PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

3 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceActing early across the care continuum Primary prevention & health promotion CURRENT LANDSCAPE: Several countries have implemented effective prevention measures: France pioneered sugar-sweetened beverage taxation with demonstrated impact, Japan’s comprehensive Health Japan 21 framework sets measurable targets across risk factors. However, implementation and enforcement of existing policies are uneven, health promotion efforts are rarely sustained across the life course, and vaccination coverage for NCD-relevant pathogens shows marked socioeconomic gradients. RECOMMENDATIONS: ■ Implement comprehensive fiscal measures to discourage unhealthy behaviours: Deploy evidence-based taxation on tobacco, alcohol and sugar-sweetened beverages at levels that demonstrably change purchasing behaviour, with regular adjustment for inflation and affordability. Ring-fence revenues specifically for prevention programmes and ensure coordination across jurisdictions to prevent cross-border purchasing that undermines policy effectiveness. ■ Create regulatory environments that support healthy choices: Establish comprehensive restrictions on marketing unhealthy products to children across all media including digital platforms. Mandate reformulation targets for processed foods with clear timelines and penalties for non-compliance. Implement smoke-free environments with sustained enforcement, learning from countries where initial success deteriorated without consistent monitoring. ■ Develop life-course health promotion with systematic education: Integrate health education throughout educational curricula from early childhood, covering nutrition, physical activity, mental health, and substance use prevention. Ensure programmes adapt to critical life transitions when health behaviours often deteriorate – particularly adolescence, employment entry, and retirement – with targeted interventions at these vulnerable periods. ■ Strengthen vaccination programmes for NCD prevention: Achieve high coverage for HPV vaccination through school-based programmes using opt-out rather than opt-in models, with targeted catch- up campaigns for missed cohorts. Ensure comprehensive hepatitis B vaccination for infants and at-risk adult populations. Monitor coverage by socioeconomic status and geography to identify and address disparities in protection. Secondary prevention: Screening & early detection CURRENT LANDSCAPE: Organised screening programmes show promise where implemented well, but progress is needed across all countries in our sample: for example, cervical screening participation in 2019 ranged from 15.7% in Poland to 70% in Spain, while within Italy, colorectal screening varies 14-fold between regions. A significant proportion of serious conditions are identified through emergency routes rather than planned pathways. For non-cancer NCDs, systematic screening remains limited despite simple, low-cost tests. Chronic kidney disease affects 10-15% of adults but lacks organised screening in most countries, with France reporting 25% of patients beginning haemodialysis in emergency situations. RECOMMENDATIONS: ■ Implement systematic risk stratification for screening programmes: Systematically deploy validated risk assessment tools like SCORE2 for cardiovascular risk and polygenic risk scores where appropriate, moving beyond simple age-based criteria. Critically, improve recording of social determinants of health so they can be incorporated into risk models, as current systems systematically ignore socioeconomic factors despite their influence on disease development. Use stratification to determine screening frequency, modality, and follow-up intensity.