The ability to enjoy the best health possible is a human right, but it is not everyone is able to see this right fulfilled. In fact, most cannot. At least half of the world’s population does not currently have full coverage of basic health services, with the vast majority of these people living in low- and middle-income countries. And if it is difficult to see a doctor and be treated for a relatively simple illness, imagine trying to get quality care for a noncommunicable disease, which often require expensive long-term or lifelong treatment. These are just a few statistics to show how the care gap affects people living with NCDs:

• Half of adults living with diabetes are unable to access the insulin they need; hypertension is only under medical control for one in five people; 
• Chronic kidney disease tends to go untreated, with up to 90% of cases undiagnosed until lifesaving dialysis or a transplant is needed;
• More than 90% of cancer patients in low-income countries lack access to radiotherapy.

The most common reason that people cannot access quality care is cost. Many people in LMICs do not have health coverage, or their coverage is too limited, so they are forced to pay for care out-of-pocket. Millions of people are pushed into extreme poverty each year due to out-of-pocket payments for healthcare. Many more die from treatable diseases because they cannot afford to pay for care. 

However, there are other barriers to care as well. Many times, people live too far from health centres to realistically visit them when needed, especially if regular care is required. Other times, services are simply not available, or are too low-quality to be effective. For instance, 47% of the global population (3.8 billion), and 81% in low- and lower-middle income countries, have little to no access to core diagnostic tools, including laboratory diagnostics and diagnostic imaging. 8.6 million avoidable deaths occur each year due to low quality or underused care in LMICs. 
 

Universal Health Coverage, or UHC, is the only way to close the care gap. Achieving UHC would mean that all people, everywhere, can access the quality health services they need without facing financial hardship. This includes the care across the full continuum of health, from disease prevention and screening to diagnosis and treatment to palliation.

UHC is the single most powerful concept that public health has to offer, and is vital for sustainable human development.

Yes, UHC can realistically happen. We can even achieve the target set by world leaders to achieve it by 2030. But it will take a lot of collaboration between all levels of government in all countries, international funders, civil society groups, private sector... health involves all areas of society, and achieving UHC requires an all‑of‑society approach.

And we have a long way to go... The 2023 State of UHC Commitment Review reports that although 70% of countries have used UHC as a goal for their national policies and plans, only 11% have adopted a clear action plan or road map. All governments should have an action plan and be in the process of implementing it. To reach UHC, countries should spend at least 5% of their GDP on health.

NCD prevention and care should be at the centre of UHC actions plans. Over 20% of the population is living with an NCD, and this number is expected to increase dramatically without decisive efforts to control NCD risk factors. A rapidly aging demographic will also cause this number to rise, so health systems need to get prepared now.

People living with NCDs have an important role to play in achieving UHC that answers the true needs of the population, as they are among those who use health systems the most.

Health, the economy and sustainable development cannot be viewed independently - they are inextricably intertwined. Healthy people, a healthy planet and a flourishing economy are the result of sustainable development. We have not yet achieved this happy vision, which requires a new approach to... just about everything.

They say money makes the world go round, but that does not mean we have to put corporate interests and profit ahead of the health and well-being of people and the environment. Only when leaders and decision-makers shift their perspective to one that prioritises human and planetary health will we be able to achieve sustainable development.

Here’s one example to illustrate this. Tobacco use is responsible for 8 million deaths each year, most of which are from NCDs like cancer and chronic respiratory diseases. The practice of farming tobacco is also harmful. It requires heavy use of pesticides and fertilizers, which contribute to soil degradation and water contamination. Land used for growing tobacco has a lower capacity for growing other crops, such as food, since tobacco depletes soil fertility. Tobacco farming accounts for about 5% of total deforestation, making it a significant contributor to climate change. Yet despite all these negative effects - and those listed here are only a very small sample - many governments continue to subsidise tobacco farming and allow the tobacco industry to provide subventions and incentives to their populations for the same.

The sustainable alternative is for governments to subsidise farming of food crops and impose higher taxes on tobacco products sold in their countries, which can then be channelled into initiatives that contribute to human and planetary health. Higher taxes on tobacco products are also proven to cut down on their use, so governments and people gain in health savings and population productivity. This reduces poverty in households and countries, and allows families to invest instead in their children’s education and social activities, for example.

You can read more on the case against tobacco farming in a recent WHO report. Similar cases can be made for the other major NCD risk factors: alcohol, unhealthy diets and ultra-processed foods, lack of physical activity, and air pollution. While the health-harming industries behind NCD risk factors often greenwash their practices and products in order to continue profiting, their “findings” are based on false or manipulated science that they have paid huge amounts of money to produce. Read more on the commercial determinants of health and how we can get a grip on them in a 2023 series by the Lancet.

Poor people, communities and countries are disproportionately affected by NCDs. This is primarily due to increased exposure to risk factors and lack of access to health services. Increased prevalence of NCDs is one consequence of poverty; it is also a cause of it.

Right now, at least 1.4 billion people are facing catastrophic or impoverishing health expenditure, because they have to pay directly for services, medications, and other related expenses like travel to health centres. And this is just the tip of the iceberg - the true cost of NCDs reaches much deeper. In households where resources are already tightly stretched, people are forced to make difficult decisions; buying the insulin they require or food for their family, paying for radiotherapy or education for children, going into debt to treat a chronic illness or losing their health or their life... these are decisions that should never be made, yet they are, millions of times each day. NCDs perpetuate poverty, and factors like debt and discontinued education create a cycle that is passed on from generation to generation.

NCD also deplete national economies, widening the gap between rich and poor countries and putting the brake on development. Together, the five leading NCDs – cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health and neurological conditions – have been estimated to cost more than US$2 trillion per year (or US$47 trillion between 2011-2030). Annual losses due to NCDs range from 3.5% – 5.9% of total GDP, and the amount they will cost developing countries alone between 2011 and 2025 will be $7 trillion, equivalent to the combined annual GDP of France, Spain, and Germany.

Despite their prevalence and impact, we have the tools to turn the tide on this chronic epidemic. An estimated 80% of NCDs can be delayed into old age or prevented altogether by reducing exposure to the main NCD risk factors - tobacco, alcohol, unhealthy diets, lack of physical activity and air pollution.

The WHO best buys for NCD prevention and control are a set of proven interventions to reduce exposure to NCD risk factors. They are cost effective and have an average return on investment of 12 to one. A 2022 study published in the Lancet builds on the best buys, adding several low-cost, high-impact interventions for NCD care. It demonstrates that by introducing a realistic and cost-effective package of 21 NCD prevention and treatment interventions, governments could avert 39 million deaths in low- and middle-income countries. These interventions could generate an average net economic benefit of $2.7 trillion, or $390 per capita, between 2023 and 2030. Implementing this set of interventions would require an additional investment of US$18 billion annually over the same seven-year period—the equivalent of the world's health ministries collectively dedicating 20% of their budgets to NCDs. The economic benefits of implementing this package outweigh the investment by 19 to one.

Taxes and regulations on unhealthy products are key interventions to improve population health and generate funds that can be channelled into NCD prevention and treatment, but these policies are usually met with strong opposition from the industries concerned. A priority for collective action is to counter industry efforts to influence policies at the expense of our health. Civil society action is key to making progress on this, and the UN High-Level Meeting on UHC in September will be an important opportunity. Watch these short videos to see how Mexico and Barbados are taking action against the ultra-processed food industry.

The United Nations General Assembly, the main decision-making body of the UN representing all 193 Member States and governments, calls a United Nations High-Level Meeting (UN HLM) to focus on specific issues that require global political dialogue. For instance, there have been three UN HLMs on NCDs, and September will see the second UN HLM on UHC.

UN HLMs serve to increase awareness of an issue and to build consensus and commitment on the way forward. A UN HLM will result in a consensus statement such as a political declaration, outcome document or statement which all UN Member States commit to.

Civil society works to influence these statements; so do health-harming industries. This is why we need everyone to get involved and act on NCDs. See how you can Take Action.