Modifiable risk factors cluster systematically along lines of socioeconomic disadvantage. In Germany, smoking rates in low-education groups are twice those in high-education groups.25 Obesity affects over 25% of some populations, with factory workers showing 50% higher rates than managers.26 Physical inactivity persists despite evidence that even modest activity reduces NCD risk substantially. Environmental exposures compound social disadvantage. Air pollution causes approximately 48,000 deaths annually in France, with the most deprived areas facing a tenfold higher risk of exposure to environmental hazards, and pollution-reduction policies disproportionately benefiting wealthy neighbourhoods.27 In Italy, environmental health risks are particularly pronounced in specific geographical areas, including air-quality risks in the Po Valley and major urban centres such as Rome and Naples. Geographical inequities create systematic disadvantages in every country examined. Rural populations face longer distances to access services, reduced specialist availability and financial barriers from travel costs, challenges particularly acute in Canada’s remote regions and Greece’s island communities. Strikingly, variations in screening coverage and specialist access within countries often exceed differences between countries.Socioeconomic factors create profound health disparities. Even in France, which has among the most universal and progressive health systems in the world, the poorest populations show 13-year shorter life expectancies than the wealthiest. These gaps had been narrowing since the Industrial Revolution but are widening again—a reversal linked to sedentary lifestyles and differential exposure to commercial determinants of health. Inequalities widen further after chronic disease develops, with the life expectancy difference between the richest and poorest increasing from four to six years post-diagnosis.28 These patterns reveal fundamental misalignments between how health systems are organized and what populations need. Piecemeal reforms cannot address problems that arise from fundamental structural misalignments. Meaningful progress requires simultaneous action across prevention and care delivery; financing; governance; workforce; technology; and environmental sustainability. The subsequent sections examine these six critical domains and how they must work together to enable earlier, more equitable intervention.1.2 Risk factors and inequalities Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 8

Acting Early on Non-Communicable Diseases 2026