More than half of countries not on track to meet global targets for chronic diseases

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, according to a new analysis published in The Lancet ahead of the third UN High-Level Meeting on NCDs commencing on 27 September 2018.

However, the problem is potentially even more far-reaching and progress is even slower when all non-communicable diseases (NCDs) – including liver and kidney disease – and all ages under 80 years are taken into account.

The 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.

“Despite clear commitments, international aid agencies and national governments are doing too little to reduce deaths from cancers, heart and lung diseases and diabetes. Progress is even slower for other diseases that are not a part of SDG target, meaning that the true health of people in most countries is even more dire,” says senior author Professor Majid Ezzati, Imperial College London, UK.

The report is the first from NCD Countdown 2030 – an independent annual monitor of progress on reducing the worldwide burden of NCDs – a collaboration led by The Lancet, World Health Organisation, 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 SCALE OF THE NCD PROBLEM

In 2016, the likelihood of dying from one of the four major NCDs between the ages of 30 and 70 years was lowest for women in South Korea (less than 5%), and highest for women in Sierra Leone (about 33%) – an almost seven-fold larger risk. For men, the risk was lowest in Iceland (10%) and highest in Mongolia (39%).

In the UK in 2016, 30-year old women had a 9% chance of dying from one of the four major NCDs before their 70th birthday, and 30-year old men a 13% chance. In the USA, the risks were 12% for 30-year old women and 18% for men, while they were 14% and 20% (respectively) in China, and 20% and 27% in India.

While there were 12.5 million premature deaths from the four major NCDs in people aged 30-70 years in 2016, there were 27.3 million deaths from all NCDs in all people aged less than 80.

The authors also note that the NCD problem in low- and middle-income countries (particularly in sub-Saharan Africa and some countries in the Middle East and north Africa) is much wider than the four major NCDs. As the NCD burden is also biggest in these countries, the SDG target could result in some countries being left behind.

PROGRESS AGAINST NCDs

The study found that although NCD mortality is decreasing in most countries, the pace of decline varies substantially, even among countries in the same region.

Of the 186 countries assessed, the majority of countries (86 countries [46%] for women and 97 countries [52%] for men) will not reach the SDG 3.4 target even by 2040 and require policies that substantially improve premature death rates. 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’ health care 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.

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) [4]. 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.

When progress was measured on the basis of all NCDs 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.

In low- and middle-income countries, reductions in NCD deaths were 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.

In high-income countries, reductions in NCD deaths are now driven by declines in deaths from cancer, cardiovascular diseases, and diabetes.

PRIORITY POLICY MEASURES

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 the health of the next generation, including child obesity, air pollution and the ever-evolving tactics of the tobacco and alcohol industries.”

The authors note some limitations, including that only around one in four countries (27%, 50 countries) within the study have high quality data on deaths. Expanding and strengthening death registration, including medical certification of cause of death, is a priority area for strengthening accountability towards NCDs.

Writing in an editorial for The Lancet, Editor-in-chief, Dr Richard Horton, says: “Calls for strengthened NCD accountability have been made for at least a decade. Many obstructions have blocked progress. Today is, therefore, an important inflexion point in the history of attempts to prevent, treat, and control NCDs. The promises made by the international community must be delivered.”

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