PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

37 Acting early on NCDs The Partnership for Health System Sustainability and Resilience2 Primary prevention and health promotion Primary prevention initiatives for non-communicable diseases across the eight country reports examined reveal a complex landscape of policy approaches, ranging from comprehensive national frameworks to fragmented regional efforts. Whilst all nations have implemented various prevention strategies, the reports indicate that these vary considerably in scope, integration, and effectiveness. Primary prevention of non-communicable diseases requires comprehensive action extending far beyond healthcare systems, encompassing fiscal policy, regulatory environments, commercial determinants, and the social conditions that shape health behaviours. While health systems cannot control all these factors, they play essential roles in advocacy, coordination, and delivery of prevention services such as vaccinations. The evidence from eight countries reveals striking contrasts between the acknowledged cost-effectiveness of health promotion at the population level and actual implementation, which remains fragmented, underfunded, and politically marginalised. Fiscal levers and market interventions The use of fiscal policies to discourage unhealthy behaviours and promote healthier choices represents one of the most widespread prevention strategies documented, though implementation varies significantly. The France report identifies the country as pioneering sugar-sweetened beverage taxation in 2012, subsequently refining it in 2018 to index tax rates to sugar content (Le Bodo et al., 2022), an approach that has influenced policy development across Europe. The Spain report documents a dramatic VAT increase on sugary drinks from 10% to 21% in 2021 (Martinez et al., 2022) whilst the Poland report describes its sweetened beverage tax introduction in 2020. The Germany report, however, notes the country opted for voluntary industry pledges through its National Reduction and Innovation Strategy for Sugar, Fats, and Salts, which research indicates has achieved only minimal reductions in dietary risk factors. Tobacco taxation reveals even greater contrasts across the reports. The France report documents some of Europe’s highest cigarette prices through aggressive taxation, supporting the goal of creating the first “smoke-free generation” by 2032. It would appear that this has not been particularly successful as smoking rates remain high, and the French report finds that cultural shift towards stigmatising smoking has yet to occur. Conversely, the Germany report indicates that tobacco tax represents the lowest proportion of retail price in the EU at 70.23% (Wissenschaftlicher Dienst des Bundestages, 2020), whilst the Poland report describes continuously increasing excise duties but struggles with enforcement. These fiscal approaches extend beyond simple revenue generation, and represent deliberate attempts to price unhealthy behaviours out of reach, particularly for young people who might otherwise initiate smoking. Alcohol policies expose cultural and political tensions within prevention strategies according to the reports. The France report reveals that wine taxation remains conspicuously low to support the national wine industry despite otherwise comprehensive sin taxes. The Germany report documents that wine is entirely exempt from alcohol taxation with beer taxes maintained at the EU minimum, reflecting both cultural preferences and industry protection. The Canada report highlights the absence of a comprehensive federal alcohol policy framework, despite evidence that alcohol accounts for a substantially greater health and socioeconomic burden than both tobacco and cannabis, suggesting that political feasibility often trumps public health evidence in policy formulation.