27 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFigure 8: Cancer – DAL Ys (per 100,000), all ages and age-standardised, 2011, 2016 and 2021 Source: IHME, 2023. Five-year survival rates provide another lens on cancer system performance, revealing both achievements and persistent challenges. Canada reports survival ranging from 22% for lung cancer to 91% for prostate cancer, with breast cancer at 89%, uterine at 82%, and bladder at 77% (Statistics Canada, 2025c; Canadian Cancer Registry, 1992–2017). Spain shows comparable patterns with prostate cancer survival at 89.8% and breast at 85.5%, but lung cancer survival remains dismally low at 17.6% for women and 12.7% for men (International Agency for Research on Cancer, n.d.). These survival disparities reflect a combination of biological factors, stage at diagnosis, and treatment availability. In Canada, breast cancer is most often diagnosed at an early stage, with 28.4 per 100,000 diagnosed at Stage I, while lung cancer is most frequently diagnosed at Stage IV (29.1 per 100,000) (Statistics Canada, 2025c). This contrast illustrates how screening availability and biological accessibility of different cancer sites influence outcomes. Cardiovascular disease, diabetes and kidney diseases These three disease categories are strongly interconnected, with each condition serving as both risk factor and consequence for the others. Diabetes drives cardiovascular disease and kidney damage, hypertension accelerates both cardiovascular events and kidney decline, while chronic kidney disease independently increases cardiovascular risk and complicates diabetes management (Ndumele et al., 2023). This bidirectional causality creates cascading health impacts that current single-disease management approaches fail to address adequately. Cardiovascular disease Cardiovascular disease remains a major source of disability and death across all studied countries, though with striking variations that reveal both achievements and missed opportunities. As Figure 9 shows, age-adjusted DALYs declined significantly between 2011 and 2021 in all countries, while unadjusted rates were more variable, declining in Canada, France, Germany, and Poland, and remaining roughly flat in Spain and Italy. Japan alone experienced a notable increase. Greece’s pattern was particularly volatile, with unadjusted DALYs falling 2011–2016 then rising 2016–2021, resulting in little net change. France achieved one of Europe’s lowest unadjusted CVD burdens at 4,024 per 100,000 in 2021 (down from 4,259 in 2011), whilst Germany records 6053 unadjusted DALYs per 100,000 (down from 6,677 in 2011) despite having one of Europe’s highest densities of cardiac catheterisation laboratories. Poland’s unadjusted rate remains more than double Canada’s. All ages: Age standardised % change (all ages) 2011 2016 2021-4.3%-4.6%-2.8%16.7% -1.9% 2.0%4.3% 0.7% 01,0002,0003,0004,0005,0006,0007,000 Canada France Germany Greece Italy Japan Poland Spain

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025