The Maldives has spent the past two years presenting itself as unusually serious about public health. It banned vapes in late 2024, then moved further still by introducing a generational tobacco ban that took effect on 1 November 2025, prohibiting tobacco use and purchase for anyone born on or after 1 January 2007. The policy attracted global attention because it attempted something rare in public health law: gradually ending the legal tobacco market for future generations.
That is why President Mohamed Muizzu’s recent statement that the government has no plans to ban sheesha, cut sugar subsidies or introduce a sugar tax deserves closer scrutiny. The comment came only days after Health Minister Abdulla Nazim Ibrahim indicated that such measures were being discussed following calls from the Maldivian Medical Association.
The episode has exposed a deeper question within Maldivian public health policy. The government has adopted some of the most aggressive tobacco regulations in the world. At the same time, it is drawing firm lines around other measures aimed at reducing the same disease burden.
The tension becomes clearest within tobacco policy itself. The generational tobacco ban reflects a simple premise: preventing young people from entering nicotine addiction today reduces long-term health costs tomorrow. The ban on vaping devices followed a similar line of thinking, particularly concerns about youth uptake and the rapid spread of new nicotine products.
Sheesha, however, sits awkwardly within this framework.
Medical evidence has repeatedly challenged the popular perception that waterpipe smoking is relatively mild compared with cigarettes. Research shows that a typical hookah session often lasts between 40 and 80 minutes and involves inhaling large volumes of smoke. According to the US Centers for Disease Control and Prevention, a single session can expose users to roughly nine times more carbon monoxide than a cigarette and significantly higher volumes of smoke overall.
The charcoal used to heat the tobacco introduces additional toxins, including heavy metals and carcinogenic compounds. Studies have linked waterpipe smoking to cardiovascular disease, respiratory illness and several cancers. These risks are widely recognised by global health authorities.
This creates an uncomfortable policy contrast. The Maldives has banned modern nicotine devices such as vapes and adopted a generational tobacco prohibition aimed at eliminating smoking among younger cohorts. Yet a combustible tobacco product commonly consumed in cafés and social settings remains outside that regulatory push.
International comparisons make the gap more visible. Kenya introduced a nationwide ban on sheesha in 2017 after health authorities concluded that waterpipe smoking posed a growing risk to young people. Observational research conducted in Nairobi later found compliance rates above eighty per cent across hospitality venues, demonstrating that restrictions on culturally embedded smoking practices can be implemented with sustained enforcement.
Whether the Maldives chooses the same path remains a political decision. But treating sheesha differently from other tobacco products inevitably raises questions about the consistency of the broader anti-tobacco strategy.
A similar contradiction appears in dietary policy.
Non-communicable diseases dominate the Maldivian health landscape. According to World Health Organization data, around 84 per cent of deaths in the country are linked to conditions such as cardiovascular disease, diabetes and chronic respiratory illness. Lifestyle factors, including tobacco use and high sugar consumption, play a central role in this burden.
Yet sugar remains subsidised through the state trading system. The policy originated as part of a food security strategy designed to keep staple commodities affordable in a highly import-dependent island economy. Over time, however, the health implications of maintaining low sugar prices have become harder to ignore.
Subsidies reduce the retail cost of a product and therefore encourage consumption. In a country facing rising rates of obesity and diabetes, the continued subsidisation of refined sugar sits uneasily with efforts to reduce lifestyle-related diseases.
Many governments confronting similar health pressures have moved in the opposite direction. Taxes on sugar-sweetened beverages have become a widely used policy tool over the past decade.
Barbados introduced such a tax in 2015 and observed a measurable decline in sales of sugary drinks alongside a rise in bottled water consumption. Bermuda adopted a comparable approach by raising import duties on sugary beverages while reducing duties on healthier food options.
These policies do not rely solely on persuading individuals to change their habits. They reshape incentives within the market itself by making high-sugar products more expensive and healthier alternatives relatively more attractive.
The Maldives already has a partial precedent for this approach. Import tariffs on energy drinks and certain soft drinks were introduced in 2017 to address rising childhood obesity. Expanding that logic into a broader sugar tax or restructuring existing subsidies would represent a continuation rather than a radical departure from earlier policy.
The economic dimension of this debate adds further weight to the issue.
The Maldivian healthcare system carries substantial fiscal pressure through the Aasandha universal health insurance scheme. According to recent performance audits, the government spent MVR 35.8 billion on health services between 2019 and 2024, with a large share directed toward the treatment of chronic diseases.
Aasandha expenditure alone reached more than MVR 3 billion in 2023. Much of that spending is tied to conditions such as cardiovascular disease, diabetes and cancer. These illnesses require long-term treatment, medication and in some cases overseas medical care.
From a fiscal perspective, policies that encourage healthier behaviour can help moderate these long-term costs. Conversely, policies that lower the price of products associated with those illnesses make the public health challenge harder to manage.
None of this means sugar subsidies alone explain the pressure on the healthcare system. But the policy direction raises an obvious question about alignment between health goals and economic policy.
Politics may help explain part of that hesitation.
Governments everywhere struggle to implement policies that directly affect everyday consumption habits. Restrictions on tobacco products often encounter resistance, but taxes on food and drink can provoke even stronger reactions because they affect household spending immediately.
The Maldives is also approaching local council elections, which tends to make governments cautious about introducing measures that might be unpopular with voters or businesses. Whether electoral considerations are shaping the current stance is impossible to determine from outside government. The timing nevertheless raises a reasonable analytical question about how political incentives interact with health policy.
The broader concern lies in the long-term impact of policy inconsistency.
Public health strategies rely heavily on credibility. Clear and consistent signals from government help shape social norms around harmful behaviours. When regulations appear selective or contradictory, that clarity weakens.
Allowing one form of combustible tobacco to remain socially normal while pursuing a tobacco-free generation policy sends mixed signals. Maintaining subsidies on sugar while warning about the dangers of non-communicable diseases produces a similar ambiguity.
None of this erases the progress the Maldives has made on tobacco control. The generational ban remains one of the most ambitious anti-smoking measures anywhere in the world. But ambitious policy works best when its underlying logic is applied consistently.
The central question therefore remains straightforward. If the Maldives is serious about protecting public health and reducing non-communicable diseases, why subsidise sugar and defend sheesha while pursuing a tobacco-free generation policy?
