Non-communicable diseases (NCDs) are the leading cause of death globally. The United Nations has set the goal of reducing deaths from these diseases by one-third by 2030.
The latest study is the first to investigate the change in NCD-mortality across countries. It finds that, from 2010 to 2019, the probability of dying from an NCD before the age of 80 fell in 152 countries for women and 147 countries for men.
Despite these gains, more than half of the countries saw slower declines in the 2010s compared with the previous decade. "Around the beginning of the millennium, we saw significantly lowered mortality rates, but despite political attention suddenly over the last decade, things are not doing as well as before," says Majid Ezzati, a co-author and global-health researcher at Imperial College London.
All 25 high-income countries in the data set saw declines in NCD mortality between 2010 and 2019, with Denmark recording the largest drop for both sexes and the United States the smallest (see 'Most and least improved'). China, Egypt, Nigeria, Russia and Brazil had a reduction in chronic-disease deaths, whereas India and Papua New Guinea experienced an increase in NCD deaths over the same period.
Veronica Le Nevez, a public-policy specialist at the George Institute for Global Health in Sydney, Australia, says that the report finds the biggest drivers of improvements in mortality rates were embedding better treatments and preventions in health-care systems, the widespread adoption of statins and hypertensives to lower risk of heart attack or stroke and the development of vaccines for hepatitis and cervical cancer.
Government restrictions on tobacco and alcohol have also helped to reduce mortality from diseases linked to their use, such as lung cancer and alcohol-use disorder.
Ezzati says that the slowdown between 2010 and 2019 could be because of underfunding, poor targeting of vulnerable populations and a lack of clarity in public-health priorities. In many countries, proven interventions to reduce chronic-disease deaths, such as treatment for high-blood pressure and diabetes and cancer screening, have stagnated or even declined since 2010, despite being low-cost and highly effective, he says. Government restrictions on tobacco and alcohol have also lost momentum in many regions, he adds.
"It is disappointing to note that liver cancer contributed towards higher NCD mortality in most countries despite the strong evidence base and availability of alcohol-control policies," says Naomi Gibbs, a health economist at University of York, UK.
High-income countries such as the United States and Germany saw a decline in improvements because of a rise in neuropsychiatric conditions, including Alzheimer's disease, other dementias and alcohol-use disorders. "Mortality from Alzheimer's disease and dementias increased in 65% of countries, and in 90% of high-income countries," says Le Nevez. Accelerated funding and the implementation of programmes addressing these conditions is needed urgently, she adds.
Le Nevez notes that the study looked only at mortality, but many people live with an NCD, and often with more than one chronic condition, for many years. "We need to also consider how to live well with chronic disease," she says.