Nearly all countries in the world can reduce premature deaths from noncommunicable diseases like cancer, cardiovascular disease and stroke, chronic respiratory diseases and diabetes by one third by 2030, shows a Health Policy paper released on 26 March as part of the Lancet NCD Countdown 2030. To achieve this, the paper outlines an investment strategy of 21 cost-effective interventions that can form the backbone of national NCD strategies, especially in low- and middle-income countries (LMICs).
Every UN Member State committed to the Sustainable Development Goals in 2015, pledging to deliver health and wellbeing for all, achieve universal health coverage, and build a more prosperous, equitable and sustainable world. But as of 2019, few countries were on track to meet SDG target 3.4, which calls for a reduction in premature mortality from non-communicable diseases (NCDs) by a third from 2015 to 2030. The COVID-19 pandemic since 2020 has put the world even further behind due to severe disruptions to essential NCD services and care.
However, if the strategy were implemented, all countries could still achieve or nearly achieve the target. The 21 interventions are aligned with the WHO NCD Best Buys. Although specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks, such as tobacco smoking, use of alcohol, and excess sodium intake, would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally tailored NCD package.
“There’s a widespread belief in the global health and development community that tackling NCDs is too expensive and that it isn’t feasible in countries with very limited resources. Our report thoroughly debunks this idea,” said Dr David Watkins, the lead author of the paper. “We show that there are a range of highly cost-effective options for preventing and treating NCDs, most of which can be delivered through primary healthcare systems. We argue that governments ignore NCDs at their own peril. Ultimately, investments in NCDs are investments in the health systems of tomorrow, and they can yield high returns—provided they are made wisely.”
Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023–30. The returns on this investment for governments are high in terms of lives saved and economic gains: it would avert 39 million deaths and generate an average net economic benefit of US$2·7 trillion, or US$390 per capita.
Protecting current NCD investments and scaling up actions is particularly important in the context of COVID-19, and a prerequisite for resilience, pandemic preparedness and health security, given that people living with NCDs have experienced increased hospitalisation, complications and fatality rates due to COVID-19.
"This Lancet paper reinforces what we already knew to be true pre-pandemic and more so today: that with relatively low investment, most countries could make big inroads into their chronic disease burdens and simultaneously reach UN targets by 2030," said Katie Dain, CEO of the NCD Alliance. "Strengthening the noncommunicable diseases response is a prerequisite for resilience, pandemic preparedness and health security."
Missed opportunities to prevent NCDs have increased population susceptibility to COVID-19-related mortality, a pattern that could repeat itself in future pandemics. Pandemic preparedness and global health security cannot be separated from efforts to prevent NCDs and strengthen basic services for chronic care and acute complications.
The paper is well aligned with WHO’s forthcoming NCD Implementation Roadmap, which aims to provide similar support to LMIC governments, thereby signalling and contributing to a more united global response to NCDs and pandemic preparedness.