Tackling NCDs in the WHO European Region: accelerating progress toward 2030 and beyond

Noncommunicable diseases and mental health conditions are the main causes of ill health in the WHO European Region. This September global leaders will gather in New York for the 4th UN High-Level Meeting on the prevention and control of noncommunicable diseases to take stock of progress toward global targets to reduce the burden of NCDs and to agree on a new political declaration for the last five years of the Sustainable Development Goals (SDG) era.

Across the WHO European Region, progress toward the Global NCD targets and SDGs is faltering and uneven. At the global level it is estimated that without increased implementation of proven and effective interventions half of all countries will fail to meet the SDG target 3.4 to reduce NCD-related premature mortality by one-third between 2010-2030 [1].

While the WHO European Region was on track to achieve this target, the Covid-19 pandemic derailed progress. In 2021 NCDs caused 2.3 million premature deaths (death between 30 – 69 years) in the region, many of which are avoidable [2]. New analysis by the WHO Regional Office for Europe found that NCDs cause 1.8 million avoidable deaths annually, 60% of which are preventable with effective public health measures and 40% of which are treatable with appropriate healthcare services. The preventable deaths can be attributed to a handful of modifiable risk factors including tobacco and alcohol use, unhealthy diets, insufficient physical activity, overweight and obesity, and raised blood pressure, lipids, and glucose, and air pollution.

Unless we accelerate implementation and enforcement of the WHO NCD best buys, our Region will have the highest tobacco use prevalence among all WHO Regions by 2030. In 2022, 179 million adults in the European Region—more than 25% of the population—were current tobacco users. Among adolescents aged 13–15, the figure stands at 4 million [3]. People over the age of 15 years in our Region are already the highest per capita alcohol drinkers in the world. Among youth, one in four deaths is alcohol-related—often the result of injury, violence, or accident. Obesity continues to rise and physical inactivity remains unacceptably high. Cardiovascular disease remains the leading cause of death in the region, hypertension is the leading risk and excessive salt intake is a key modifiable risk factor [4]. Deaths from cancer comprise 40% of avoidable deaths [2].

But there is reason for hope. Ten countries in the Region have achieved the European Program of Work target for premature mortality reduction ahead of schedule (25% reduction between 2010 and 2025) and 26 are on track to do so this year. They are succeeding through addressing both preventable and treatable mortality, through reducing exposure to risk factors, and investing in management and delivery of care. For example, an integrated approach of salt reduction strategies and hypertension control in PHC can make a difference.

Despite their established effectiveness, implementation and enforcement of the WHO NCD best buys has been uneven and disappointing. This has been attributed to the false perception that the benefits take too long to realize and are therefore not attractive to policymakers. WHO Europe experts conducted a systematic review of the best buys and other recommended interventions, to identify 25 NCD quick buys–interventions that demonstrate public health impact in less than five years (Table 1) [5]. These findings offer guidance to policymakers by identifying effective interventions that both align with political cycles as well as the 2030 SDG goal of reducing premature mortality from NCDs. A key task for the WHO European Region over the next five years is to accelerate implementation and enforcement of these policies. Investment NCD surveillance and monitoring to assess progress is also essential.

When mandatory and government-led, these policies save lives. A recent study by the WHO Regional Office for Europe found that taxation and availability measures –both quick buys—decreased all-cause mortality and increased life expectancy in the Baltic states [5]. Moreover, increasing excise taxes can bring in additional state revenue, which in turn can offset some of the economic costs incurred by the use of these harmful products or be used for other purposes by governments. While taxation of alcohol and tobacco is reported by nearly all countries in the WHO European Region, by contrast, taxation of sugar-sweetened beverages lags behind with fewer than 45% of countries in the region taxing sugar-sweetened beverages [6]. Early intervention in childhood is critical to establishing lifelong healthy habits and preventing noncommunicable diseases. Implementing strong marketing restrictions on unhealthy foods and mandatory reformulation and front of pack labelling systems to reduce sugar, salt, and fat content can help protect children from diet-related health risks and create healthier food environments from an early age. Despite effectiveness, these policies face many challenges including crowded political agendas, disinformation, and industry interference.

The WHO Regional Office for Europe has identified tacking NCDs as a core priority of the Second European Programme of Work (EPW2). To inform this work WHO/Europe collected and synthesized over 1200 inputs on priority actions from policymakers, health and care providers, people with lived experience, youth, civil society and WHO experts. Key priorities that emerged include: strengthening political commitment; fostering multisectoral collaboration and meaningful engagement; countering commercial determinants of health; leveraging data for impact; advancing implementation of the best buys; addressing climate change; enhancing health literacy and self-managment; and strengthening international cooperation. Responding effectively to these priorities requires a whole of government and whole of society approach. It requires raising NCDs and mental health on local and global political agendas, implementing and enforcing proven policies, and advancing a fundamental shift toward multisectoral approaches.

Addressing these challenges and responding to the complex needs of individuals and systems in the face of the rising megatrends—health security, climate change, ageing populations, rising burden of NCDs and mental health disorders, and technological advances–requires better integration of our systems for prevention and management of physical and mental health and transforming our environments– natural, built, and digital–putting people at the centre of the process. Leveraging this expertise, passion, and real-world experience, particularly from those living with NCDs, is key to reshaping health systems, care delivery, and environments. This approach underpins WHO/Europe’s dual-track effort to accelerate collective action to deliver public health gains by 2030 (RACE to the Finish) and ultimately shape healthier environments and communities (Vision 2050).