More than half of the countries are not on track to meet the global targets for chronic disease

** National data available **

Cancer, cardiovascular disease, chronic respiratory disease and diabetes accounted for 12.5 million deaths among people aged 30 to 70 worldwide in 2016.

Attention, more than half of the countries are not on track to achieve the UN goal of reducing by one third the rate of premature deaths from noncommunicable diseases (NCDs) from here. 2030.

One in ten countries have seen mortality rates stagnate or worsen – in the United States, for example, women's NCD rates have stagnated, with nearly a 30-year-old woman dying before her 70th birthday. 20 women in the best performing country (South Korea).

A broader view of chronic diseases among people aged 0-80 offers a less promising picture, with only 17 countries (9%) for women and five countries (3%) for men 2030.

According to a new analysis published in The Lancet before the third meeting of the United Nations, more than half of the countries should not reach the United Nations goal to reduce premature deaths due to cancer, cardiovascular disease, diseases chronic respiratory and diabetes care by 2030. NCD level meeting as of 27 September 2018.

However, the problem is potentially even more serious and progress is even slower when all noncommunicable diseases (NCDs), including liver and kidney diseases [1] – and all ages under 80 are taken into account.

The authors say countries need to implement policies that reduce premature deaths faster if they want to meet target 3.4 of the Sustainable Development Goals (SDGs) – reduce by one-third the number of deaths caused by the four major NCDs in people aged 30 to 70 years. from here 2030.

"Despite clear commitments, international aid agencies and national governments are not doing enough to reduce deaths from cancer, heart and lung diseases and diabetes. Progress is even slower for other diseases that are not part of the Sustainable Development Goals. people in most countries are even more terrible, "says Professor Majid Ezzati, lead author, Imperial College London, UK. [2].

The report is the first of NCD Countdown 2030 – an annual independent follow-up of progress in reducing the global burden of NCDs – a collaboration led by The lancet, World Health Organization, Imperial College London and NCD Alliance. It compares the evolution of mortality rates for 186 countries from 2010 to 2016 to understand the likelihood that countries will reach the SDG target for noncommunicable diseases. In addition, the study includes a more comprehensive measure of all noncommunicable diseases [1] in the elderly between birth and 80 years.

The magnitude of the problem of NCDs

In 2016, the probability of dying from one of the four major noncommunicable diseases aged 30 to 70 years was the lowest for women in South Korea (less than 5%) and the highest for women in Sierra Leone (about 33%). risk almost seven times higher. For men, the risk was lowest in Iceland (10%) and highest in Mongolia (39%) (complete country by country data available in a spreadsheet at the end of the press release).

In the United Kingdom in 2016, women aged 30 were 9% likely to die from one of the four major noncommunicable diseases before their 70th birthday and 30 year old men by 13%. In the United States, the risks were 12% for women aged 30 and 18% for men, compared to 14% and 20% respectively in China and 20% and 27% in India.

While there were 12.5 million premature deaths in the four major noncommunicable diseases among people aged 30 to 70 in 2016, there were 27.3 million deaths from all NCDs in all people under 80 years old.

The authors also note that the problem of NCDs in low- and middle-income countries (particularly in sub-Saharan Africa and in some countries in the Middle East and North Africa) is much broader than the four major diseases. non-transmissible. Since the burden of NCDs is also greatest in these countries, the SDG target could lead to the loss of some countries.

Progress against NCDs

The study showed that although mortality from NCDs is decreasing in most countries, the rate of decline varies considerably, even between countries in the same region.

Of the 186 countries evaluated, the majority of countries (86 countries [46%] for women and 97 countries [52%] for men) will not reach the goal of SDG 3.4 by 2040 and will require policies that will significantly improve premature mortality rates. This includes China and India, the two most populous countries in the world, where premature mortality of the four major noncommunicable diseases has decreased, but not fast enough to meet target 3.4 of the SDGs.

In addition, the reduction in deaths from noncommunicable diseases has stagnated or increased since 2010 among women in 15 countries (8%) and men in 24 countries (13%) – including the United States for women. [3].

The reasons for a lack of progress in most of these countries are not known, but the authors believe that this could be caused by a worsening or lack of improvement of the main risk factors of NCDs (tension). arterial, diabetes, obesity, alcohol consumption, etc.). and smoking), or that health care systems in these countries are not able to adequately prevent, treat and manage NCDs.

The authors estimate that the stagnation in the United States is due to the lack of a reduction in premature deaths from non-communicable diseases other than cancer, which has continued to decline, while the decline of other noncommunicable diseases has slowed down. or inverted. The authors say that this seems to be particularly common in the poorest rural communities.

The study showed that 35 countries (19% of all countries) for women and 30 countries (16%) for men will likely reach target 3.4 of the SDGs – these countries go from high-income countries where the reduction is continuing (Norway, Denmark, South Korea and New Zealand), to middle-income countries starting with high rates and finding a rapid decline in NCD mortality (such as Brazil, Iran, Russia and other countries of Central and Eastern Europe) [4]. In addition, if 50 other countries (27%) for women and 35 countries for men (19%) slightly accelerated the rate of decline of deaths from NCDs, they could achieve the goal. [5].

When progress was measured on all NCDs and all children under 80, they were even slower – only 17 countries (9%) for women and five countries (3%) for men death by a third party [6].

In low- and middle-income countries, the reduction in deaths from noncommunicable diseases was mainly due to the reduction of cardiovascular diseases. For NCD mortality to decline more rapidly in these countries, the reduction in mortality from cardiovascular diseases needs to accelerate, as well as approaches to reduce the number of deaths from cancer, chronic respiratory diseases, diabetes and other noncommunicable diseases.

In high-income countries, reductions in deaths from noncommunicable diseases are now due to lower deaths from cancer, cardiovascular disease and diabetes.

Priority political measures

To accelerate the reduction of premature deaths from NCDs, the authors call for policies and interventions to reduce tobacco and alcohol consumption, including tax and regulatory measures such as taxation, warning labels, smoking in the audience.

They also advocate early diagnosis and treatment of NCDs, including rapid diagnosis and treatment of hypertension, diabetes, treatable cancers and other acute and chronic noncommunicable diseases.

"In the future, the 2030 NCD Countdown is a boost for the global response to the NCD epidemic, which has long called for a stronger accountability process," said Katie Dain. CEO of NCD Alliance, UK. "The inaugural countdown analysis could not be more timely with the upcoming UN high-level meeting on noncommunicable diseases on the horizon." The aspirations and promises of the political leaders made at the meeting are now Even governments on the right track can not be complacent – they must remain vigilant and respond effectively to new threats to the health of the next generation, including childhood obesity, air pollution and evolving tactics. tobacco and alcohol industries. [2]

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

In an editorial for The Lancet, Dr. Richard Horton, Editor-in-Chief, said, "There have been calls for at least a decade to strengthen the accountability for NCDs, with many obstacles blocking progress. , the treatment and control of noncommunicable diseases, the promises made by the international community must be kept. "