Many countries are falling behind on global commitments to cut premature deaths from chronic diseases such as diabetes, lung cancer and heart disease.

These are the findings from the 2nd global review of international efforts to reduce the risk of people dying prematurely from chronic diseases – collectively termed ‘non-communicable diseases’ or NCDs. 

Published today in The Lancet, the NCD Countdown 2030 report – led by researchers at Imperial College London, World Health Organization and the NCD Alliance – reveals that around the world, the risk of dying prematurely from often preventable and largely treatable chronic diseases such as stroke, heart disease, and stomach cancer has declined steadily over the past decade.  

Every country still has options to achieve the target, but they need to address multiple diseases and have strong health systems Prof. Majid Ezzati Imperial College London

But death rates from other chronic diseases, such as diabetes, lung cancer, colon cancer, and liver cancer are declining too slowly or worsening in many countries, with the United States, China and the United Kingdom are among a number of nations falling behind on global targets to cut premature deaths. 

According to the researchers, the internationally agreed target to cut premature deaths from NCDs by one third by 2030 is still achievable, but many countries are falling short, and the added impact of the COVID-19 pandemic is severely disrupting health services’ ability to deliver regular screening, diagnosis, treatment and prevention. 

The authors recommend a raft of measures which could help nations to get back on track, including improved national health screening and referrals, alcohol and tobacco control measures, and equitable access to healthcare.  

The report is published ahead of the Global Week of Action on NCDs next week. 

Professor Majid Ezzati, from Imperial’s School of Public Health, who led the study, said: “No country can reach that target by simply addressing a single disease – what is needed is a package of measures, a strong health system, which addresses prevention, early detection and treatment, tailored to the national situation.” 

Cutting chronic disease deaths 

Chronic diseases are estimated to kill almost 41 million people a year worldwide, making up seven out of ten deaths globally. Of these deaths, approximately 17 million are classed as premature, with people dying significantly younger than expected on average.  

In 2015, international leaders signed up to achieve the United Nations' Sustainable Development Goal 3.4 of a one-third reduction in the risk of death between 30-70 years of age from four key NCDs by the year 2030. These disease areas include cancer, cardiovascular disease, chronic respiratory disease, and diabetes – collectively termed NCD4.  

The latest report reveals that among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet the SDG target for both men and women if they maintain or surpass their recent rates of progress. 

Based on recent trends (2010-2016), the report finds that 17 countries are already on track to reach the target for women: Belarus, Denmark, Iran, Kazakhstan, South Korea, Kuwait, Luxembourg, Latvia, Maldives, Norway, New Zealand, Russian Federation, Singapore, Serbia, Timor-Leste, Ukraine. 

Fifteen countries are on track for men: Bahrain, Belarus, Czech Republic, Denmark, Finland, Iran, Iceland, Kazakhstan, South Korea, Luxembourg, Maldives, Norway, New Zealand, Singapore, Slovakia.  

It also shows the risk of dying prematurely from NCD4 is declining rapidly in central and eastern Europe.   

However, large countries that showed stagnation or small increases in risk of premature death from these NCDs are Bangladesh (men), Egypt (women), Ghana (men and women), Cote d'Ivoire (men and women), Kenya (men and women), Mexico (men), Sri Lanka (women), Tanzania (men) and the USA (women).  

Tracking progress 

Worldwide, deaths from stroke, heart disease and stomach cancer are falling, although overall progress has slowed compared to the previous decade, according to WHO. Deaths from diabetes, lung cancer, colon cancer and liver cancer are stagnating or rising in many countries.  

The NCD Countdown 2030 report shows that:  

• The risk of premature death from ischaemic and haemorrhagic stroke, heart disease, chronic lung diseases and stomach cancer declined faster than that of other causes. However, heart disease remains the leading cause of premature death in most countries for men and in about half the countries for women.   
• In contrast, the risk of premature death from diabetes, colorectal cancer, liver cancer, breast cancer and prostate cancer declined more slowly than other causes, as did lung cancer among women.  
• For lung cancer in women and colorectal, liver and prostate cancers in men, the risk of premature death increased in more than half of countries.  

The report notes that although premature death from NCDs is declining in the majority of countries, the pace of change is too slow to achieve the global target in most. The authors used mathematical modelling to assess how many options countries have for accelerating mortality decline. 

To that end the report highlights the set of interventions needed to move countries forward: 

• Tobacco and alcohol control and effective health system interventions, such as a ban on advertising, increasing taxes, plain packaging, public smoking/drinking bans. 
• Quality primary care - including equitable access to doctors' surgeries and community-based clinics. 
• Quality referral systems and consistent maintenance of people in care to help patients get the right treatment at the right time. 
• A range of medicines and techniques available for early diagnosis and treatment - such as increased equitable access to preventative cholesterol-lowering, hypertension and diabetes medicines.
• Effective cancer screening and treatment - to diagnose and treat cancers earlier, reducing long-term health impacts and premature deaths. 

“To move forward we must learn from those countries that are doing well and replicate their strategies to NCD prevention and healthcare,” added Professor Ezzati, who is also an academic lead within the MRC Centre for Environment and Health and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA) based at Imperial. “Our analysis shows that every country still has options to achieve SDG target 3.4 but they need to address multiple diseases and have strong health systems.” 

Dr Bente Mikkelsen, Director of Noncommunicable Diseases, World Health Organization, said: “Young people must lead the fight against NCDs. An estimated 150 million people will lose their lives too early from a noncommunicable disease over the next decade and right now NCDs are intensifying the impact of COVID-19. We must ensure that all NCDs are addressed in COVID-19 recovery plans so that we can turn this deadly tide. We cannot allow NCDs to become a generational catastrophe, where human potential is wasted, and inequality is exacerbated.”  

Katie Dain, CEO of the NCD Alliance, added: “COVID-19 has exposed how a failure to invest in effective public health to prevent NCDs and provide health care for people living with NCDs can come back to bite us. The good news is that all countries can still meet the 2030 targets, with sound policies and smart investments. NCD prevention and treatment can no longer be seen a 'nice to have', it must be considered as part of pandemic preparedness.” 

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‘NCD Countdown 2030: pathways to achieving Sustainable
Development Goal target 3.4' by NCD Countdown 2030 collaborators is published in The Lancet. DOI:10.1016/
S0140-6736(20)31761-X