PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

45 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceChronic respiratory disease screening Unlike for other NCDs, WHO and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) do not recommend population-based screening for COPD in asymptomatic individuals. GOLD guidelines recommend spirometry for diagnosis only in symptomatic patients with dyspnea, chronic cough, sputum production, or those with significant risk factor exposure (GOLD, 2024). The diagnosis requires post-bronchodilator FEV1/FVC ratio <0.70 confirmed by spirometry. This targeted approach reflects evidence that screening asymptomatic individuals does not alter disease outcomes or mortality. Respiratory disease screening shows the most limited development. Only Poland operates a COPD screening programme using spirometry aligned with GOLD guidelines, though coverage remains limited. France restricts screening to high-risk groups with occupational or environmental exposures, missing the broader population of smokers and those with early symptoms. The remaining six countries lack systematic respiratory screening despite substantial disease burden. This gap is particularly concerning given that spirometry – the key diagnostic test – is relatively simple and inexpensive compared to cancer screening technologies. The absence of respiratory screening likely reflects multiple factors: COPD’s association with smoking may reduce political support, early disease has non-specific symptoms easily dismissed, and nihilism about treatment effectiveness persists despite evidence that early intervention improves outcomes. Implementation challenges and coverage disparities Within-country disparities often exceed between-country differences in all countries. Italy exemplifies this: cervical cancer screening coverage ranges from 78% in the autonomous province of Trento to just 16.9% in Calabria, a twelve-fold difference. Poland shows three-fold variations in cervical screening rates between regions in 2023, whilst Japan reports 20–30 percentage point differences in cancer screening participation between prefectures (MHLW, 2024e; Maria Skłodowska-Curie – National Research Institute). Rural access challenges are widespread. Greece’s geography leaves 15 of 52 regions with less than half their population within 15-minute hospital access (Eurostat, 2025b). Spain, Italy, Canada, and France all report similar rural disadvantages. Even well-funded programmes face engagement challenges. Japan’s Specific health checkups achieve only 58.1% uptake despite universal coverage and no cost barriers. Poland’s Prevention 40 PLUS reached just 20% of eligible individuals. These patterns repeat across all eight countries, suggesting systematic barriers beyond programme design. Financial sustainability threatens programmes in at least three countries. Greece’s PROLAMVANO programme depends entirely on temporary Recovery and Resilience Fund support ending in 2025. Spain’s regional programmes are primarily funded through global budgets allocated to Autonomous regions, which receive fixed funding, whilst Poland’s new “My Health” programme lacks confirmed long-term funding. This reliance on temporary financing affects nearly half the studied countries, undermining population trust in screening continuity. Risk assessment and population targeting Effective screening requires identifying who to screen, when, and how intensively. Traditional age- based criteria increasingly give way to sophisticated risk assessment that considers multiple factors: family history, biomarkers, environmental exposures, and social determinants. Yet the implementation of risk-stratified approaches reveals both promise and persistent challenges in moving from population-wide to precision prevention. The foundation of risk-based screening lies in validated assessment tools that can reliably identify those most likely to benefit from early detection. These tools must balance sensitivity – capturing those who will develop disease – with specificity to avoid overwhelming health systems with false