PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

106 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceSecond, market forces and professional dynamics can reinforce structural misalignments. Across different health system models, healthcare workers often concentrate in urban centres where practice opportunities are greatest, diagnostic technologies cluster in wealthy regions, and incentives encourage a shift towards specialism and away from generalist medicine needed to manage patients living with ML TCs. These dynamics operate even within publicly-funded systems. The resulting disparities, with screening coverage varying substantially within countries and notable urban-rural gaps in specialist access, reflect how market forces can advantage those with greater resources. The imperative for transformation Continuing on current trajectories presents mounting challenges. Demographic changes guarantee increasing NCD prevalence. Healthcare spending that outpaces economic growth while outcomes plateau threatens sustainability. Workforce constraints make traditional responses of simply adding providers unfeasible. Environmental pressures, including healthcare’s substantial carbon footprint, demand new approaches. Meanwhile, the development of innovative medicines and digital technologies offers unprecedented tools for improvement, though their potential remains constrained by outdated delivery structures. The COVID-19 pandemic revealed both vulnerabilities and possibilities. Chronic disease management proved fragile under acute pressure, with widespread disruption to screening, diagnosis, and routine monitoring. Yet the crisis also demonstrated that rapid system transformation is possible when urgency demands it. Digital solutions previously stalled for years were implemented in weeks. Virtual care expanded from marginal experiment to mainstream delivery. These experiences proved that perceived barriers often reflect institutional inertia rather than genuine impossibility. Breaking the cycle of inadequate NCD management requires fundamental restructuring. Care must shift from episodic interventions to continuous and integrated management with accountability for entire pathways. Information must flow seamlessly across providers, incorporating social determinants into risk assessment. Payment systems must reward outcomes and population health rather than service volume. Geographic and socioeconomic disparities cannot be accepted as inevitable but must be actively addressed through minimum standards and targeted investment. Prevention must move from rhetoric to reality through protected multi-year funding and health considerations embedded across all policy sectors. The narrowing window The opportunity for deliberate reform may be time-limited. Each year of delay compounds the challenge: more people develop preventable conditions, creating decades of future care needs; underinvestment in prevention increases disease burden; workforce trained in traditional models becomes harder to redirect; and health inequities become more entrenched. Countries that strengthen the entire care continuum, from primary prevention to improving early detection, reducing diagnostic delays, ensuring timely access to effective therapies, and managing established disease systematically, position themselves to manage future challenges. Those deferring action risk being overwhelmed by predictable but preventable disease burden. The evidence is clear and the costs of inaction accumulate daily. For the millions living with NCDs and the millions more at risk, the difference between early action and delayed intervention determines quality of life, independence, and survival. The question is not whether health systems can afford to transform but whether they can afford not to. The choice made in this decade will determine whether NCDs remain an escalating crisis or become a manageable challenge. The path forward demands political courage, sustained commitment, and recognition that acting early is not just technically sound but morally imperative.