The rising burden of noncommunicable diseases (NCDs) has been an increasing public health concern globally. In 2005, the World Health Organization (WHO) estimated that 61% of deaths (35 million) and 49% of the global burden of disease were attributable to NCDs (1). Eighty percent of such deaths occurred in low- and middle-income developing countries where health resources are limited (2). If current trends continue, by 2030 chronic diseases will account for 70% of total global deaths and 56% of the global disease burden (1).

Oman, located in the southeastern corner of the Arabian peninsula, has a land area of 309,000 square kilometers. In 1959, the country emerged from several wars between tribal factions in the interior and coastal areas (3). The last conflict, which took place in the south, ended in 1982 with the forging of a treaty between Oman and Yemen. Since then, the country has maintained internal peace and stability and peace with its neighbors. In 1970, Sultan Qaboos bin Said assumed power and set the country on the path of modernization. In less than 20 years, Oman acquired all the attributes of a modern state: running water, electricity, telephone, television, shopping malls, schools, university education, hospitals, and clinics (4).

Like many developing countries, Oman bears a high burden of NCDs. Several studies have documented the distribution of risk factors associated with NCDs in this relatively small country (5-9). We describe the rapid changes in the epidemiologic map of Oman from one dominated by first-generation diseases (i.e., infectious diseases) to the emergence of NCDs as the dominant feature of ill health. Furthermore, we elaborate on the accompanying demographic, socioeconomic, and behavioral risk factor changes that have contributed to the current epidemiologic transition.

The Directorate General of Planning of the Omani Ministry of Health routinely collects data for health planning purposes. Data on morbidity, mortality, and use of health care services are compiled from primary-, secondary-, and tertiary-care regional health institutions by a Health Information Unit, headed by a statistician, in each of Oman's 10 administrative regions. These data are fed into electronic templates and sent to the central Health Information Unit. There, information is reviewed and published as an annual health report. We reviewed these reports for the years 1990 through 2005.

In addition, the Oman Ministry of Health's Research Department designs and conducts national health surveys every 5 to 10 years to provide decision makers with community-based data on certain variables, including behavioral and biological risk factors for NCDs. We reviewed the report of the Oman National Health Survey 2000 (10), the Joint Study Report on Mortality and Health Transitions in Oman (3), several WHO consultants' reports on primary care in Oman (11,12), and the 1999 World Bank Cost-Effectiveness Review of the Health Sector (13). We also searched the National Library of Medicine's MEDLINE database for publications on chronic diseases pertinent to Oman.

Although the accuracy of the health information data gathered by the Directorate General of Planning in the Omani Ministry of Health has not been formally assessed, health information officers from various WHO member states in the Eastern Mediterranean Region (EMR) have visited Oman several times to learn from its health information systems. In addition, the International Agency for Research on Cancer, a specialized WHO agency, has examined Oman's cancer registry data and has considered it sufficiently reliable to be included in its publication, Cancer Incidence in Five Continents (http://www.iacr.com.fr/statist.htm). Oman is 1 of only 2 countries among the 22 EMR member states whose cancer data were included.

The health care system of Oman faces formidable challenges in its efforts to prevent chronic diseases from eroding the achievements of the past 4 decades. First, increases in the population will lead to an estimated 210% increase in the demand for health care by 2025, and treatment of CVD alone will account for 21% of total health care expenditures (32). Furthermore, the Omani health system currently suffers from overuse of health services, both by patients, with 5.6 visits per person per year, and by physicians, with 70% of tests requested being unnecessary (33). Second, patients' expectations for quality of care and better health outcomes are increasing; continuing with the current modest standards of clinical care may erode the public's confidence in the national health system. Third, the current rate of increase in the cost of health care is a cause of great concern for sustainability of health care services, especially given the rapid rate at which costs are increasing. Although Oman's per capita expenditure on health (U.S. $220) is lower than that of neighboring Arab Gulf states (U.S. $665 in United Arab Emirates and U.S. $539 in Bahrain) (34), health care expenditures increased by 64% from 1995 to 2005. Clearly, improving care for chronic diseases would put incrementally increased financial demands on an already resource-constrained health care system. Fourth, there is a great need to shift health care services from acute and episodic treatment to treatment that meets the ongoing needs of people with chronic conditions, with greater focus on health promotion and chronic disease prevention.

Despite the fact that preventive health care services were emphasized in every 5-year plan of the Oman Ministry of Health, until recently health care policy makers have focused on meeting public demand for health facilities and services by providing curative clinical services to the newly developing regions of Oman. One positive aspect of this has been the availability of secondary-care services in all regions of Oman. Another has been the rapid expansion of the PHC centers network throughout the country. However, the current primary care system is still geared more to combating infectious diseases, providing immunizations, and providing prenatal care rather than to meeting needs arising from the growing burden of NCDs. Most primary care physicians and nurses are not educated beyond their basic training to deal with common complex diseases like diabetes, hypertension, asthma, and psychiatric conditions. Drugs necessary to treat common conditions such as hyperlipidemia (statins), hypertension (angiotensin-converting enzyme inhibitors), depression, and other common chronic conditions are dispensed not in primary care facilities where most people access health care, but mostly in secondary and tertiary care facilities. Antiobesity and tobacco-cessation medications have yet to be added to the national formulary and can be obtained only through private-sector pharmacies at appreciably higher costs.

Two of the major risk factors propelling the current epidemic of NCDs, namely tobacco and obesity, can be curbed through implementation of appropriate strategies, such as the WHO Global Strategy on Diet, Physical Activity, and Health (35). Furthermore, the call by Strong et al (2), to set a target to reduce deaths from chronic diseases by an annual rate of 2% deserves due consideration and integration into Oman's national health goals.

Decision makers and health planners need to have greater political commitment to the provision of services for people with chronic diseases. Commitment is most likely to be forthcoming if more evidence is produced nationally demonstrating the increasing burden of NCDs. Greater commitment to providing chronic disease services will result from national research and from continuous dialogue between advocates of chronic disease control and policy makers. Greater emphasis on health promotion will enable people, both the chronically ill and the healthy, to increase control over their health and to improve it.

Finally, various departments of the government make polices and decisions that inevitably have an impact on major risk factors and, ultimately, on the health of the nation. However, collaboration and joint planning among government sections are still rudimentary and need to be strengthened through development of a national planning framework under the leadership of the Ministry of National Economy. Preventive health programs would have better outcomes if public polices on taxation, trade, food, urban planning, and the like are evidence-based and set with due consideration of public health.

Oman faces an epidemic of chronic NCDs. Oman's rapid socioeconomic development coupled with demographic trends over the past 37 years reflects positively on Oman's health indicators, most notably on the increase in life expectancy at birth. However, such achievements may be overshadowed by the dramatic rise of chronic diseases, including cardiovascular disease, diabetes and other obesity-associated syndromes, chronic renal failure, and cancer, which are costly to treat. If the achievements in the health of the nation accomplished over the past 4 decades are to continue, there must be concerted efforts and coordinated policies on the part of government with greater emphasis on proven, cost-effective primary prevention services that focus on lifestyle and behavior change.