PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

2 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceIntroduction This analysis, conducted by the Partnership for Health System Sustainability and Resilience (PHSSR), examines eight health systems that have achieved high rates of health coverage and high life expectancies, yet face mounting challenges from NCDs: Canada, France, Germany, Greece, Italy, Japan, Poland, and Spain. The report focuses on four disease categories that collectively represent over 80% of premature NCD deaths: cancer; cardiovascular disease, diabetes and chronic kidney disease; and chronic respiratory diseases. Drawing from comprehensive country assessments using a structured research framework, the report examines both service delivery across the care continuum and the system enablers that determine effectiveness, including governance, financing, workforce, medicines and technologies, and environmental sustainability. All eight countries have demonstrated significant achievements in health system development, with life expectancies ranging from 77.2 to 84.1 years and age-adjusted NCD mortality falling consistently over the past two decades. Countries have proven that dramatic improvements remain achievable: some have halved cardiovascular disease burden through sustained prevention, others have achieved world-leading low premature mortality rates, and reach millions annually through population screening programmes. System innovations, from expanded diagnostic capabilities in primary care to structured chronic disease management programmes, show that health systems can successfully reorganise for earlier intervention. These diverse successes prove that transformation is possible regardless of starting point or system design. Yet despite these foundations, a consistent pattern emerges: health systems are intervening too late. Prevention remains undervalued despite proven cost-effectiveness, early detection is inconsistent, referral pathways are slow and fragmented, and chronic disease management is poorly aligned to the needs of patients with multiple long-term conditions. The evidence shows that solutions exist and are technically feasible, but implementation lags. Acting earlier across the care continuum represents both the critical challenge and achievable opportunity for the next decade. Current burden and future trajectories Age-adjusted disability-adjusted life years (DALYs) from NCDs have fallen across all countries, reflecting real progress in controlling age-specific risks. Yet unadjusted DALYs have risen, showing how population ageing brings accumulated lifetime exposures into clinical manifestation. Health systems therefore face growing pressure not because ageing causes disease, but because more people are living to an age where accumulated risks emerge as chronic illness. Cardiovascular disease illustrates what sustained intervention can achieve, with consistent declines in both adjusted and unadjusted burden in most countries. Cancer now accounts for the largest share of DALYs in six of eight countries, and while age-adjusted rates are falling, outcomes remain highly stage-dependent, underlining the importance of timely detection. Diabetes presents the most concerning trajectory, with rising burdens even after age adjustment in seven of eight countries, a sign of worsening metabolic health that goes beyond demographic change. Chronic kidney disease trends are concerning, with an increasing burden in seven of the eight countries in our sample. Chronic respiratory diseases are also a significant contributor to the NCD burden, with COPD and asthma driving avoidable hospitalisations, intensified by under-diagnosis and continued exposure to tobacco smoke and air pollution. Inequalities are pronounced: socioeconomic gradients in life expectancy and chronic disease outcomes persist, with France, for example, showing a 13-year life expectancy gap between the poorest and richest 5% of men. Geographic disparities within countries often exceed those observed between countries. These inequities compound disadvantage, leaving rural and low-income populations systematically underserved.