Why investing in NCD prevention and control is an urgent priority

Noncommunicable diseases (NCDs) including cardiovascular and chronic respiratory diseases, cancer, and diabetes are the leading cause of death worldwide, accounting for 74% of all deaths. Each year, they claim at least 43 million lives, of which 18 million are below the age of 70 years, also called premature deaths.[1] Low- and middle-income countries bear a disproportionate burden of the crisis, accounting for more than 80% of premature deaths. Additionally, over 1 billion people worldwide are affected by mental health conditions, with suicide emerging as the third leading cause of death among young people.[2] The economic impact of NCDs and mental health conditions is enormous, driven by direct costs of care as well as indirect costs, such as productivity losses. The cost of care and support when someone in the family is affected by any of these chronic diseases can push the family into a poverty trap from where they cannot escape. This situation is not inevitable, as both NCDs and mental health conditions are largely preventable and treatable. Cost-effective high-impact interventions are available, but these need to be scaled up in scale and speed so that these are accessible to all who need it the most, thereby preventing deaths and prolonging life and livelihoods.[3] Unfortunately, however, NCDs and mental health problems continue to increase in every country, affecting every community, making them urgent issues for public health.[4] Despite the huge health and economic impact these diseases have, as articulated above, the programs to tackle these diseases continue to suffer from a lack of visibility and resources. The economic burden of NCDs and mental health is compounded by limited investment in prevention and treatment services. Clearly, addressing these problems requires high-level political commitment both at international and national levels as well as investments in promoting health and preventing disease. Investments in NCD prevention and control, therefore, can not only save lives but also yield economic benefits and contribute to achieving sustainable development goals (SDGs) and health equity.[5] The health and socioeconomic consequences associated with NCDs make the prevention and control of these diseases a monumental developmental imperative in the 21st century. Why Invest in Noncommunicable Diseases? There are many compelling reasons to do so: First, as previously noted, NCDs are major contributors to mortality and morbidity. They lead to prolonged periods of ill health, adversely affecting quality of life and livelihoods. A significant proportion of NCDs occur in low- and middle-income countries, thereby hindering their health and economic development.[3] Investing in NCD prevention and control can save lives, reduce suffering, improve overall health and well-being, and alleviate the substantial emotional and financial burden on individuals and families. Clearly, one of the critical inputs for advocacy is strengthened surveillance and monitoring (the theme of this special issue) and capability in each country to generate evidence that can inform and convince the policymakers on the need for action now.[6] Tracking the targets transparently – through robust surveillance and regular reporting mechanism – can help monitor trends, see progress being made by programs over time, identify gaps, and hold political leaders accountable. Second, NCDs constitute a heavy economic burden due to protracted illness and associated healthcare cost, as well as loss of productivity. Investing in prevention and control, on the other hand, can contribute to a healthier population and protect against catastrophic expenses relating to health care which, in turn, can help boost national income prosperity. Besides traditional approach to health care, if programs could also focus on self-care with individuals and communities urged to take responsibility of safeguarding their own health, preventing getting ill by avoiding risky behaviors, and managing their own illness better.[7] For example, people can take a more proactive role by practicing yoga, exercising regularly, or getting screened for chronic diseases such as hypertension, diabetes, or cancer. Integrating self-care approach to primary health care can also lead to fewer visits to health facilities and to less pressure on fragile health infrastructure. Third, cost-effective and high-impact interventions dubbed as “best buys” – a set of interventions that are affordable, feasible, providing substantial health benefits – are available to prevent and manage major NCDs. While each of the “best buys” offers individual health benefits, their impact is significantly greater when implemented together. These include increasing tobacco taxes to reduce smoking prevalence and tobacco-related NCDs; implementing alcohol taxes and advertising bans to achieve immediate reductions in consumption and related harms; taxing sugar-sweetened beverages to curb obesity and diabetes; promoting salt reduction to control hypertension; and strengthening cervical cancer screening programs.[8] Creating smoke-free environment can eliminate exposure to second-hand smoke. Health system-related intervention such as managing hypertension can prevent heart attacks and strokes, and scaling up cervical cancer screening can substantially reduce cervical cancer and mortality. School- and community-based activities such as promotion of physical activity and healthy diet can reduce obesity risk among young people. Fourth, efforts to address NCD prevention and control have a significantly high return to investment, with every one dollar spent on NCDs yielding a 7–19 dollar return of investment.[9,10] The returns are from illnesses averted, healthcare costs reduced, and increased economic productivity. In addition, it can help improve governance, health service delivery, and broadly health system strengthening by reducing burden on caregivers, as well as in promoting and forging multi-sectoral engagement for health and sustainable financing. Finally, investing in NCD prevention and control contributes at the societal level to achieving the SDGs, reducing health inequities, and promoting social justice. As NCDs disproportionately affect the poor and vulnerable, such investments also help reduce vulnerability to poverty. The Way Forward According to the latest UN report, there is some progress in addressing NCDs and the risk factors, there is the tobacco use is declining, more countries have national strategies in place, and access to treatment is expanding.[4] However, the progress has recently slowed and the world is unlikely to achieve the SDG target of 3.4 of a one-third reduction in premature mortality from NCDs by 2030. Unless substantial resources, both national and external, are mobilized and become available.[11] In fact, the coronavirus disease 2019 (COVID-19) pandemic offered an excellent opportunity to advance the NCD agenda and highlight the need to address chronic diseases in reducing population vulnerabilities. Data indicate that most deaths due to COVID-19 occurred among individuals with comorbidities such as cardiovascular disease, cancer, hypertension, or diabetes. These comorbidities are, in fact, NCDs.[12,13] Patients infected with the COVID-19 virus who also had these NCDs were more likely to develop severe illness requiring hospitalization, and many did not survive. The pandemic also exposed the vulnerabilities of people living with NCDs to other health conditions, including infectious diseases. People living with NCDs, especially if they were not treated, were at higher risk of severe COVID-19, including mortality. Given the uncertain and volatile geopolitical climate globally, there is an urgency to address NCDs and mental health including making an investment case as never before. The United Nations General Assembly, meeting in September 2025, issued a declaration to address NCDs and mental health, setting 2030 targets for ongoing efforts such as tobacco reduction and hypertension control, while also introducing goals to improve access to mental health services for the first time.[14] It highlighted the need to ensure equitable access to health technologies such as lifesaving medicines, diagnostics, and vaccines. It further stressed that NCD and mental health programs must be integrated in primary health care to achieve universal health coverage. However, these declarations will remain meaningless unless NCDs are accorded the priority they deserve by all stakeholders, and adequate resources—both domestic and external—are mobilized to scale up the “best buys” and make a tangible difference in the lives of people living with chronic NCDs. Ethical approval statement Not applicable.