More than half the world to miss chronic disease targets

More than half of all countries are predicted to fail to reach the UN target to reduce premature deaths from cancers, cardiovascular disease, chronic respiratory disease and diabetes by 2030.

That’s according to new analysis published in The Lancet ahead of the third UN High-Level Meeting on NCDs (non-communicable diseases), commencing on 27 September. The study authors say that countries must implement policies that reduce premature deaths sooner if they are to meet sustainable development goal (SDG) target 3.4 — to reduce the number of deaths caused by the four major NCDs in people aged between 30 and 70 years by a third by 2030.

The report is the first from NCD Countdown 2030 — a collaboration led by The Lancet, the World Health Organization, Imperial College London and NCD Alliance. It compares the change in death rates for 186 countries from 2010 to 2016 to understand how likely it is for countries to achieve the SDG target for NCDs. In addition, the study includes a more comprehensive measure of all NCDs in people aged between birth and 80 years.

The study found that 35 countries (19% of all countries) for women and 30 countries (16%) for men are likely to achieve SDG target 3.4 — these countries range from high-income countries seeing continued reduction (such as Norway, Denmark, South Korea and New Zealand) to middle-income countries starting with high rates and seeing fast declines in NCD mortality (such as Brazil, Iran, Russia and other countries in central and Eastern Europe). In addition, if another 50 countries (27%) for women and 35 countries for men (19%) slightly accelerated the rate of decline of NCD deaths they could achieve the target.

But although NCD mortality is decreasing in most countries, the majority (86 for women and 97 countries for men) will not reach the SDG 3.4 target even by 2040. This includes China and India, the two most populous countries in the world, where premature mortality from the four major NCDs has declined but not sufficiently quickly to meet SDG target 3.4. In addition, the reduction in NCD deaths has stagnated or increased since 2010 among women in 15 countries (8%) and men in 24 countries (13%) — including the USA for women.

The reasons for a lack of progress in most of these countries are not known, but the authors believe that this might be caused by a worsening or lack of improvement in major NCD risk factors (such as blood pressure, diabetes, obesity, alcohol use and tobacco use) or that these countries’ healthcare systems are not able to adequately prevent, treat and manage NCDs.

The authors believe that the USA’s stagnation is due to failures to reduce premature deaths from NCDs other than in cancer, which has continued to decrease, while the decline from other NCDs has slowed down or reversed. The authors say that this is thought to be particularly common in poorer rural communities.

When progress was measured on the basis of all NCDs (including liver and kidney disease) and all ages under 80 years, it was even slower — only 17 countries (9%) for women and five countries (3%) for men would be on track to reduce the probability of premature death by a third.

The authors also note that the NCD problem in low- and middle-income countries is much wider than the four major NCDs, with reductions in NCD deaths mainly driven by reductions in cardiovascular diseases. For NCD mortality to decline faster in these countries, the decrease in cardiovascular disease mortality must accelerate, as well as approaches to reduce deaths from cancers, chronic respiratory diseases, diabetes and other NCDs.

To accelerate reductions in premature deaths from NCDs, the authors call for policies and interventions that reduce tobacco and alcohol use, including fiscal and regulatory measures, such as taxation, warning labels, restriction of availability and sales, and banning of marketing, advertising and public smoking. They also call for early diagnosis and treatment of NCDs, including timely diagnosis and treatment of hypertension, diabetes, treatable cancers and other acute and chronic NCDs.

“Going forward, the NCD Countdown 2030 is a shot in the arm for the global response to the NCD epidemic, which has long needed a stronger accountability process,” said Katie Dain, CEO of the NCD Alliance, UK.

“The Countdown’s inaugural analysis couldn’t be more timely with the upcoming UN High-Level Meeting on NCDs on the horizon. The aspirations and promises of commitments from political leaders made at the meeting are now on notice. Even those governments who appear to be on track cannot be complacent — they must remain vigilant and respond with effective policies to emerging threats to health of the next generation, including child obesity, air pollution and the ever-evolving tactics of the tobacco and alcohol industries.”

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