PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

66 Acting early on NCDs The Partnership for Health System Sustainability and Resilienceindicator-specific action plans or accountability mechanisms for major NCDs developed within the past decade. This suggests weaknesses in strategic planning capacity that go beyond resource constraints to reflect institutional limitations. Canada illustrates both the potential and limitations in national NCD planning. The Canadian Strategy for Cancer Control (2019–2029) stands out as a comprehensive framework, developed through extensive consultation with stakeholders and supported by clear accountability and dedicated resources (Canadian Partnership Against Cancer, 2019). By contrast, other high-burden NCDs such as cardiovascular and respiratory diseases lack comparable national strategies. In some cases, civil society has attempted to fill these gaps, for example, the Heart Failure Policy Framework led by the HeartLife Foundation (HeartLife Foundation, 2024a, 2024b) demonstrates how non- governmental actors can drive strategic development in the absence of government leadership. Nevertheless, uneven presence of national frameworks leaves large segments of the patient population without systematic policy attention. Where strategies do exist, their quality and implementation capacity vary substantially, determining their ultimate effectiveness. Japan has applied SMART criteria to establish numerical targets for both outcome evaluation and primary prevention. Currently, specific numerical targets for outcome evaluation and primary prevention are set for cancer, cardiovascular diseases, and CRD. The third term of Health Japan 21 also adopts key evaluation indicators such as age-adjusted mortality rates for cancer, cerebrovascular and heart diseases, and COPD, as well as the annual number of new dialysis patients due to diabetic nephropathy. However, in several critical NCD areas, appropriately setting goals according to disease characteristics remains a challenge for Japan. In CKD, the focus is solely on dialysis initiation rates, with inadequate indicators for prevention and early detection. Additionally, asthma lacks sufficient indicators that reflect the quality of disease management, such as reducing emergency visits due to attacks and improving patient QOL. Furthermore, diabetes requires comprehensive indicators for preventing severe complications, such as blood glucose control status and incidence rates of complications. Establishing multidimensional evaluation indicators tailored to disease characteristics is crucial for implementing more effective measures (MHLW, 2024k). Italy has incorporated comprehensive Key Performance Indicators spanning cancer screening, maternal and child health, chronic disease management, and health promotion into its strategic framework. However, there are persistent challenges to implementation, with poor IT interoperability and resource disparities between regions posing major obstacles. France’s 2018–22 National Health Strategy, despite its comprehensive scope and ambitious objectives, had limited measurable impact due to the absence of specific monitoring mechanisms and unclear implementation pathways. These examples demonstrate that strategic planning without operational capacity, dedicated resources, and accountability mechanisms remains largely aspirational. Data and evidence for policy making The quality of strategic planning and implementation depends on the availability and use of evidence to guide decisions. The relationship between health data collection and policy development reveals important governance challenges across the studied countries. Health information infrastructure Countries have developed varied approaches to collecting population health data through registries and surveillance systems, each reflecting different stages of development and governance priorities. Disease registries show considerable variation in coverage and maturity. Greece’s National Cancer Registry, which became operational in 2025 following 2019 legislation, illustrates the implementation complexities health systems face. During this six-year transition, policy