National health planning typically works on a five-year cycle, focused on infrastructure, staffing, service coverage, disease surveillance, vaccination programs. These plans are necessary and need to keep happening. But there is a different kind of health policy work that is not getting systematic attention, which is adapting what we already know into proactive policy before problems become crises, and preparing for changes we can see coming instead of being caught off guard.
Medical research produces actionable knowledge faster than our policy structures absorb it. We know certain viruses cause specific cancers and can be prevented through vaccination. We know strength training in older adults is one of the most effective interventions for healthy aging and independence. We know potassium-enriched salt substitutes can prevent cardiovascular deaths at population scale. We know that how you hold your body and move, the muscular imbalances you develop, contribute to chronic pain decades later. We know far-UVC light can neutralize airborne viruses in occupied spaces without harming people. We know digital health monitoring devices are becoming cheap enough and good enough for population-level deployment.
The question is whether we wait for this knowledge to slowly diffuse through public consciousness over decades, or whether we systematically adapt it into policy now while the evidence is fresh and we still have the opportunity to prevent harm rather than just treat it. This essay argues for the second approach and proposes convening medical and public health experts to work through specific emerging issues and evidence-based interventions that should shape health policy over the next twenty years.
Pharmaceutical policies to ensure medicine availability
The Maldives is implementing aggressive tobacco control measures, including a generational smoking ban and increased tobacco taxes. This makes effective cessation drugs like bupropion immediately relevant. Are these readily available? Covered by health insurance? Do primary care doctors know how to prescribe them? Right now tobacco control policy and cessation drug policy are operating on separate tracks when they should be working together.
Mental health is increasingly urgent globally and here. But drug scheduling for mental health treatments is based on categorizations that have not kept up with pharmacology or clinical need. Some non-addictive antidepressants are blocked from import while others are available, not because of differential risk but because of outdated blanket restrictions. Restricting amphetamines makes sense given addiction risk. Restricting acyclic antidepressants or Ritalin when addiction risk is genuinely low is harder to justify, especially when there are patients who could benefit and doctors who want to prescribe them.
What needs to happen is a systematic review of drug scheduling based on clear criteria that weigh clinical benefit against actual risk for each molecule. Update the schedules, remove barriers that keep safe treatments out while maintaining tight control on genuinely high-risk substances. This is not complicated policy work but it requires someone to actually do the review and make the updates rather than letting outdated rules persist indefinitely because nobody has prioritized fixing them.
There is also a structural problem with single-importer monopolies. Some essential medicines can only be imported by one designated supplier. If that supplier is not actually bringing in adequate stock, the drug becomes unfindable locally even though there is demand. This is already happening. The solution is to track which medicines are unavailable despite having authorized importers, revoke permissions that are not being used effectively, and either rebid to qualified suppliers or open import to any licensed importer, with renewals tied to actual delivery performance.
We should also set up a reporting system where pharmacies flag whenever a requested medicine is not in stock. Medicines that are repeatedly flagged as unavailable should trigger automatic review. If they have sole import rights or restrictions, those should be reconsidered. If they are not imported at all but there is consistent demand, someone needs to work on bringing them in. This creates a feedback loop between what doctors are trying to prescribe, what patients are trying to access, and what supply policy actually delivers.
Looking forward, GLP-1 agonists like Ozempic are becoming normalized globally for diabetes and weight management. Use is increasing including off-label use. The Maldives needs a policy position before this becomes widespread and chaotic. How much will health insurance cover? Are these frontline prescriptions or reserved for specific conditions? What are the equity implications if only wealthy people can afford them for weight management while obesity-related health risks are often higher in lower-income groups? Better to develop this strategy now before there is widespread unmonitored use rather than trying to regulate retroactively.
Population interventions with large effects
Some public health interventions are remarkably cost-effective but require coordinated policy action to implement at scale. Potassium-enriched salt substitutes are one example. Most countries including the Maldives consume multiple times the recommended daily salt intake. High sodium is a dominant blood pressure risk. Research from rural China focused on high-risk individuals showed that using salt substitutes (75% sodium chloride, 25% potassium chloride) significantly reduced stroke, major cardiovascular events, and deaths with no increase in harmful hyperkalaemia. Population modelling suggests nationwide salt substitution could prevent 8-14% of cardiovascular deaths annually, which in a large country like China would mean hundreds of thousands of lives saved per year.
This is actionable policy. Set mandatory sodium reduction targets for processed foods sold in the Maldives, encourage potassium-enriched salt substitution particularly for high-risk individuals, work with food manufacturers on reformulation, communicate the change to the public. This is not experimental. It is adapting what we know works in other contexts to local implementation.
For chronic disease management more broadly, individual counselling and clinic visits are not sufficient on their own. Policy needs to act on environmental drivers as well. That means regulating salt and sugar content in processed foods, restricting marketing of unhealthy products to children, redesigning urban spaces so daily walking and cycling become realistic options instead of theoretical possibilities, tightening occupational health standards in sectors like tourism and construction where long hours and stress are the norm. These are policy choices that shape the environment people live in, not just lifestyle messages directed at individuals.
Preventing the cancers we can prevent
Research increasingly shows that viruses cause a significant share of cancers. The International Agency for Research on Cancer estimates one in five cancer cases worldwide are caused by infection, most by viruses. HPV causes cervical and penile cancers and some head and neck cancers. Hepatitis B virus causes hepatocellular carcinoma. Hepatitis C causes some carcinomas and lymphomas. Epstein-Barr virus causes some lymphomas. Human T-lymphotropic virus causes adult T-cell leukaemia. There are others. Almost every virus has the potential to cause cancer but only a small proportion actually do so, and we are still discovering which ones matter.
We have vaccines for some of these already. HPV vaccination programs have begun to alter cancer patterns internationally. Hepatitis B vaccination is widespread. What we should do is develop a comprehensive vaccination strategy that frames these not just as vaccines against specific infections but as anti-cancer vaccines as a class. Remove the association of HPV vaccination specifically with sexual activity by grouping it with other anti-cancer vaccines and making it routine to ask: are you up to date on all your anti-cancer vaccines? This reframes prevention as a collective public health measure rather than an individual risk calculation tied to assumptions about sexual behaviour.
For cervical cancer specifically, high-coverage one-dose HPV vaccination combined with HPV-testing-based screening programs can feasibly put cervical cancer on an elimination path. This is achievable with current technology and sufficient political will and sustained funding. The barrier is not scientific, it is organizational and budgetary and whether this gets prioritized consistently over time.
Beyond viral cancers, we should also investigate environmental causes of the cancers and NCDs that are increasing in the Maldives. This means commissioning systematic analysis of potential environmental factors. What is in the water supply? What about air quality in dense urban areas like Malé? Are there specific industrial or agricultural practices creating exposure risks that could be eliminated? If necessary, bring in scientific teams from international labs to test hypotheses rigorously rather than relying on speculation or anecdote. The goal is to identify sources that can be shut down through regulation or infrastructure changes rather than just treating the downstream health effects after people are already sick.
This kind of investigation is expensive and may not find definitive actionable causes. Environmental health is complex and proving causation is genuinely difficult. But if even one major environmental driver is identified and eliminated, the long-run health and economic benefits could be enormous compared to the investigation cost. It is worth doing properly rather than assuming we already know the answer or that environmental factors are not significant.
Preparing for airborne threats
COVID-19 showed that for an economy powered by tourism, the cost of lockdowns and border closures is catastrophically high. We cannot rely on crude isolation measures as the primary strategy for dealing with airborne infectious disease. What we need instead is ambient defense: a set of measures that slow transmission of pathogens in the background, allowing society and economy to keep functioning even when infection rates rise.
This starts with the built environment. Most public buildings – schools, ferry terminals, waiting rooms – were designed without any regard for airborne transmission. They are effectively mixing chambers for viruses. We should upgrade ventilation standards across the board, and deploy upper-room far-UVC sanitation technology in critical nodes like airport terminals, ferry cabins, schools, hospital waiting areas.
Far-UVC light at 222nm wavelength cannot penetrate human skin or eyes – unlike traditional UV-C which is harmful to people – but it neutralizes viruses and bacteria in the air in real-time. Research from Columbia University and other institutions shows far-UVC can reduce airborne pathogens by over 98% within minutes, which is equivalent to 184 air changes per hour, far surpassing what any mechanical ventilation system can achieve. Installing these systems in high-traffic spaces creates firebreaks in transmission chains. It moves the burden of biosecurity from individual behaviour, which is hard to enforce and sustain, to infrastructure, which just works continuously in the background.
The immediate benefit is reducing spread of ordinary colds and flus, which has some value on its own. The strategic benefit is that if a novel airborne pathogen reaches the Maldives before global health authorities have identified it and developed vaccines or treatments, the built environment already provides a buffer against rapid spread. This could be the difference between a manageable crisis where the health system copes and a catastrophe where it gets overwhelmed and we have to shut down the economy again.
We should also tighten antimicrobial stewardship as part of this same agenda. National antimicrobial resistance plans should include WHO AWaRe-based antibiotic use targets and systematic GLASS reporting on resistance patterns and antibiotic consumption. And build climate-resilient health services with heat-health action plans and modern ventilation and filtration standards in facilities, which addresses climate risks and airborne disease risks simultaneously rather than treating them as separate problems.
Physical health across the lifespan
Knowledge about how bodies work and break down has advanced significantly in recent decades, but this knowledge has not been systematically integrated into health policy or education. We now know that posture, gait, muscular imbalances, and inflexibility contribute substantially to chronic pain later in life. We know that strength and muscle mass in older adults is one of the strongest predictors of healthy aging, independence, and longevity. We know that many of these issues are preventable or at least manageable with relatively simple interventions if started early enough.
The opportunity here is to act on this knowledge proactively instead of waiting for it to slowly diffuse through public consciousness over decades. Update physical education curricula in schools to include posture, gait, balance, and basic biomechanics, not as abstract lessons but integrated into normal physical activity. Teach proper lifting technique, how to sit and stand without straining your back, balance exercises that reduce fall risk decades later. These are things that pay dividends for a lifetime if learned young, but most people never learn them formally and only figure them out – if at all – after they have already developed chronic problems.
For older adults, we should implement policies that actively encourage strength training and preventive physiotherapy before people become frail. Muscle loss with aging is not fully preventable but it can be significantly slowed with modest interventions, and the earlier people start the more quality of life and independence is preserved. But this requires shifting cultural expectations from waiting until you are already weak to starting strength and balance work in your 50s or 60s when you are still relatively healthy and can build from a strong baseline.
This is not primarily about individual motivation. It is about building systems that make these interventions normal and accessible. Subsidized community strength training programs for older adults. Physiotherapy services integrated into primary care for prevention, not just injury treatment after something goes wrong. School PE that actually prepares children for lifelong physical health rather than just teaching sports and then hoping they stay active on their own.
Mental health treatment access and root causes
Mental health needs are not going away and if anything are intensifying given social and economic patterns of modern life. Policy needs to work on treatment access and root causes simultaneously, not one or the other.
On treatment access, mental health services need to move from the margins into the core of the health system. Primary healthcare providers need training to recognize, manage, and refer common mental health conditions so that someone does not have to already be in crisis to get help. A network of community-based services should offer talk therapies and social support in familiar environments, not only in hospital psychiatric wards. We need more therapists, more counsellors, more trained peer supports. But also recognition that different people need different kinds of help. Some people benefit most from clinical psychology. Others need community groups or peer support. Others need medical intervention with medication. The system should have different paths that match different needs rather than trying to force everyone through the same narrow channel.
For children and adolescents specifically, we need clear evidence-based policy on smartphones, internet, and social media in schools. We know enough now about effects on attention, sleep, and mood to set some age-appropriate rules and school-day norms. This is not about banning technology entirely, which is neither realistic nor necessarily desirable. It is about deciding what is appropriate at what ages and in what contexts, and giving schools and parents clear frameworks instead of leaving everyone to figure it out individually while dealing with social pressure from other families doing different things.
But treatment access alone is fighting a losing battle if root causes are ignored. Mental health is affected by economic insecurity, housing stress, lack of community, atomization, absence of purpose or meaning. These are not things mental health services can fix on their own. They require coordination across housing policy, economic policy, urban planning, and community programming. We need to address the conditions that are making people unwell, not just treat the symptoms of unwellness after the fact.
Digital health monitoring: deciding how far to go
Health monitoring devices are becoming cheaper, smaller, and more capable. Health rings can now track heart rate, sleep quality, exercise, blood oxygen, and temperature continuously without being bulky or intrusive. This creates real possibilities for population health monitoring, particularly for at-risk individuals and the elderly. Continuous monitoring can catch problems early when they are easier to treat and it can help doctors make better diagnostic and treatment decisions because they have more complete information about patterns over time rather than just snapshots at appointments.
The policy question is how far to go with this. Do we distribute monitoring devices to all elderly people? To people with diabetes or heart conditions? Set up automated flagging when metrics suggest health issues developing? Allow doctors to access full device data with patient permission to see patterns that would not be visible otherwise?
There are real benefits but also real risks around privacy, data security, and creating anxiety through over-monitoring or false alarms. What we need is a deliberate framework that decides the scope of population monitoring and builds in clear consent mechanisms, opt-outs, and data protections from the beginning. Citizens should know what is being collected about them, who can see it, and for what purpose. Health data should not be used for unrelated commercial profiling or law enforcement or employment decisions. People should retain the right to opt out of non-essential data flows without losing access to care.
The alternative is a patchwork where some people have access to monitoring through private purchase and others do not, where data practices are inconsistent across providers, and where privacy protections are afterthoughts added later rather than designed in from the start. If we are going to integrate digital health monitoring into public health strategy, better to do it deliberately and equitably with protections built in from day one.
The need for systematic strategy
These are not idle academic questions. They are practical policy issues that will get resolved one way or another over the next twenty years. The choice is whether we address them systematically through expert convening and deliberate strategy development, or whether they get resolved by default through accumulated individual decisions, market forces, and crisis response after problems have already escalated.
The proposal here is not to provide final answers in this essay. We don't have those answers, and trying to prescribe specific solutions without proper expert consultation would be irresponsible. Instead, the proposal is to charge the National Development Plan committees with creating a dedicated long-term health strategy body. This body would convene clinical, public health, and regulatory experts to produce systematic frameworks for the issues outlined above. The deliverable should be a twenty-year strategy that sits alongside five-year operational plans, not replacing them but addressing a different timescale and different kinds of questions that do not fit neatly into annual budget cycles or electoral timelines.
Some of this work will require primary research and environmental investigation. Some will require expert judgment calls where the evidence is not yet conclusive or where different studies point in different directions. Some will require difficult trade-offs between competing values like access versus cost control, or privacy versus monitoring benefit, or individual autonomy versus public health benefit. The point is to work through these questions deliberately with the right expertise at the table rather than drifting into answers by accident or by whoever has the most lobbying power or by whatever crisis hits first.
The common thread running through all of these issues is that we now have knowledge, or can see trends emerging clearly enough, that make proactive policy possible. Viruses cause cancers and we have vaccines that can prevent some of those cancers. Salt substitutes reduce cardiovascular deaths at population scale and we can mandate reformulation. Far-UVC neutralizes airborne viruses in occupied spaces and we can install it in high-traffic areas. Strength training preserves function in older adults and we can make it routine and accessible. GLP-1 agonists are already being used increasingly and we need coverage and equity policy before use becomes widespread and chaotic. Digital monitoring is becoming technologically and economically viable and we need privacy frameworks before data practices become entrenched.
Acting on what we know means building policy infrastructure now while the evidence is available and we still have the opportunity to prevent harm rather than just treating it after it has occurred. The alternative is waiting decades for knowledge to slowly diffuse through public consciousness, during which time preventable deaths accumulate, preventable pain and disability accumulate, and preventable costs to the health system and economy accumulate.