of cross-sectoral NCD prevention policy, and a range of further measures.