PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

21 Acting early on NCDs The Partnership for Health System Sustainability and Resilience1 The burden of NCDs, risk factors and inequalities This chapter examines the current burden of non-communicable diseases (NCDs), their risk factors and distribution across eight high-income countries (i.e Canada, France, Germany, Greece, Italy, Japan, Poland, and Spain) providing the epidemiological foundation for understanding how their health systems are performing and where early intervention is most needed. Acknowledging that population ageing does not cause the rising NCD burden but reveals accumulated risks across the life course that health systems can significantly mitigate, this chapter analyses population health through three lenses: the overall burden of NCDs and its evolution, the disease-specific patterns across five major NCD categories, and the distribution of risk factors and inequalities across populations. The analysis reveals three critical patterns that frame all subsequent discussions in this report. First, the divergence between unadjusted and age-adjusted DALY trends demonstrates that whilst countries are reducing age-specific risks for some conditions, population ageing ensures that actual health system burdens continue rising. Second, disease trajectories vary markedly: cardiovascular disease shows success with declining burdens, cancer maintains progress despite demographic pressures, whilst diabetes reveals systemic failure with deteriorating outcomes across all ages. Third, NCDs concentrate along predictable lines of geographic, socioeconomic and educational disadvantage, with risk factors clustering systematically among vulnerable populations in patterns that health systems often reinforce rather than mitigate. Current NCD burden and trajectories Mortality rates The eight countries studied present a complex picture of NCD burden that defies simple categorisation. Whilst all have achieved life expectancies that are high by global standards, ranging from 77.2 years (Poland) to 84.1 years (Japan), this nearly seven-year gap reflects important variations in disease burden and population health trajectories (IHME, 2023). NCDs account for 87– 93% of all deaths across the studied countries (Figure 1), yet substantial variation persists in both overall and premature mortality. In 2021, age-standardised NCD mortality rates ranged from 230.7 Figure 1: Proportion of all deaths due to NCDs (%), 2019 Source: WHO, 2025a. 27.2% 26.2%34.2% 37.0%33.7%26.0%40.8% 28.3%31.4% 32.6%27.6%27.6%29.2% 32.3%29.5% 28.5%6.8% 3.7%5.0%4.3% 5.1% 4.2%2.5% 9.0%18.9%19.6%18.7% 14.6% 19.1% 20.4%13.6% 20.1%89.4%86.9%91.9%90.3%93.0% 87.3%90.0%91.8% Canada France Germany Italy Japan Poland SpainCardiovascular diseasesTotal cancersChronic respiratory diseasesChronic kidney diseaseDiabetes mellitusOther NCDTotal NCD Greece