Mortality reductions are slowing. Between 2000 and 2021, all countries reduced age-standardized NCD mortality, yet the pace of improvement has slowed. The average annual mortality reduction across the sample of countries declined from 1.78% in the 2000–2010 period to just 0.98% in the 2010–2021 period, a 45% deceleration affecting even the strongest performers. Age-adjusted and unadjusted measures of disease burden measures tell two different stories. When adjusted for age, DALYs from NCDs fell across all countries, showing that people at any given age face lower risks than before. Yet total unadjusted DALYs increased universally.9 This divergence reflects how population ageing transforms health systems: more people are living to ages where accumulated lifetime exposures result in chronic disease, placing growing demands on health systems even as age-specific risks decline. Cardiovascular disease (CVD) illustrates what sustained intervention can achieve. Most countries show consistent declines in both adjusted and unadjusted burden. These improvements reflect comprehensive approaches combining primary prevention with acute care innovations including minimally invasive procedures, and organized stroke networks. Yet substantial variation persists: Poland’s CVD burden remains more than double Canada’s, while Germany reports avoidable heart failure hospitalizations exceeding averages for countries in the Organisation for Economic Co-operation and Development (OECD), despite its comparatively well-resourced healthcare system. Cancer contributes the largest share of DALYs in six of eight countries, overtaking cardiovascular disease.10 While age-adjusted rates are falling, outcomes depend heavily on early detection. In Canada, five-year breast cancer survival exceeds 89%, while lung cancer survival remains at 22%.11,12 This reflects when disease is diagnosed: breast cancer most frequently at Stage 1, lung cancer at Stage 4.13 Gender-specific outcomes reveal historical smoking patterns: in Spain, male lung cancer DALYs declined, while female rates increased, reflecting smoking uptake among women since the 1970s.14,15 Diabetes presents the most alarming trajectory among all NCDs examined. Between 2011 and 2021, unadjusted diabetes DALYs increased universally, exceeding 30% in several countries.16 More concerning, age-adjusted rates also rose in seven out of eight countries, with only Italy achieving a decline.17 Even otherwise strong performers suffered: Canada experienced a 21.3% age-adjusted increase despite having the lowest overall NCD burden, while Japan saw a 14.8% increase despite its world-leading life expectancy. The implications extend beyond diabetes itself: uncontrolled diabetes drives chronic kidney disease, amplifies cardiovascular risk and worsens multiple conditions. Diabetes-related amputation rates ranged from 2.5 per 100,000 in Italy to 8.5 in Germany,18 revealing systemic failures even in well- resourced health systems.Chronic kidney disease (CKD) presents a mixed picture that varies dramatically by country. Between 2011 and 2021, unadjusted CKD DALYs increased in seven out of eight countries. Greece’s 134% unadjusted increase likely reflects improved diagnosis rather than true deterioration. Spain and Japan achieved age-adjusted declines despite unadjusted increases, while Poland achieved both.19 However, major diagnostic gaps persist universally. France reports 95.5% of stage 3 CKD cases go undiagnosed, with 25% of patients beginning haemodialysis in emergencies.20 Early detection and guideline-directed medical therapy can slow progression and reduce burden.21 The missed opportunity is striking. CKD links directly to diabetes and hypertension – conditions already monitored regularly. Systematic screening integrated into existing diabetes and hypertension management would simultaneously address multiple conditions through cascading prevention yet this remains largely unexploited. Without integration, health systems continue to catch CKD at its most expensive and debilitating stages. Chronic respiratory diseases are a significant cause of preventable hospitalizations. Chronic obstructive respiratory disease (COPD) and asthma admission rates vary fivefold among countries, from 23 per 100,000 in Italy to 193 in Germany in 2021.22 These hospital admissions often reflect gaps in primary care, as many exacerbations could be prevented through outpatient management. Studies estimate that two-thirds of people with airflow obstruction have no prior diagnosis, a finding consistent across multiple countries.23 Gender disparities in mortality rates are also apparent, with increased deaths from COPD particularly among women, contributing to a slowdown in life expectancy gains in Germany.24 Overall, underdiagnosis, alongside marked variations in hospitalization rates, point to unmet need and missed opportunities for early intervention.1.1 Disease-specific patterns and trends Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 7

Acting Early on Non-Communicable Diseases 2026