Brendan Shaw
“Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4.“
- NCD Countdown 2030, The Lancet, 2020
In a little over 10 years from now – about 122 months or 3,700 days from today – the world will be evaluating how it has gone in achieving the United Nations 2030 Sustainable Development Goals.
These were agreed by all nations at the 2015 UN General Assembly as key goals for the global community to achieve by 2030.
Within the health goals contained in Goal 3, one of the key ones is 3.4 which is a goal to reduce pre-mature mortality from non-communicable diseases (NCDs) by one-third by 2030 compared to 2015 and to promote mental health and wellbeing.
Amidst the understandable current focus on Covid-19, it is worth remembering the impact that NCDs have on global health.
Around 41 million or 71% of all global deaths worldwide result from NCDs. The ‘big 4’ NCDs (cancers, cardiovascular disease, chronic respiratory diseases and diabetes – NCD4s) are responsible for the bulk of these and mental health is also a key part of Goal 3.4.
Source: WHO. 2018. "The top 10 causes of death", https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death, accessed1/11/2020.
Of all these NCD deaths, 44% of are pre-mature, meaning the person has died from them before the age of 70. Almost half (46%) of NCD deaths in low- and middle-income countries are premature.
NCDs also impose substantial economic and social costs on countries. A recent report from the Victorian Institute of Strategic Economic Studies for the US Chamber of Commerce demonstrates the substantial economic and social benefits for countries if they invest in initiatives to address NCDs.
Falling behind
So, how is the world going in meeting the 2030 target to reduce pre-mature death by one-third by 2030?
Are we on track?
In short ... no.
Senior officials at the WHO, for example, have already warned that the world not achieve this goal if current trends continue.
A recent article in The Lancet co-authored by a suite of international experts under the banner of NCD Countdown 2030, with Imperial College London, the NCD Alliance and the World Health Organization reviews the world's progress.
This comprehensive analysis examines the trends of cause-specific mortality across 176 countries and territories by age and sex and concludes:
“Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4.“
Money matters, gender matters
The study found what has come through time and time again, namely that how wealthy a country is has a major impact on health risks.
Globally, the lowest risk of dying from an NCD4 prematurely – that is, between the ages of 30 and 70 – was in high-income countries in the Asia-Pacific, western Europe, Australasia and Canada.
The highest risk was in low- and middle-income countries, particularly in Sub-Saharan Africa and, for men, in Central Asia and Eastern Europe.
Similar differences were seen for both men and women, although men had higher risks in many parts of the world.
While income levels matter, so does whether you’re a man or a woman.
The study found that the risk of dying prematurely (between the age of 30 and 70) from an NCD4 was greater for men than for women in most countries, except for diabetes where it was the same.
The study also ranked individual NCDs by probability of early death to identify which diseases posed the most risk for populations around the world. The result was quite a powerful analysis of the risk of dying prematurely from an NCD by age and sex.
For example, the study found that:
“Ischaemic heart disease was the leading NCD4 cause of death in people aged between 30 and 70 years in 146 (83·0%) countries for men and 98 (55·7%) for women. The highest risk of a 30-year-old dying from ischaemic heart disease before their 70th birthday was seen in eastern Europe, central Asia, the Middle East and north Africa, and south Asia. For men, the risk reached as high as 20% and for women as high as 13% in some countries.”
If you think about it, that means for example that a 30 year old man living in Eastern Europe today has a one-in-five chance of dying from heart disease before they turn 70.
And that’s from just one disease. Forget every other disease or illness or accident that can happen, that's a one-in-five chance of dying before 70 just from ischaemic heart disease.
The pace of change is too slow
Crucially, the study also looked at the pace of change to estimate how many countries were likely to meet the UN SDG target of a one-third reduction on pre-mature mortality from NCDs by 2030.
The sobering news is that not many countries are going to meet their target.
Source: NCD Countdown 2030. 2020. "NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4", The Lancet, 396: 918-34, https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931761-X, accessed 12/10/2020.
The study found that:
“Based on 2010–16 trends, women in 17 of 176 (9·7%) countries and men in 15 of 176 (8·5%) countries are expected to achieve SDG target 3.4, a third reduction relative to 2015 levels in the probability of dying from NCD4 between 30 years and 70 years of age.”
So, only around 15 to 17 countries in the world are currently on track to achieve the 2030 goal, or around 9% of countries.
So, no, on current trends most countries are going to fail.
Perhaps even more telling, the numbers of countries where the probability of dying pre-maturely has not changed or even increased are 14 countries for women (8%) and 20 countries for men (11.4%).
With 10 years left to go until 2030, that’s not great progress.
And, it’s not just low-income countries that have a problem here.
Remember that the goal is a one-third reduction in 2015 pre-mature mortality level, not the overall level.
So rich countries can fail in this just as much as poor countries.
In fact, the study shows that the United States has a real problem here even by international standards:
“The least favourable changes in the probability of death from these causes were seen in sub-Saharan Africa, and for men in south Asia and Oceania. Among high income countries, the USA did badly, with probability of death from all but three causes of death increasing in both men and women.”
The good news is that some of the areas with the highest risk of dying, countries like Belarus, the Czech Republic, Slovakia, Bosnia and Herzegovina, Latvia, Russia, Serbia and Ukraine are all seeing big reductions in pre-mature mortality risk from NCDs.
While they have a long way to go, they are making progress.
The study nominates Denmark, Iran, Kazakhstan, Luxembourg, the Maldives, New Zealand, Norway, Singapore and South Korea and as countries where both women and men are on track to achieve the one-third reduction by 2030, while women in Kuwait and Timor-Leste and men in Bahrain are also on track.
What to do about it
The study also looks at what sorts of reductions are required for men and women in different disease areas for countries to achieve the 2030 target.
This chart below looks at the number of countries worldwide in which the cause of death needs to fall by a fast pace to achieve the SDG 3.4 goal.
While action is needed across the board, clearly for men in particular the areas that need big improvements are ischaemic heart disease and diabetes.
Source: NCD Countdown 2030. 2020. "NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4", The Lancet, 396: 918-34, https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931761-X, accessed 12/10/2020.
The good news is that there are things countries can do to make better progress.
Different countries have different pathways they can follow to achieve a one-third reduction.
There is still hope and there is still time.
In most countries, the strategy to achieve the 2030 goal includes better tobacco and alcohol control, behavioural changes, ensuring good primary care systems including diagnosis and screening, as well as acute treatment for diseases using treatments and therapies.
The WHO released a major report earlier this year reviewing country progress in implementing NCD prevention measures, showing the progress that has been made but also the work that still needs to happen.
And there are roles for various stakeholders working together to achieve this. As the UN SDGs envisage, the public, private and NGO sectors all have roles in helping to achieve the one-third reduction in premature mortality by 2030.
The good news is that there are some great initiatives, collaborations and partnerships across sectors to address the issue.
There are various examples of ongoing attention on the issue. Ranging from the United Nations, the WHO's Global Coordination Mechanism for NCDs, NGOs like the NCD Alliance, through to private sector initiatives like the pharmaceutical industry's Access Accelerated initiative, there is significant effort being directed to this.
Just as an example, Boston University's latest Access Observatory report examining pharmaceutical company partnerships to address NCDs found that more than half of company programs it reviewed had a public sector partner.
So, there is some good work being done to beat NCDs.
But clearly more needs to be done.
We’ve got a long way to go and we don’t have much time left but, with a will and a way, the world can get there.