Executive summary Non-communicable diseases account for 75% of global deaths and threaten health system sustainability worldwide.1 Despite robust evidence that early intervention is cost-effective in improving outcomes and minimizes environmental impact, most health systems remain oriented towards reactive, late-stage care. This white paper draws on comprehensive assessments by the Partnership for Health System Sustainability and Resilience (PHSSR) of eight health systems: Canada, France, Germany, Greece, Italy, Japan, Poland and Spain. Despite different stages of economic development, system structures and policy approaches, these countries face remarkably similar challenges in addressing NCDs effectively. The analysis reveals critical dynamics: –Health systems perpetuate existing inequalities without deliberate intervention prioritizing underserved populations. –Resources frequently fail to align with population needs. Technology, infrastructure and workforce supply prove insufficient without deliberate attention to distribution, organization and coordination. –Performance varies dramatically even within countries, revealing both significant untapped potential and an urgent need for coherent action. –Health systems fail to act early and miss critical synergies, organizing care around single diseases despite biological interconnections between conditions.The paper provides actionable recommendations across six interconnected domains: –Prevention and care –Governance and accountability –Financing mechanisms –Workforce development –Medicines and technologies –Environmental sustainability and climate adaptation These are underpinned by five principles for transformation: address root causes across sectors; integrate action within health systems; design explicitly for equity; sustain commitment beyond political cycles; and enable evidence-based implementation. Wide variations in performance – both within and between countries – reveal that no system excels at everything, but each has experiences to offer. Success requires coordinated action within health systems, and shared learning can accelerate progress across all domains.Despite evidence of what works in tackling NCDs, consistent delivery proves elusive in even the most sophisticated health systems. Success requires integrated action, not piecemeal reforms. Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 4

Acting Early on Non-Communicable Diseases 2026