NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries

Abstract

Most countries have made little progress in achieving the Sustainable Development Goal (SDG) target 3.4, which calls for a reduction in premature mortality from non-communicable diseases (NCDs) by a third from 2015 to 2030. In this Health Policy paper, we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4; country-level applications require additional analyses and consideration of the local implementation and utilisation context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We show how cost-effectiveness data and other information can be used to define locally tailored packages of interventions to accelerate rates of decline in NCD mortality. Under realistic implementation constraints, most countries could achieve (or almost achieve) the NCD target using a combination of these interventions; the greatest gains would be for cardiovascular disease mortality. Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023-30; this investment could avert 39 million deaths and generate an average net economic benefit of $2·7 trillion, or $390 per capita. Although specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks, such as tobacco smoking, harmful use of alcohol, and excess sodium intake, would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally tailored NCD package. By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Our report concludes with a discussion of financing and health system implementation considerations and reflections on the NCD agenda beyond the SDG target 3.4 and beyond the SDG period.

Figure 1

Achievable reductions in cause-specific mortality from scale-up of priority NCD interventions across low-income and middle-income countries The density plots show the distribution of the rate of change in cause-specific mortality across all 123 low-income and middle-income countries. We compare historical (2015–19) average annual rates of change to average annual rates of change that would be observed over the period of 2015–30 if all interventions in table 1 were simultaneously fully implemented in 2023 (including all clinical interventions at 90% population coverage). The vertical dotted line marks the annual rate of change of –2·67%, which corresponds to a reduction in cause-specific mortality by a third over 15 years. The final row shows the distribution of the rate of change in the probability of death from NCD4 between ages 30 and 70 years (ie, the metric for the Sustainable Development Goal target 3.4) as a whole. NCDs=non-communicable diseases. NCD4=four main non-communicable diseases (cancer, cardiovascular diseases, chronic respiratory diseases, and diabetes).

Figure 2

Cost-effectiveness of priority clinical interventions for NCDs, by world region The values reflect the ranking of each intervention from largest to smallest change in the probability of death from NCD4 between ages 30 and 70 years resulting from a US$1 million increase in spending over 2023–30 in each region (for a list of countries in each region see appendix p 36). Cost-effectiveness (appendix pp 7–9) is evaluated from the perspective of the health-care system. To allow comparison with other studies, the values are also colour-coded on the basis of their cost-effectiveness in US dollars per disability-adjusted life-year averted as a share of gross domestic product per capita. Cardiovascular diseases include ischaemic heart disease and ischaemic and haemorrhagic stroke. Costs are in 2020 US dollars. NCDs=non-communicable diseases. NCD4=four main non-communicable diseases (cancer, cardiovascular diseases, chronic respiratory diseases, and diabetes). COPD=chronic obstructive pulmonary disease.