PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

15 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceIntroduction The global NCD crisis Non-communicable diseases (NCDs) represent the defining health challenge of the 21st century. In 2021, NCDs were responsible for an estimated 43.8 million deaths worldwide, accounting for approximately 75% of all non-pandemic-related deaths, while also increasing people’s vulnerability to the virus (WHO, 2024a). In addition to their health impact, NCDs impose substantial direct costs to healthcare systems from healthcare utilisation and pharmaceutical expenditure and indirect costs through productivity losses, placing immense pressure on health systems already straining to meet needs with constrained resources. Their treatment also contributes a significant proportion of health systems’ carbon emissions, escalating with disease progression. NCDs have been included in the 2030 Agenda for Sustainable Development represented global recognition of this crisis, with target 3.4 committing to reduce premature mortality from NCDs by one third through prevention and treatment. Yet as the United Nations prepares for its fourth high- level meeting on NCDs in 2025, the world is not on track to meet this target. The UN Secretary- General’s 2025 progress report emphasises that without urgent, concerted action, the long-term trajectory of NCDs will have profound socioeconomic impacts, weakening human capital and diverting resources to treating conditions that could have been prevented (United Nations, 2025). While low- and middle-income countries bear a disproportionate burden, accounting for 73% to 86% of premature deaths from NCDs, high-income countries face major challenges including aging populations with multiple long-term conditions (MTLCs), rising healthcare costs, budget impact associated with novel treatments and technologies,, and persistent health inequalities within their borders. The rise of NCDs represents a troubling reversal of 20th-century health equity gains, when public health initiatives and welfare state protections helped narrow health disparities. However, today’s emphasis on personal responsibility for health choices combined with the scaling back of welfare state protections has been associated with widening health disparities. Addressing NCDs effectively requires comprehensive approaches that mobilise health systems to actively counter rather than inadvertently reinforce social disadvantage. This requires more proactive intervention, encompassing not just primary prevention but timely and equitable access to appropriate care for secondary and tertiary prevention, from identifying at-risk populations through screening programmes, to prompt diagnosis using necessary technologies, to swift referral to evidence-based treatment and disease management that prevents progression and complications. But although the case for early intervention is well-established and increasingly recognised in national health strategies, there is often a gap between rhetoric and practice. Policy Roadmaps for Acting Early on NCDs In this context, the Partnership for Health System Sustainability and Resilience (PHSSR) has launched its Policy Roadmaps for Acting Early on NCDs, bringing together research teams from eight high-income countries to conduct systematic assessments of their health systems’ capacity for early action. This report synthesises findings and recommendations from forthcoming the reports on Acting Early on NCDs in Canada, France, Germany, Greece, Italy, Japan, Poland, and Spain, developed through evidence review and extensive stakeholder consultation within each national context, with a common research framework.