The prevention and care continuum2 Effective NCD action requires coordination, from population prevention through screening to disease management. Yet systematic failures fragment patient journeys and delay necessary interventions. Primary prevention aims to reduce disease incidence by addressing modifiable risk factors before disease develops. Despite clear evidence linking tobacco use, poor diet, physical inactivity and harmful alcohol consumption to NCDs, translating this knowledge into effective population- level interventions remains challenging. Prevention strategies targeting individual behaviour show limited impact without addressing structural determinants. France’s high cigarette prices have minimal effect where social acceptability persists.29 Germany’s voluntary industry commitments depend on manufacturers choosing healthier reformulations.30 Greece’s anti-smoking law initially succeeded but compliance deteriorated when enforcement weakened.31 Health promotion rarely sustains across the life course, concentrating in childhood despite evidence that transition periods – adolescence, employment entry, retirement – represent high-risk windows for behavioural deterioration. Across these examples, approaches that rely on individuals making different choices – whether through price signals, voluntary industry action or behavioural restrictions – prove insufficient without addressing the environmental, social and structural factors that shape those choices, and health systems bear the resulting burden. 2.1 Primary prevention: Addressing environmental, social and structural factors Current landscape –Implement comprehensive fiscal measures: Deploy evidence-based taxation on tobacco, alcohol and sugar-sweetened beverages at levels demonstrably changing purchasing behaviour, with regular adjustment for inflation and affordability. Ring-fence revenues specifically for prevention programmes and ensure coordination across jurisdictions to prevent cross-border purchasing undermining policy effectiveness. –Create regulatory environments supporting healthy choices: Establish comprehensive marketing restrictions on unhealthy products aimed at children across all media, including digital platforms. Mandate reformulation targets for processed foods with clear timelines and penalties for non-compliance. Implement smoke- free environments with sustained enforcement, learning from countries where initial success deteriorated without consistent monitoring. –Develop life-course health promotion: Integrate health education throughout educational curricula from early childhood, covering nutrition, physical activity, mental health and substance-use prevention. Ensure programmes adapt to critical life transitions when health behaviours often deteriorate, with targeted interventions at vulnerable periods. –Address social determinants: Recognize that behavioural risk factors reflect social and environmental contexts. Prevention strategies must explicitly target disadvantaged populations that experience the highest exposure to health risks while facing the greatest barriers to healthy behaviours.Policy levers Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 9

Acting Early on Non-Communicable Diseases 2026