PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

26 Acting early on NCDs The Partnership for Health System Sustainability and Resilience16.5% for cardiovascular disease. Japan shows a similar pattern (23.1% vs 17.6%), followed by Spain (20.9% vs 16.5%), Italy (21.6% vs 19.1%), and Canada (19.9% vs 15.9%). Germany represents a transition point with near-parity between cancer (20.7%) and cardiovascular disease (20.6%). Only Poland and Greece maintain cardiovascular disease as their dominant burden in DALY terms, though the margins remain relatively narrow: 25.6% vs 23.5% in Poland and 23.2% vs 21.9% in Greece (IHME, 2013). This epidemiological transition reflects relative success in cardiovascular prevention as much as challenges in cancer control. Figure 7: Proportion of NCD DAL Ys from cardiovascular disease and cancer , 2021 Source: IHME , 2023. Cancer: Progress amid persistent challenges Cancer has become the leading contributor to NCD disability-adjusted life years in six of the eight studied countries, reflecting a shift in disease burden patterns. As Figure 8 shows, While age- adjusted cancer DALYs fell substantially in all countries between 2011–2021 (for example, France - 15.7%, Canada -15.8%), unadjusted rates showed varied patterns. In 2021, unadjusted cancer DALYs ranged from 4,806 per 100,000 in Canada to 7,109 in Poland, representing approximately one-fifth to one-quarter of the total NCD burden across all countries (IHME, 2023). In Spain, unadjusted cancer DALYs rose 2011–2016 then fell 2016–2021, leaving 2021 slightly above 2011 levels (+0.7%). Greece showed unadjusted increases in both intervals, more sharply in the first period, while Japan and Poland also experienced overall increases. This divergence between falling age-adjusted rates and stable or rising unadjusted rates indicates sustained progress in cancer prevention and treatment, but population ageing continues to drive up the observed burden in several systems. Gender-specific trajectories in lung cancer reveal the long shadow of historical smoking patterns. In Spain, between 2000 to 2021 age-standardised DALYs among men declined from 1,497.8 to 969.0 per 100,000 population, but increased from 175.3 to 277.4 among women (IHME, 2023). France reports similar patterns, with lung cancer burden reduction of only 6.1% between 1990 and 2019, far below the European average reduction of 23.3% (Francis-Oliviero et al., 2024), and incidence in women beginning to increase, reflecting smoking uptake among women since the 1970s (Olié et al., 2020). These divergent trajectories, occurring 20-30 years after changes in smoking behaviour, underscore the temporal dynamics that complicate prevention efforts and political accountability. 19.9%23.9% 20.7%23.2% 21.6%23.1%25.6% 20.9% 15.9%16.5%20.6%21.9% 19.1% 17.6%23.5% 16.5% Canada France Germany Greece Italy Japan Poland Spain Cancer CVD