22 Acting early on NCDs The Partnership for Health System Sustainability and Resilienceper 100,000 in Japan to 460.2 in Poland, a two-fold difference that persists despite universal access to medical knowledge and similar levels of economic development. As Figure 2 shows, between 2000 and 2021, all countries achieved reductions in age-standardised mortality from NCDs, though at markedly different rates. Spain and Italy achieved the most dramatic transformations, with reductions exceeding 30%. Poland achieved the largest absolute reduction yet remains the worst performer due to its exceptionally high baseline (640.1 in 2000), while Japan’s more modest 20.5% reduction may partly reflect the challenge of improving from an already-low baseline. Critically, the pace of NCD mortality reduction has slowed markedly across all eight countries. During 2000–2010, countries achieved an average annual reduction of 1.78%, but this declined to 0.98% during 2010–2021, a 45% relative slowdown. This deceleration was universal, affecting even the strongest performers. Spain, despite achieving the fastest improvement rate in the second decade (1.58% annual reduction), still experienced slower progress than its own first-decade performance (1.91%). This pattern, where even the best contemporary performer cannot match earlier rates of improvement, underlines the systemic nature of the challenge. Figure 2: Age-standardised NCD mortality rate (per 100,000 population), 2000–2021 Source: WHO, 2025b. Figure 3 showing GHO data on premature NCD mortality (i.e. the proportion of deaths before age 70) reveals more disparities. In 2021, rates ranged from 13.85% in Japan to 32.71% in Poland, a 2.4- fold variation suggesting that health system differences are particularly pronounced in preventing early deaths. Between 2012 and 2021, Japan achieved a remarkable 38.6% reduction (from 22.56% to 13.85%), demonstrating that substantial progress is possible, even from a strong baseline. Most European countries achieved modest reductions of 6–12%. However, Canada stagnated (26.86% to 26.99%), while Poland maintained rates more than double Japan’s. The COVID-19 pandemic exposed underlying vulnerabilities, with Canada experiencing a sharp spike in 2020 (+2.05 percentage points) while most European countries maintained their trajectories. Notably, Japan continued improving even during the pandemic, reducing premature mortality by 1.92 percentage points between 2019–2021. 200300400500600 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020Poland 460 Germany 350 Greece 347 Canada 310 Italy Spain285 282 274 230 JapanFrance640 462 452 411 412 392410 290

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025