PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

34 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFrance shows a 13-year life expectancy difference between the poorest and richest 5% of men, with an 8-year gap for women. Once disease develops, socioeconomic disparities widen further, with the life expectancy gap between the richest and poorest deciles increasing from 4 to 6 years after chronic disease develops (DREES, 2022). These gaps persist despite high rates of healthcare coverage, reinforcing that health systems must actively counter rather than inadvertently reinforce existing disadvantages. It is important to acknowledge that inequalities in NCDs outcomes are also shaped by socioeconomic determinants outside the healthcare system including housing, education, and level of income. The most profound inequalities emerge where multiple disadvantages intersect. Indigenous Peoples in Canada face a disproportionate NCD burden shaped by socioeconomic deprivation, cultural marginalisation, and geographic isolation rooted in the enduring impacts of colonialism. This has produced significantly higher rates of kidney disease, end-stage renal disease, and rheumatic disease, particularly among First Nations communities. Implications for health systems The divergence between unadjusted and age-adjusted DALY trends reframes how we understand the NCD challenge. Population ageing does not cause these diseases but rather reveals the accumulated impact of risks acquired across the life course: decades of smoking, uncontrolled hypertension, and metabolic dysfunction that compound until manifesting clinically in later life. This understanding has important implications for health system organisation. The evidence demonstrates that whilst many countries have reduced age-specific risks, particularly for cardiovascular disease and cancer, the actual burden on health systems continues rising as populations age. Since population ageing will continue inexorably in all studied countries, unadjusted burdens will keep rising unless the accumulation of risks across the life course is interrupted. The success of cardiovascular disease prevention, where adjusted rates fell enough to reduce even unadjusted burdens in most countries, proves this is achievable. Conversely, diabetes’s parallel increase in both dimensions warns that without addressing root causes early in life, health systems will face unsustainable demands. The substantial variation in outcomes across countries demonstrates that current performance gaps reflect implementation failures rather than knowledge deficits. The widespread treatment- control gaps and under-diagnosis of conditions revealed throughout this analysis point to systematic failures in applying existing knowledge. These are not problems requiring new scientific breakthroughs but rather better organisation of care delivery. The shifting disease composition presents additional complexity. With cancer overtaking cardiovascular disease in most countries, combined with the universal surge in diabetes and increases in kidney disease, growing numbers of patients live with multiple, interacting conditions. Current health systems, organised around single-disease programmes and specialist silos, are poorly aligned with this reality. The bidirectional relationships between diabetes, cardiovascular disease, and kidney disease exemplify how single-disease approaches miss critical intervention points. The achievements of countries that have successfully reduced specific cardiovascular conditions demonstrate that substantial improvement remains possible even from strong baselines. Yet the universal slowdown in mortality improvements suggests diminishing returns from treatment- focused strategies. The contrasts in cancer survival by stage of diagnosis highlight the potential of earlier detection and intervention. The persistence of inequalities despite universal healthcare coverage reveals another dimension of the challenge. The concentration of risk factors along socioeconomic gradients, compounded by