PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

28 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFigure 9: Cardiovascular diseases – DAL Ys (per 100,000), all ages and age-standardised, 2011, 2016 and 2021 Source: IHME, 2023. The fact that countries with substantial cardiovascular infrastructure still experience high disease burden, suggests that technology and specialist availability alone are insufficient without systematic prevention and coordinated risk management. The variation across countries indicates enormous potential for improvement through better implementation of proven interventions in blood pressure control, lipid management, smoking cessation, and acute coronary care. Analysis of specific cardiovascular conditions reveals where the greatest progress has been achieved. Japan’s 56% reduction in age-standardised ischaemic heart disease DALYs from 1990 to 2021 represents one of the most successful population-level cardiovascular interventions documented (IHME, 2023). Spain achieved similarly impressive results in cerebrovascular disease, with age-standardised stroke DALYs declining from 1,015.9 per 100,000 in 2000 to 483.6 in 2021, and age-standardised stroke mortality falling from 57.7 to 24.2 per 100,000 over the same period, positioning the country well below the OECD average (IHME, 2023). These dramatic improvements that targeted interventions, whether Japan’s focus on salt reduction and blood pressure control or Spain’s comprehensive stroke care networks, can achieve population-level impact. As shown in Figure 10, WHO data on hypertension management illustrates both progress and persistent challenges. While treatment rates have improved across European countries, with Germany increasing from 59.4% to 62.6% between 2011 and 2019, critical gaps remain between treatment and control. Germany achieved only 45.2% control among hypertensive adults by 2019, meaning over half of those with hypertension remain at elevated cardiovascular risk despite the country’s substantial healthcare resources. Spain’s prevalence among adults aged 30–79 declined from 36% in 2000 to 27.2% in 2019, consistently maintaining rates below OECD averages (WHO, 2025d). Yet this still represents more than a quarter of the adult population living with a major cardiovascular risk factor. Moreover, Spain’s control rates reached only 28.3% in 2019, despite 53.6% receiving treatment, suggesting many patients were subjected to suboptimal management strategies. Although, the reliability of these treatment and control indicators among countries is questionable and dependent upon frequency of measurement and data collection systems. All ages: Age standardised % change (all ages) 2011 2016 2021-0.5%-5.5%-9.3%1.2% 6.0%-3.8% 0.3% 01,0002,0003,0004,0005,0006,0007,0008,000 -0.9% Canada France Germany Greece Italy Japan Poland Spain