NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

Summary

The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4—a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030—will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010–2016 rate of decline in NCD mortality. Most of these are high-income countries with already-low NCD mortality, and countries in central and eastern Europe. An additional 50 (27%) countries for women and 35 (19%) for men are projected to achieve such a reduction in the subsequent decade, and thus, with slight acceleration of decline, could meet the 2030 target. 86 (46%) countries for women and 97 (52%) for men need implementation of policies that substantially increase the rates of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women in 15 (8%) countries and men in 24 (13%) countries. NCDs and age groups other than those included in the SDG target 3.4 are responsible for a higher risk of death in low-income and middle-income countries than in high-income countries. Substantial reduction of NCD mortality requires policies that considerably reduce tobacco and alcohol use and blood pressure, and equitable access to efficacious and high-quality preventive and curative care for acute and chronic NCDs.

Introduction

Non-communicable diseases (NCDs) are the leading causes of ill health in the world and account for seven of ten worldwide deaths.1, 2 NCD mortality is higher in low-income and middle-income countries, and, at least in high-income countries, in people with lower socioeconomic status,3, 4, 5 making NCDs an important obstacle to reducing global and national health inequalities.⁶

Following the first UN High-Level Meeting on the prevention and control of NCDs in 2011, WHO member states committed to reduce, by 2025, mortality from four NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes; referred to as NCD4 hereafter) in people aged 30–70 years by 25% relative to their rates in 2010 (termed the 25 × 25 target). NCDs are also included in Sustainable Development Goal (SDG) target 3.4, to “by 2030 reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. The indicator used to measure progress in reducing premature NCD mortality is the same as the 25 × 25 target, and suicide mortality is used as a tracer indicator for mental health.

2018 is an important year for action on NCDs,⁷ with the third UN High-Level Meeting on NCDs in September of this year set to review global and national progress, and renew and enhance political commitment towards reducing NCD mortality. Supporting these deliberations and commitments requires data on how NCD mortality is changing in different countries, and on what interventions and policies can reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim (panel 1). This first report from NCD Countdown 2030 examines the current worldwide status of mortality from NCDs and whether, based on recent trends, each country is expected to reduce mortality in line with SDG target 3.4. We also assess the importance of outcomes and age groups beyond those included in this target and its indicators, and discuss the implications for NCD policies.

Key messages

In all but about 20 countries, people have a higher risk of dying prematurely from non-communicable diseases (NCDs) than from communicable, maternal, perinatal, and nutritional conditions combined. The risk of dying from NCDs is highest in low-income and middle-income countries, especially in sub-Saharan Africa, for both sexes, and in central Asia and eastern Europe for men.

Progress towards Sustainable Development Goal (SDG) target 3.4 varies markedly across countries. At the current rates of decline in NCD mortality, SDG target 3.4 is expected to be achieved for women in 35 countries (19% of all countries) and men in 30 countries (16%). A further 50 countries (for women) and 35 countries (for men) could achieve the target with a slight acceleration in decline.

Mortality from the four NCDs included in SDG target 3.4 (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes) has stagnated or increased since 2010 among women in 15 and men in 24 countries. Another 86 countries (for women) and 97 (for men) are progressing too slowly, and need policies that substantially increase the rates of decline if they are to meet SDG target 3.4.

NCD deaths beyond the age range and causes of death included in SDG target 3.4 cause a larger mortality burden in low-income and middle-income countries than in high-income countries.

Substantial reduction of NCD mortality requires policies that considerably decrease tobacco and alcohol use and blood pressure, and that provide equitable access to efficacious and high-quality preventive and curative care for NCDs in the context of universal health coverage.