43 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencechallenges: identifying high-risk populations requires sophisticated data systems, low-dose CT scanning demands significant infrastructure, and high false-positive rates create downstream costs. Yet lung cancer’s lethality and potential to reduce mortality from targets screening programmes means that lung cancer screening programmes should be subjected to further piloting and evaluation. Notably, lung cancer in never-smokers accounts for 10–25% of all lung cancers globally, with higher proportions observed in East Asian countries where approximately 32% of NSCLC patients are never-smokers (Cho et al., 2017). Women are disproportionately affected, comprising over 80% of never-smokers with non-small-cell lung cancer in some cohorts. Environmental factors including air pollution have been identified as potential risk factors (Zhang et al., 2021; Cho et al., 2017). This suggests a need to incorporate additional risk factors beyond smoking history into lung cancer screening policies. Cardiovascular, kidney and metabolic disease screening Screening for non-cancer NCDs shows even greater variation, from comprehensive national programmes to complete absence of systematic approaches. The WHO’s approach to cardiovascular disease screening emphasises total cardiovascular risk assessment rather than screening for individual risk factors. Through the HEARTS technical package, WHO recommends risk-based CVD management using validated risk prediction tools that incorporate age, sex, blood pressure, cholesterol, diabetes status, and smoking (WHO, 2020). While WHO recognises chronic kidney disease as a major public health concern, specific global screening recommendations are limited, with most guidance coming from international nephrology organisations like KDIGO. However, there is increasing recognition that cardiovascular disease, kidney disease, and metabolic disorders are interconnected conditions that share common risk factors and pathophysiological pathways. This understanding has led to calls for more integrated screening approaches, exemplified by the 2023 US presidential advisory from the American Heart Association that defined cardiovascular-kidney-metabolic (CKM) syndrome and recommended coordinated screening strategies across these traditionally siloed conditions (Ndumele et al., 2023). Such integrated approaches acknowledge that screening for these conditions together, rather than in isolation, may improve early detection and enable more comprehensive risk stratification and management, but they have yet to translate into widespread practice. Japan’s Specific Health Checkups (since 2008) provides the most comprehensive approach, mandating screening for individuals aged 40–74 by health insurers. The programme includes blood pressure, lipids, glucose, metabolic syndrome assessment, and kidney screening through urinalysis. Despite universal coverage, participation reached only 58.1% in 2022 (30.17 million of 51.92 million eligible) (MHLW, 2023b). Germany’s “Check-up” programme for cardiovascular and metabolic screening achieves only 24% annual participation despite full insurance coverage, demonstrating that removing financial barriers alone is insufficient for population engagement (dkfz, 2024; Tillmanns et al., 2022) Poland transitioned from “Prevention 40 PLUS” (20% uptake by 2024) to “My Health” (May 2025), expanding eligibility to age 20+ with age-stratified intervals. The programme includes comprehensive blood tests, body measurements, and screening for cardiovascular disease, diabetes, kidney disease, thyroid disorders, and selected cancers. Yet the previous programme achieved only 20% uptake despite extensive promotion, raising questions about whether expansion without addressing participation barriers will improve coverage. The inclusion of mental health screening and vaccination status represents recognition that NCDs require holistic approaches.

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025