PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

44 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceGreece’s PROLAMVANO programme, launched in 2024, targets 5.5 million individuals aged 30–70 with cardiovascular screening including lipid profiles and risk assessment. The use of digital prescriptions for accessing screening represents innovation in reducing administrative barriers. Spain implements screening through primary care with significant regional variation. Some autonomous communities have specific programmes – Madrid’s PreveCardio for cardiovascular prevention, Catalonia’s PAFES integrating physical activity prescription – while the national system uses electronic health records for risk stratification (Orueta et al., 2013). This decentralised approach enables local innovation but creates postcode lotteries where residents of different regions receive vastly different preventive services. France, Italy, and Canada rely primarily on opportunistic testing rather than organised programmes. France’s HAS has produced screening recommendations for cardiovascular and metabolic diseases but only for high-risk groups, missing opportunities for population-wide prevention. Italy includes NCDs in its National Prevention Plan 2020–2025 but regional resource disparities, a lack of intersectoral governance and poor IT interoperability all present significant challenges to national achievement of key indicators. Canada’s fragmented provincial approaches mean some provinces have advanced screening whilst others lack basic programmes. Despite affecting 10–15% of adults and often progressing silently until irreversible damage occurs, screening for CKD remains underdeveloped across all countries examined. Effective screening requires only simple, inexpensive tests – urine analysis for protein (albuminuria) and blood testing for creatinine to calculate estimated glomerular filtration rate (eGFR) – yet no country has achieved comprehensive systematic implementation. Among the countries in our sample, Japan’s Specific Health Checkups includes urinalysis for protein detection as part of standard examinations, though it notably lacks eGFR testing that would identify additional cases. Poland has recently integrated kidney function assessment into its “My Health” expanded from its national “Profilaktyka 40+” (2021–2025) preventive programme, which includes both creatinine and urine testing for adults, with screening intervals of every five years for those aged 20-49 and every three years for those over 49, but coverage remains uncertain, especially given the low uptake of its predecessor programme. France has guidelines recommending risk-stratified screening and prevention programmes like “Mon Bilan Prévention” that include chronic disease risk assessment for specific age groups, yet approximately 25% of patients begin haemodialysis in emergency situations, indicating these patients are being missed by early diagnosis measures. A 2020 survey found only 20% of GPs engaged in organised prevention programmes for high-risk populations, though new prevention assessments introduced in 2024 may improve engagement. Canada takes a targeted approach through its “Kidney Check” programme, which provides culturally safe screening for kidney health, diabetes, and blood pressure in high-risk Indigenous communities across Alberta, Manitoba, and British Columbia (Kidney Check, n.d.). While addressing populations with elevated CKD risk, Canada lacks a coordinated national screening strategy, and systematic early detection for other at-risk groups is still limited (Kidney Foundation of Canada, n.d.). The remaining countries – Germany, Greece, Italy, and Spain – appear to have no organised CKD screening programmes, with the report on Greece noting that there is no systematic capture of CKD staging or kidney function tracking in electronic records, with studies showing delayed referral patterns. This variation in approach to screening screening for CKD represents a critical missed opportunity for early intervention, particularly given that timely detection and management can slow progression, prevent cardiovascular complications, and delay or avoid the need for costly dialysis or transplantation.