Many Countries Underperforming in Reducing Non-Communicable Disease Mortality

Only 6 high-income countries are on pace to effectively reduce by 1/3 non-communicable disease (NCD) mortality by the year 2030.

According to the NCD Countdown report published by The Lancet, these countries include Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea.

In 2015, the United Nations developed the Sustainable Development Goal (SDG) target 3.4, which called for a global commitment to lower death rates related to specific NCDs—cancer, cardiovascular disease, chronic respiratory disease, and diabetes, specifically—among individuals aged 30-70 years.

Trends between 2010-2016 showed that while few countries have made acceptable advances in eventually achieving this goal for both men and women, most have fallen behind or just under the expected level of progress.

The report acknowledged that countries like the USA, Mexico, and Egypt, among numerous other large countries, have shown either stagnation or slight elevations in NCD mortality.

Furthermore, from 2010-2016, the number of deaths from NCDs increased from 11.2 million to 12.6 million globally, despite a declining probability of mortality in most countries. The authors attributed this to changes in age structure and population growth.

In that same time span, the risk of premature death due to ischemic and haemorrhagic stroke, heart disease, chronic lung diseases and stomach cancer declined more rapidly compared to other causes.

However, the trends showed heat disease to be the continued leading cause of premature mortality in the majority of countries for men and about half of the countries for women.

Diabetes, colorectal cancer, liver cancer, breast cancer, and prostate cancer were among the slowest mortality risks to decline.

Conversely, premature death risk for lung cancer in woman and colorectal, liver, and prostate cancers for men saw an increase.

Of course, as the authors noted, each country has their own set of differences in terms of priority diseases and NCD mortality rates.

“This diversity suggests that countries might need to take different routes towards achieving SDG target 3.4 by addressing different combinations of diseases,” they wrote.

In their report, the authors determined various scenarios and illustrated the levels of disease priority between men and women for each country. The analysis showed which diseases required a faster rate of decline in order to achieve the target, and which diseases had a more acceptable average rate of decline.

The takeaway, however, is that simply targeting a single cause of death would not be enough for individual countries to address NCD trends and ultimately achieve their goals.

The report also stressed that in order to achieve the most optimal reductions, especially at the rate of the leading countries, it becomes important for countries to consider the various social, environmental, behavioral, nutritional, and clinical determinants related to NCDs.

For example, limiting tobacco and alcohol consumption, as well as increasing the effectiveness of health-system interventions can reduce the causes of death attributed to NCDs for many countries.

“The diverse national pathways show that accelerating progress towards SDG target 3.4 requires two important considerations,” they wrote. “First, national NCD strategies based on the combination of local epidemiology and feasibility, and second, an accessible and equitable health system that integrates population-based prevention with the entire continuum of care [...] rather than isolated and vertical programmes."

The study, “NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4,” was published online in The Lancet.