From burden to action: Tunisia steps up the fight against noncommunicable diseases

30 September 2025, Tunis, Tunisia - Tunisia faces one of the highest burdens of noncommunicable diseases (NCDs) in the Eastern Mediterranean Region. Nearly 86% of deaths are linked to conditions such as cardiovascular and chronic respiratory diseases, diabetes and cancer. Cardiovascular diseases alone are responsible for more than 30% of all deaths. Obesity and diabetes rates are rising sharply, particularly among women and young people.

Behind the figures lie structural drivers - urbanization, food insecurity, unemployment and lifestyle factors. Unhealthy diets and physical inactivity are widespread. Smoking rates are increasing, especially among young people and women.

From Principle to Action: multisectoral collaboration

Recognizing that health outcomes are shaped by a wide range of social and economic factors, the Tunisian Government, in collaboration with the World Health Organization (WHO), is advancing the Health in All Policies approach. This involves active engagement with sectors beyond health, including education, youth and sports, cultural affairs, religious affairs, higher education and civil society, to address the broader determinants of health and jointly monitor progress.

The Healthy Cities Programme is helping municipalities promote well-being through better urban governance, civic participation and prevention of risky behaviors such as drug use.

Road safety is another example of the multisectoral approach. With WHO support, Tunisia launched the 2024-2034 Operational Plan for Road Safety, aiming to reduce traffic deaths by 50% by 2034. The plan brings together government agencies, civil society, local communities and the private sector to protect vulnerable users, improve infrastructure and promote safe behaviours. By treating mobility as a public health priority, Tunisia is showing how cross-sector collaboration can save lives.

Tunisia's National Health Policy 2030, officially endorsed in 2021 with the signing of the National Charter for Health System Reform by the government, civil society and professional organizations, has helped build momentum. WHO played a key role in the process which elevated NCD prevention to the top of the national agenda and helped ensure that equity, transparency and citizen participation were embedded as guiding principles.

A national strategy for NCD prevention

Since 2017, the Ministry of Health, with WHO support, has led the development of the National Multisectoral Strategy for NCD Prevention and Control (2018-2025). The strategy has translated into concrete progress despite challenges.

A budgeted operational plan was finalized and aligned with national development priorities.

Tobacco control advanced through revised legislation, advocacy for higher tobacco taxes and a new investment case demonstrating the economic cost of tobacco use.

Awareness campaigns such as World No Tobacco Day, Pink October and World Diabetes Day have mobilized public engagement.

A partnership with the Ministry of Youth and Sports and the National Olympic Committee promotes physical activity nationwide.

There have been advances in cancer research, including survival studies at the Salah Azaiz Institute.

The creation and signing in 2023 of a National Charter for Tobacco Control by 9 ministers demonstrated political commitment and multisectoral engagement to protect the population against tobacco use.

The establishment of the Tunisian Alliance against Tobacco, which brings together 9 associations and scientific societies, is playing a key role in raising awareness, advocating for tobacco control policies and mobilizing citizens.

The successful implementation of the strategic vision developed by the Tunisian government, WHO and civil society organizations has been made possible through strong technical and operational support from WHO.

Community engagement: when health meets culture and sports

Tunisia's fight against NCDs is as much about people as it is about policies and strategies. Creative, community-based initiatives are making health education more engaging, accessible and impactful.

SahaCiné in Hay Hlel

In one of Tunis's most underserved neighbourhoods, cinema has become a tool for enhancing dialogue on smoking, addiction, mental health and gender-based violence. Over 4000 residents participated in screenings, workshops, and discussions, sparking behavioural change and giving youth and community leaders ownership of solutions.

Theatre for Health (Ras Jebel)

In partnership with Tunisian actor and mediator Raouf Ben Yaghlane, cardiovascular health messages have been transformed into compelling performances. Young actors and residents co-create plays that are staged in cafés, schools and public spaces, reaching diverse audiences and promoting dialogue on smoking, nutrition and well-being.

Family Move

On World No Tobacco Day 2023, Tunisia organized Family Move across all 24 governorates. More than 29 000 participants, including children, women and people with disabilities, joined from all age groups. The programme combined family walks, sports demonstrations, music, drawing contests and cultural performances. Interactive stands run by health professionals offered nicotine dependence tests, counseling and referrals to cessation services. Over 4100 people received direct awareness sessions, nearly 2000 smokers completed dependence assessments and more than 1200 smokers were referred for cessation support. The initiative concluded with the signing of a national charter by 9 ministers in the presence of the Head of Government.

Tobacco-Free Schools and Kids Athletics

In 2025, Tunisia introduced a National Charter for Tobacco-Free Schools in 19 underserved areas, shielding children from exposure to tobacco and e-cigarettes, while the Kids Athletics programme engaged more than 7000 students in fun, skills-based activities, with trained teachers promoting physical activity.

Data and innovation: evidence driven policy

WHO has supported the strengthening of Tunisia's digital health information systems, and research, including cancer survival studies and NCD surveillance. These evidence-based tools now underpin national policies on tobacco control, nutrition and mental health, ensuring that interventions are guided by robust data and tailored to population needs

Success stories and the road ahead

Tunisia kept essential NCD services running throughout the COVID-19 pandemic, safeguarding continuity of care through regional follow-up visits. The country also established a technical committee for NCDs, helping to ensure that multisectoral governance does not remain an aspiration but becomes a reality.

One of the most striking aspect of the Tunisian approach has been the integration of health, culture and sports to promote healthier lifestyles. By linking health promotion with cultural events and physical activity programmes, particularly for youth, Tunisia is fostering community engagement and encouraging behavioural change in a way that resonates with local values and interests. This cross-sector collaboration is helping to shift public perception of health from a medical issue to a shared societal goal.

Tunisia's experience shows that even when faced with a heavy NCD burden, progress is possible as long as political will, community engagement and multisectoral action converge.

By advancing the Health in All Policies agenda, investing in innovation and data and scaling up creative, community-driven initiatives, Tunisia is charting a path that can inspire peers across the Eastern Mediterranean Region.