PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

16 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceOur research focuses on four disease categories accounting for over 80% of premature NCD deaths: cancer; cardiovascular disease, diabetes and chronic kidney disease; and chronic respiratory diseases (United Nations, 2025). While NCDs encompass a broader spectrum including neurological, musculoskeletal, and mental health conditions, these four categories were selected for their disproportionate impact, established evidence base for early intervention, and interconnected nature through shared risk factors and pathways, meaning that they frequently co-occur. This provides the rationale for examining these diseases together, as interventions targeting one condition often influence outcomes across multiple NCDs. All countries show substantial variations in NCD outcomes: mortality rates range two-fold between Japan (230.7 per 100,000) and Poland (460.2 per 100,000), whilst within-country disparities are even more striking, with screening coverage varying up to 14-fold between regions in Italy. These variations demonstrate that current performance levels are not fixed constraints but reflect political choices, resource allocation decisions, and implementation capacity. Critical gaps persist between evidence and practice across all countries: prevention spending remains below 5% of health budgets universally, with chronic conditions frequently undiagnosed, and proven interventions systematically underutilised despite widespread recognition of their effectiveness. Perhaps most concerning, the analysis reveals that whilst mortality from NCDs continues to decline, the burden of disease as measured by disability-adjusted life years actually increased in all eight countries between 2011 and 2021. The pace of mortality improvement itself has slowed by 45%, from 1.78% annual reduction during 2000–2010 to just 0.98% during 2010–2021. Yet the evidence also points to enormous potential for improvement. Countries that have achieved specific successes, such as Japan’s 38.6% reduction in premature mortality, substantial cardiovascular disease reductions in several countries, and pandemic-driven digital health transformations, which demonstrate that substantial improvements are achievable with focused action and political commitment. The research teams have identified different solutions to these challenges that reflect their countries’ unique institutional contexts and health system architectures. These policy levers are holistic in scope, covering the organisation and delivery of health care services, their governance, how they are financed, the health and care workforce, how systems make use of medicines and technologies, and environmental sustainability and resilience. Common themes emerge, for instance around the need for integrated care models, data infrastructure enabling outcome tracking, and financing reforms that incentivise early action across the care spectrum. These levers align with and extend beyond the UN’s existing recommendations. This synthesis does not present universal prescriptions but rather offers a menu of policy options developed by countries grappling with similar challenges. Whilst the ultimate destination of reducing NCD burden through early action may be shared, the pathways must be tailored to each country’s unique circumstances, resources, and institutional arrangements. These findings have immediate relevance for the upcoming UN General Assembly discussions on NCDs, providing evidence-based options for the health system reform required to meet global targets. Full country reports forthcoming in Q4 2025 will offer more detailed analysis of national contexts and implementation strategies. Methodology The Partnership for Health System Sustainability and Resilience (PHSSR) commissioned research teams in eight countries to assess their health systems’ capacity to act early on non-communicable diseases (NCDs): Canada, France, Germany, Greece, Italy, Japan, Poland, and Spain. These countries were selected to reflect a range of different demographic, economic, and healthcare financing (i.e general and local taxation, social health insurance systems), and provision (i.e. predominantly public, or mixed public and private provision) contexts.