PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

99 Acting early on NCDs The Partnership for Health System Sustainability and ResiliencePolicy frameworks Several countries have developed sophisticated policy frameworks linking environmental and health objectives, demonstrating clear progress in recognising the interconnected nature of these challenges. Implementation remains uneven, but the foundations for systematic change are being established. France’s 2023 national roadmap for healthcare sustainability marks an important milestone as the country’s first systematic approach to reducing the sector’s environmental impact. The roadmap establishes policy goals for energy reduction, waste minimisation, and sustainable procurement practices, while the National Health Insurance Fund (CNAM) has integrated ecological transition as a strategic objective since 2024. These developments signal institutional commitment even as operational implementation varies across regions. However, unless addressed, structural barriers may limit the impact of these positive developments. Admission-based healthcare reimbursement systems may inadvertently incentivise high-emission facility-based care over lower-emission community and home-based alternatives. While there is growing recognition that better health outcomes can significantly reduce healthcare’s environmental footprint, for example, research shows that preventing CKD progression through guideline-directed care can halve the condition’s CO 2 impact by avoiding years of resource-intensive dialysis (Zoccali et al., 2023), there are legitimate concerns about how to integrate these considerations without creating barriers to patient access. While HTA bodies are considering including environmental considerations in HTA processes, there is currently no consensus on standardised methodologies for assessment of environmental footprint. Such policies must be approached with caution given the risk of further delaying or restricting access to needed care, and hence compromising health systems’ capability to act early on disease, which as in the case of CKD, may itself have significant environmental benefits. Some jurisdictions are exploring approaches outside the core HTA process. For example, Germany’s 2025 pharmaceutical rebate tender, launched by statutory health insurers TK, HEK, and hkk, operates as a procurement incentive offering bonus payments for certified environmentally friendly active ingredient production and compliance with wastewater limits in antibiotic manufacturing (Techniker Krankenkasse, 2025). The development of such policies must take into account whether incentives are better targeted at the corporate-level sustainability performance, rather than individual product level, for which there is a lack of standardised life cycle assessment frameworks and where patient outcomes remain of paramount importance. Meanwhile, the development of comprehensive measurement systems that demonstrate how improved patient outcomes reduce environmental footprint through avoided disease progression, reduced hospitalisations, and less intensive treatments can help build the evidence base for future policy development. Professional training should also incorporate environmental sustainability, raising awareness amongst healthcare workers about opportunities to reduce environmental impact through better disease management and prevention, without compromising patient care or access. Specific vulnerabilities of people with NCDs People with NCDs face disproportionate climate risks through multiple pathways. Extreme heat exacerbates cardiovascular and respiratory conditions through dehydration, increased cardiac workload, and air pollution interactions. Patients with heart failure face particular risks as heat stress increases cardiac demand whilst dehydration from diuretics becomes dangerous. Respiratory patients struggle with heat-induced air quality deterioration, yet most heat plans provide generic rather than condition-specific guidance. Where power infrastructure is unreliable, as in some of Greece’s more remote island, this threatens medication storage and equipment operation. Power outages during extreme weather events