Effective action on NCDs requires a tailored policy mix that reflects national risk factor profiles and health priorities. Nevertheless, successful NCD strategies rest on three interconnected pillars: empowering individuals, creating supportive environments, and building responsive health systems. Empowerment depends not only on providing information, but also on strengthening motivation and practical skills that enable sustained behaviour change. At the same time, environments strongly shape health choices, and policies that make healthy options accessible, affordable and attractive are essential. Health systems, particularly primary care, must operate across the full NCD continuum, from prevention and early detection to long-term management. Strengthening screening, counselling and people‑centred care can substantially improve outcomes. Together, these three pillars provide a coherent framework for integrated, high-impact NCD strategies that deliver lasting health, economic and societal benefits.
The Health and Economic Benefits of Tackling Non‑Communicable Diseases
Abstract
Three core policy considerations for tackling NCDs
Addressing NCDs requires a tailored policy mix that reflects each country’s health priorities and the distribution of risk factors in the population. But although the emphasis differs, all successful NCD strategies share three interconnected pillars: empowering individuals, creating supportive environments, and building responsive health systems.
Empowered individuals: Sustained progress in controlling NCDs depends on individuals having the knowledge, motivation, and skills to make healthier choices. Accessible information helps people understand the risks of unhealthy behaviours, or the potential benefit of participation in screening. However, awareness alone is insufficient. The Information – Motivation – Behavioural Skills (IMB) model highlights that effective health education must not only provide information but also foster motivation and teach practical skills. Policymakers should therefore design health information initiatives that combine facts with motivation and actionable guidance, delivered through diverse and equitable channels.
Supportive environments: Environments heavily influence exposure to NCD risk factors. Even motivated individuals struggle to make healthy choices when confronted with environments that encourage unhealthy behaviour. To reduce NCDs, policymakers must therefore design environments that make the healthy choice the easy, accessible, and affordable one, and address the impact of social, environmental, economic, commercial and market factors. Countries can learn from international experience but must adapt interventions to local cultural, political, and economic contexts to ensure feasibility and acceptance.
Many environmental policies to promote healthy behaviours also contain an element of education and information. Previous OECD analyses have shown that environmental and informational policies have an excellent benefit-cost ratio (Figure 5.3). (OECD, 2019[1]; OECD, 2021[2]). Most policies return more in economic benefits than they cost to implement, with some returning more than USD 5 for every USD 1 invested. In addition, regulatory and price‑based policies are also commonly used to influence healthier behaviours by discouraging harmful product use and encouraging healthier market choices. Evidence suggests that multi-pronged approaches, tailored to each country’s context, deliver the greatest impact and value by combining interventions that work together to address complex health determinants.
Responsive health systems: Health systems, particularly primary care, must engage across the full NCD continuum: prevention, early detection, and long-term management. Primary care providers are trusted sources of advice and play a key role in counselling patients about healthy behaviours. Yet opportunities are often missed: fewer than half of adults over 45 report receiving advice on physical activity, and only a third receive guidance on healthy eating.
Screening and early diagnosis are essential components of responsive health systems. Primary care supports cancer screening programmes by performing tests, referring patients, and motivating participation. However, uptake remains uneven: across OECD countries, around 57% of eligible women were screened for breast or cervical cancer in 2023, and only 46% for colon cancer. Letters or reminders from general practitioners significantly increase screening rates. Screening is also crucial for detecting complications, such as chronic kidney disease in people with diabetes, allowing for early intervention and better outcomes.
Effective NCD care requires people‑centred approaches that treat patients as partners in managing their health. Evidence from OECD’s PaRIS shows progress but also gaps: On average, patients scored their experience of care co‑ordination 8.2 out of 15, but in some PaRIS countries this was as low as 5. There was even greater variation in the preparedness of primary care practices to co‑ordinate care and exchange medical records electronically: ranging from none of the primary care practices participating in PaRIS in a country to all of them.
Addressing NCDs requires a tailored policy mix that reflects each country’s health priorities and the distribution of risk factors in the population. For instance, some countries may decide to invest heavily in reducing smoking prevalence, while others may instead prefer to focus on increasing the uptake of cancer screening. Although the priorities may differ, there are three core policy considerations that underpin all successful NCD strategies:
Empowering individuals through information and education,
Creating environments that support healthier choices,
Building responsive health systems that deliver NCD prevention and care.
These three pillars – empowered individuals, supportive environments, and responsive health systems – are mutually reinforcing (Figure 5.1). Empowering individuals with information and education is critical, but its impact is amplified when the environment around people makes healthier choices the easier, more affordable, and more accessible ones. At the same time, even the most informed and motivated individuals may need support from a responsive health system to detect problems early and prevent complications. In turn, primary care plays a crucial role in providing individuals with information and education. Together, they create a comprehensive foundation for sustainable NCD prevention and control (Box 5.1).
Like many other regions, the European Union faces a significant and growing burden of CVDs. CVDs already account for 17% of all premature deaths, and this burden is expected to rise sharply in the coming decades. Between 2026 and 2050, population ageing alone is projected to increase the annual number of new CVD cases by 43%. Even if the population size remains stable, health expenditures related to CVDs are expected to rise by more than 75%.
CVDs have therefore become a central focus of the European Union’s health strategy, aimed at improving public health and fostering economic growth. In December 2024, the 27 EU Health Ministers adopted the Council Conclusions on the Improvement of Cardiovascular Health in the EU, signalling a strong political commitment to tackling CVDs (Council of the European Union, 2024[3]). The Council called for intensified efforts in prevention, early detection, treatment, and rehabilitation. Key priorities include:
Preventive measures: enhancing health literacy, raising awareness about cardiovascular health, and discouraging harmful behaviours such as smoking, harmful alcohol consumption, and unhealthy diets.
Equitable access and workforce training: ensuring equal access to cardiovascular care, integrating screening into routine health checks, and strengthening training for healthcare professionals.
Co‑ordinated and comprehensive action: integrating efforts to address all key aspects of cardiovascular health, from health promotion and disease prevention to screening, early detection, treatment, rehabilitation, and the advancement of research and innovation.
When it comes to preventing CVD, a major priority should be addressing obesity rates. While other risk factors have improved since 2010, obesity rates have increased. This rise in obesity will result in nearly 200 000 additional cases of CVD every year, between 2026 and 2050.
Aligning obesity rates to the Top Quartile across the EU could prevent nearly 500 000 cases of CVD every year, between 2026 and 2050, and 30 000 premature deaths per year. In addition, it would save USD PPP 24 billion per year in healthcare expenditure, and increase GDP by more than half a per cent. This is more than 40% of the total potential impact of improving risk factors, with diet, air pollution and smoking making up 15‑17% each.
But improving access to care for CVDs, as well as the quality of care, is also vital. In nearly half of all EU countries, improving CVD survival rate is in the top three of priority actions to reduce premature mortality. For the EU as a whole, aligning CVD survival rates to the Top Quartile would save 35 000 premature deaths per year.
Source: OECD SPHeP NCDs model 2025.
Lasting progress in preventing and controlling NCDs depends on individuals having the knowledge and skills to make healthier choices. Clear, accurate, and accessible information enables people to understand the risks associated with smoking, harmful alcohol consumption, unhealthy diets, and physical inactivity, and to take steps to reduce them. By raising awareness of the importance of regular screening, individuals are more likely to participate. Equipping people with the knowledge to recognise early symptoms empowers them to take timely action, reducing the risk of complications and improving outcomes.
However, education and information should not just tell individuals about their risks. Individuals are more likely to act when they not only understand what is at stake, but also feel motivated, and possess the skills to translate intentions into practice. This is the Information – Motivation – Behavioural Skills (IMB) model. The IMB model was first developed to change AIDS-risk behaviour, and has since been widely used for health behaviour change (Fisher and Fisher, 1992[4]; Chang et al., 2014[5]).
Using colorectal cancer screening as an example, individuals first need information about their cancer risk and the available methods. Yet knowledge alone is insufficient; they also require motivation, both personal (such as recognising their vulnerability and valuing the potential life‑saving benefit) and social, for instance encouragement from family, peers, or trusted health professionals. Finally, individuals must have the behavioural skills to act on this knowledge and motivation, such as understanding how to use a stool kit correctly or navigating the healthcare system to book a colonoscopy.
As for any type of health promotion, there are multiple, interacting levels of influence, including interpersonal relationships, organisational settings, community environments, and public policy (McLeroy et al., 1988[6]). Information, motivation, and behavioural skills should be reinforced across all these layers of society. For example, while an individual may receive information about cancer screening from a physician, uptake is more likely when peers and family encourage it, workplaces allow time off, community leaders endorse it, and public campaigns provide information on how to use the test kit (Figure 5.2).
Examples of health information and education delivery following the Information – Motivation – Behavioural Skills model and the socio‑ecological model
Note: Examples are illustrative and non-exhaustive.
Source: OECD analysis, based on models from McLeroy et al. (1988[6]), “An Ecological Perspective on Health Promotion Programs”, https://doi.org/10.1177/109019818801500401 and Fisher and Fisher (1992[4]), “Changing AIDS-risk behavior”, https://doi.org/10.1037/0033-2909.111.3.455.
For policymakers, this means that health information campaigns should be designed not only to convey facts but also to build motivation and provide actionable guidance. Moreover, for these messages to achieve broad and equitable impact, they must be delivered through multiple channels across the different layers of society. Such a comprehensive approach to empower individuals to improve their health and well-being can be very cost-effective (Box 5.2).
Mois sans tabac (“Tobacco-Free Month”), launched in France in 2016, provides a strong example of a health information initiative that operates across multiple levels of society, and addresses information, motivation and skills.
Interpersonal: The campaign encourages participants to sign up with friends, family, or colleagues, creating social support networks that reinforce motivation.
Organisational: Pharmacies, healthcare providers, and employers are mobilised to distribute materials, advise participants, and normalise quitting in everyday settings.
Community: Local events, regional health agencies, and community organisations run workshops, support groups, and outreach activities, particularly in high-prevalence areas.
Public policy: The Ministry of Health and Public Health France co‑ordinate national media campaigns, fund resources, and align the initiative with broader tobacco control legislation. To motivate participants, an online calculator allows people to estimate monthly and yearly cost savings. To build the required skills, Public Health France provides quit kits, which include a 40‑day program, tips, flyers, and information about quitting tools.
An OECD analysis of the Mois sans tabac programme in France found that it was very cost-effective. It is estimated that the programme saves EUR 94 million per year in health expenditure, compared to a running cost of EUR 12.5 million – returning seven euros for every one euro invested.
Source: Sante Publique France (2023[7]), Mois sans tabac: le kit pour arreter de fumer, https://www.santepubliquefrance.fr/determinants-de-sante/tabac/documents/outils-d-intervention/mois-sans-tabac-le-kit-pour-arreter-de-fumer (accessed on 26 September 2025); Tabac Info Service (n.d.[8]), Combien pourriez-vous economiser?, https://www.tabac-info-service.fr/ (accessed on 26 September 2025) ; Sante Publique France (2025[9]), Mois sans tabac, https://mois-sans-tabac.tabac-info-service.fr/ (accessed on 26 September 2025) ; Devaux et al. (2023[10]), Devaux et al. (2023), “Évaluation du programme national de lutte contre le tabagisme en France”, https://doi.org/10.1787/b656e9ac-fr.
The Ottawa Charter for Health Promotion, adopted in 1986 at the first International Conference on Health Promotion, marked a turning point in how health was understood and advanced (WHO, 1986[11]). Until then, much of public health and healthcare policy focussed narrowly on medical care and individual responsibility. The Charter was among the first to clearly state that health is created and lived in the settings of everyday life: in schools, workplaces, homes, and communities.
This insight remains highly relevant today (Box 5.3). The everyday settings where people live, work, and learn continue to shape their exposure to risk factors for NCDs. While individual knowledge and motivation are important, they alone are not sufficient when environmental factors steer people toward unhealthy choices. Creating environments that promote health is therefore essential to reducing NCDs and improving well-being. Policymakers can create health-promoting environments by making the healthier choice the easier and more accessible one, and addressing the impact of social, environmental, economic, commercial and market factors. Such efforts not only support individual behaviour change but also help shift norms and expectations.
In September 2025, at the Fourth High-Level Meeting of the United Nations General Assembly on the prevention and control of non-communicable diseases and the promotion of mental health and well-being, member states negotiated a political declaration titled “Equity and integration: transforming lives and livelihoods through leadership and action on noncommunicable diseases and the promotion of mental health and well-being”, which was formally adopted in December 2025. The declaration sets specific global targets for 2030, including 150 million fewer tobacco users, 150 million more people with controlled hypertension and 150 million more with access to mental health care.
The declaration explicitly recognises that NCDs and mental health conditions are shaped not just by individual behaviour but also by wider social, economic and environmental factors. It therefore calls for multisectoral action to create health-promoting environments that make healthy choices easier and reduce harmful exposures. It also recognises the value of implementing the World Health Organization’s evidence‑based “Best Buy” interventions.
Source: WHO (2025[12]), “Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being”, https://cdn.who.int/media/docs/default-source/ncds/finalized-pd-on-ncds-and-mental-health-rev4-3-september-2025.pdf?sfvrsn=78ae5b05_1.
As health is shaped by the full spectrum of social, economic, and physical settings in which people live their daily lives, the ways to improve environments for better health are effectively endless. Every decision about food systems, transport, housing, education, employment, and even digital spaces has the potential to influence NCD risk factors. Countries can draw valuable lessons from international experience, learning from policies that have proven effective elsewhere (Box 5.4). However, no single model can be applied universally. Each country must adapt these approaches to its own social, cultural, political, and economic context, ensuring that interventions are feasible, acceptable, and aligned with local priorities.
The OECD Best Practices in Public Health initiative supports countries in identifying and implementing best and promising interventions across key NCD risk factors, such as smoking, harmful alcohol consumption, obesity and physical inactivity. This includes interventions on integrated care, focussing on how patients and health professionals can work together to deliver high quality care aligned with patient preferences and values (OECD, 2023[13]), interventions that promote healthy eating and active lifestyles (OECD, 2022[14]), urban planning policies aimed to increase physical activity (OECD, forthcoming[15]) and interventions that address addictive behaviours such as smoking and harmful alcohol use (OECD, forthcoming[16]).
One example of an initiative that aims to create a health promotion environment is the Young People at a Healthy Weight (JOGG) project. JOGG is a community-based programme targeting children under 19 years old by reshaping the environment to promote healthy lifestyles with a focus on tackling excess weight and obesity.
Over 500 schools covering close to 52 000 children participate in “The Daily Mile” which encourages kids to move for 15 minutes every day during schools hours, equivalent to walking one mile.
Approximately 750 schools have adopted healthy canteens under the Healthy Nutrition in Schools Agreement (e.g. substituting a puff pastry snack for a whole‑wheat sandwich or panini).
Over 1 200 companies and organisations have signed up to the healthy workplace initiative, which encourages companies to implement initiatives such as healthy work canteens and facilities to promote active modes of transport. This activity is designed for young adults (18‑19) who may begin working directly out of school.
OECD analyses show that over 95 000 LYs and 13 089 DALYs are expected to be gained by scaling up JOGG across the Netherlands by 2050. JOGG is expected to be both cost-effective and cost-saving in most OECD and EU27 countries, with estimated health expenditure savings of EUR 51.94 per person in the Netherlands by 2050 and savings equivalent to 0.06% of total health expenditure per year when transferred to all OECD and EU27 countries.
For further details on these interventions, along with additional best practice case studies, please refer to: https://www.oecd.org/en/about/projects/best-practices-in-public-health.html.
Air pollution in particular requires a focus on creating a healthier environment. There are some actions that individuals can take – reduce their use of motorised transport, improve energy use, limit outside activities during high pollution days – but the largest gains are made at the national level. This however depends on the active involvement of other key sectors, including energy, transport, and urban planning. Shifting energy systems toward cleaner sources, redesigning cities to reduce reliance on polluting transport, and integrating green infrastructure into urban planning can all significantly lower exposure to harmful pollutants. By bringing these sectors together, governments can tackle the root causes of air pollution (Box 5.5).
The European Environmental Bureau commissioned a study to explore whether the EU can meet the new air quality standards by 2030 through the implementation of 10 policies, across the energy, agriculture and transport sectors (Ricardo, 2025[17]). It found that both the measures in the energy sector and the transport sector delivered significant reductions in PM2.5 levels (the focus of air pollution in this report):
Strengthened introduction of non-combustion renewable energy
Ban on solid fossil fuel heating
Improved energy efficiency
More support for active mobility
Low or zero emission zones for traffic
Full Emission Control Areas in all European seas
Introduction of Low emission zones for non-road mobile machinery
Urban design can also contribute to lower air pollution, while increasing physical activity at the same time. For example, the Superblocks model in Barcelona introduces functional and structural changes to the streets and layout to make the city more people centric and less reliant on motor vehicles.
Source: Ricardo-AEA (2025[17]), Climate impact of air pollution levels aligning with European Commision’s proposed air quality standards – report for European Environmental Bureau, https://eeb.org/wp-content/uploads/2025/02/Final_Merged_Report.pdf and OECD (forthcoming), Healthy and Sustainable Cities.
Many environmental policies to promote healthy behaviours also contain an element of education and information. For example, menu labelling provides nutritional information at the point of purchase, helping consumers make more informed food choices. Workplace and school-based interventions often combine education on healthy behaviours with changes to the school or work environment, for example by improving the availability of healthy meals and increasing opportunities for exercise. Regulations on food advertising, particularly those targeting children, reduce exposure to persuasive marketing of unhealthy products, helping to shape a healthier information environment.
Previous OECD analyses have shown that environmental and informational policies have an excellent benefit-cost ratio (Figure 5.3) (OECD, 2019[1]; OECD, 2021[2]). Most policies return more in economic benefits than they cost to implement, with some returning more than USD 5 for every USD 1 invested. However, even policies that do not fully cover their cost by providing economic benefits should be considered for their health impacts.
Benefit-cost ratio, in USD returned in GDP benefits for every USD invested in the policy, for interventions that only focus on information, and policies which combine information and environmental changes
Note: In this context, “environment” refers to the setting in which the interventions take place, such as school, workplace and community settings. Estimates are calculated by dividing the increase in GDP produced by the intervention on average over the period to 2050 by the cost of implementing the intervention in the countries analysed. Diet related interventions were analysed in 36 OECD countries, while interventions targeting harmful alcohol use interventions were analysed in selected EU and G20 countries in addition to OECD countries. For more details see the Preventing Harmful Alcohol Use and Heavy Burden of Obesity publications (OECD, 2021[2]; OECD, 2019[1]). Interventions with a comparatively lower impact on GDP (and effectiveness on population health) may have a higher return of investment if they have a low implementation cost. This list provides only examples of evaluated interventions and is not intended to be exhaustive.
Source: OECD (2019[1]), The Heavy Burden of Obesity: The Economics of Prevention, https://doi.org/10.1787/67450d67-en and OECD (2021[2]), Preventing Harmful Alcohol Use, https://doi.org/10.1787/6e4b4ffb-en.
In addition to environmental and informational measures, regulatory and price‑based policies are also commonly used to promote healthier behaviours at the population level. OECD analyses and international evidence consistently show that interventions such as taxes on tobacco products, minimum unit pricing to address cheap alcohol products, disproportionately consumed by individuals with problematic drinking patterns, and restrictions on marketing unhealthy products to children are among the most cost-effective policy tools available to governments (Devaux et al., 2023[10]; OECD, 2021[2]; OECD, 2019[1]). When well designed, these policies not only discourage consumption of harmful products but may also help shift market incentives toward healthier alternatives. For example, the United Kingdom structured its tax on sugar-sweetened beverages to encourage reformulation by manufacturers, resulting in a 47% average reduction in sugar in soft drinks in scope of the tax between 2015 and 2024 (UK Government, 2025[18]). However, these types of policies also involve the highest degree of interference with individual choice (Sassi and Hurst, 2008[19]).
Previous OECD work on promoting healthier lifestyles shows that multi-pronged approaches consistently deliver greater impact and better value for money (OECD, 2019[1]; OECD, 2021[2]). Whether aimed at informing individuals, increasing the availability of healthier options, regulating exposure to risk factors, or increasing the price of unhealthy products, individual measures alone are unlikely to comprehensively address the complex factors that shape health. In some cases, they may also lead to unintended consequences or trade‑offs among stakeholders (OECD, 2019[1]; OECD, 2021[2]). OECD analyses conclude that combining interventions into comprehensive prevention packages maximises synergies between policy components, resulting in the highest impact on population health and excellent returns on investment. Ultimately, it is for each country to determine the most appropriate mix of policies based on its own context, priorities, and institutional capacity.
Health systems, and primary care in particular, need to be engaged across the entire NCD care pathway, not only in curing acute episodes. Primary care providers should deliver preventive care, by promoting healthier behaviours and addressing risk factors early. The health system also plays a central role in screening and early detection, helping identify conditions such as cancer or chronic kidney disease before they progress. Once diagnosed, patient-centred long-term management in primary care is essential, through co-production of health and co‑ordination of care.
Primary prevention
As trusted and regular points of contact, primary care physicians are ideally placed to offer personalised guidance on healthy lifestyle choices. Doctors are credible sources of health information: people trust their doctor more than the healthcare system as a whole, and 78% of the patients with chronic health conditions indicated that they trusted the last care professional they saw (OECD, 2025[20]). Indeed, a poll across 28 countries found that people are perceived as the most trustworthy profession, ahead of scientists, teachers and all other occupations (IPSOS, 2021[21]). This trust means that patients are more likely to listen to the advice of their healthcare professionals, making every contact with a primary care professional a value opportunity for health promotion.
However, this opportunity is frequently missed. For example, findings from the OECD’s PaRIS suggest that less than half of people aged 45 and older who visited a primary care physician received lifestyle advice on physical activity in the previous 12 months (Figure 5.4). Even fewer received advice on healthy eating, at less than a third of PaRIS respondents. Only one‑quarter of people who were daily or nearly daily drinkers received advice on alcohol. The most commonly offered counselling in primary care was on smoking, with just over half of smokers receiving advice on smoking cessation. For all four areas of lifestyle advice, people living with NCDs were more likely to receive advice than people without NCDs. Nevertheless, even for people with NCDs there remains considerable scope for improvement.
Percentage of patients receiving counselling in primary care, by country and the average across the OECD and EU countries in the PaRIS study, stratified by NCD status
Note: Average refers to the average across the 19 countries/regions included in the PaRIS analysis. For alcohol counselling, the average covers 17 countries, as Iceland and Saudi Arabia were excluded due to small numbers. For counselling among daily smokers, the average covers 18 countries as the United States was excluded as data on daily smoking for the United States was coded as missing to avoid identification. In this figure, EU and OECD averages are reported as simple (i.e. unweighted) means across member countries who took part in the survey. For this analysis four NCDs were included: cancer, CVD, CRD and diabetes. Country proportions are calculated using a PaRIS age‑sex standardised population. PaRIS data included people aged 45 years and older who had at least one primary care contact in the six months prior to the survey, and who lived in a private household in the community (i.e. not in a nursing home or other residential institution) at the time of the survey.
Source: OECD PaRIS 2024 Database.
Screening and early diagnosis
Primary care plays a critical role in the early detection of NCDs and their complications (Box 5.6). For cancer, population-based screening programmes play a crucial role in the early diagnosis of disease. However, uptake varies substantially across countries, leaving room for improvement (Figure 5.5). For example, among OECD countries providing data, only 57% of eligible women were screened for breast cancer in 2023 – ranging from 15% in Greece to 83% in Sweden. Equally, only 57% of women were screened for cervical cancer, varying from 4% in Costa Rica to 78% in Sweden. For colon cancer, the uptake is even lower, with only 46% of the eligible population screened, varying from 9% in Hungary to 74% in Finland (OECD, 2023[22]).
While universal screening programmes (i.e. screening all asymptomatic healthy adults) for certain cancer types have been well established in most OECD countries, population-wide screening for other NCDs is less common. However, many countries do recommend targeted screening for NCDs in high-risk individuals.
Most OECD countries do not recommend universal screening for type 2 diabetes, as the evidence of benefit is generally judged weak or insufficient (Peer, Balakrishna and Durao, 2020[23]; Jonas et al., 2021[24]). However, many countries do have guidelines for diabetes screening in people with known risk factors – such as older age, obesity, a family history of diabetes, certain ethnicities, or specific lifestyle factors. For example, primary care guidelines in the Netherlands recommended that people over the age of 45, who also have another risk factor, are opportunistically screened with a blood glucose test when they visit their doctor (NHG, 2025[25]).
For COPD, the focus tends to be on case finding (testing people with symptoms) rather than screening (testing asymptomatic individuals) (Haute Autorité de Santé, 2020[26]; Agustí et al., 2023[27]; NHG, 2025[28]; US Preventive Services Task Force, 2016[29]). For example, France recommends that a spirometry test is done in all patients over 40 years of age with a symptom and a risk factor (smoking and occupational exposure in particular) (Haute Autorité de Santé, 2020[26]).
Screening for cardiovascular diseases is also primarily focussed on individuals at higher risk. The European Society of Cardiology recommends a CVD risk assessment to be systematically done in individuals with any major vascular risk factor (i.e. family history of premature CVD, familial hypercholesterolemia, CVD risk factors such as smoking, arterial hypertension, diabetes mellitus, raised lipid level, obesity, or comorbidities increasing CVD risk) (ESC Scientific Document Group, 2021[30]).
It is important to note that screening for NCDs is an evolving space, informed by shifts in country specific disease patterns, age of onset, and advances in early detection and treatment. At present, however, cancer screening remains the most evidence‑based and systematically promoted form of population-wide NCD screening.
Population coverage of breast, cervical and colorectal cancer screening programmes, 2023
Note: Based on programme data provided by countries to OECD Health Statistics. Screening rates are based on survey or programme data. Programme data are collected to monitor national screening programmes, capturing participation among the eligible population. It does not include examinations outside the national programme and may not capture exams that effectively function as screening but cannot be reliably distinguished. For cervical and colorectal cancer, the differences between countries in target age groups, screening frequency and screening methods lead to variations in the data coverage reported across countries. Survey data may be affected by recall bias. In this figure, EU and OECD averages for each indicator are reported as simple (i.e. unweighted) means across member countries with data for the indicator.
Source: OECD Health Statistics, 2025.
Primary care can play a vital role in improving cancer screening uptake. Of the 26 countries responding to the 2023 OECD Policy Survey on Cancer Care Performance, 15 reported that they rely considerably on primary healthcare providers to deliver cancer screening activities for cervical cancer, while 12 do so for colorectal cancer (OECD, 2024[31]). For cervical cancer, the screening itself often takes place in primary care settings, whereas for colorectal cancer, specialists, hospitals or GPs are involved, depending on the country.
In addition to delivering screening, primary care can also help increase uptake by encouraging and reminding patients to attend screening. Letters from GPs encouraging participation in screening have been shown to increase uptake, as did reminder letters sent out by GPs, telephone outreach and group health information session at the GP (Hewitson et al., 2011[32]; Benton et al., 2017[33]; Shankleman et al., 2014[34]).
The health system also plays a key role screening for NCD complications. For example, diabetes is a leading cause of chronic kidney disease (CKD) worldwide (Francis et al., 2024[35]), and almost half of patients with diabetes have CKD (Thomas, Cooper and Zimmet, 2015[36]). Without appropriate treatment, CKD can progress to end stage kidney disease (ESKD), which can be life threatening, and may require dialysis or kidney transplant. Screening for protein in urine (albuminuria) can help detect the early stages of kidney dysfunction in individuals with diabetes, allowing for early intervention that delay or prevent the development of CKD (Galea et al., 2025[37]; WHO, 2025[38]). There are various ways to encourage screening for complications in primary care, such as incorporating reminders into the patient electronic medical record, physician training and quality control audits (Anabtawi and Mathew, 2013[39]).
Person-centred disease management
Putting people at the centre of their care has been a priority for health systems in recent decades (OECD, 2021[40]), but it is particularly important when addressing NCDs. NCDs frequently require the management of multiple conditions at once, making standard, disease‑specific care insufficient. Moreover, NCD management often depends on active patient involvement: patients need to monitor their own health, such as checking blood pressure or blood glucose levels; manage and adhere to multiple medications; adopt and sustain lifestyle changes like healthier eating or increased physical activity; and recognise warning signs that require medical attention.
Health systems can provide person-centred disease management through personalised care plans, medication reviews, counselling, digital tools, and ongoing communication that helps patients feel equipped and confident. When patients are engaged as partners in these ways, they are better able to manage their conditions, improve outcomes, and maintain quality of life, while the health system benefits from more efficient, co‑ordinated, and sustainable care.
Results from PaRIS show that there is still some way to go in creating people‑centred health systems (Figure 5.6). Among people age 45 and over who visited their primary care provider, around three in five said they receive enough support to self-manage. However, in some PaRIS countries this is as low as two in five respondents. On average, patients scored their experience of care co‑ordination 8.2 out of 15 (where 15 would reflect and ideal experience of co‑ordination of care from the perspective of patients), but in some PaRIS countries this was as low as 5. There was even greater variation in the preparedness of primary care practices to co‑ordinate care and exchange medical records electronically: ranging from none of the primary care practices participating in PaRIS in a country to all of them (OECD, 2025[20]).
Country performance on people‑centred care for people with NCDs, for countries in the PaRIS study, and the OECD16/17 and EU11 averages
Note: 1. Calculated by matching patient data with primary care practice data: number of patients in practices reported as well-prepared to co‑ordinate care (practice questionnaire) divided by the total number of patients per country (patient questionnaire). Results are age and sex-standardised across countries. PaRIS data included people aged 45 years and older who had at least one primary care contact in the six months prior to the survey, and who lived in a private household in the community (i.e. not in a nursing home or other residential institution) at the time of the survey. Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. United States sample only includes people aged 65 years or older and does not include data collected from practices. The OECD average for the last two indicators therefore only covers 16 countries. In this figure, EU and OECD averages are reported as simple (i.e. unweighted) means across member countries with data shown for the indicator.
Source: OECD (2025[20]), Does Healthcare Deliver? Results from the Patient-Reported Indicator Surveys (PaRIS), https://doi.org/10.1787/c8af05a5-en.
Another key element of patient-centred disease management for NCDs is regular medication reviews. By regularly reviewing treatment plans, primary care providers can deprescribe unnecessary medications, simplify regimens, and ensure that prescriptions are evidence‑based and tailored to the patient’s evolving health status (Box 5.7). This is particularly important for people with multiple NCDs, who are often on a large number of different medications at once.
Almost 1 in 10 hospitalisations in OECD countries may be caused by a medication related event and as many as 20% of inpatients experience medication-related harms during their hospital stay, together costing over USD 54 billion in OECD countries.
In addition to medication-related harms, almost half of all patients receive prescriptions for medications that do not meet their clinical needs, due to inappropriate dose or duration, inappropriate medication or medication given when an alternative intervention may be equally or more effective. Going further, half of all medicines are not taken appropriately, increasing hospital costs and worsening patient outcomes.
Medication safety is especially important in patients with NCDs, as they tend to have polypharmacy and have increased hospitalisations compared to patients without NCDs. Each hospital visit carries the chance of changing a patient’s list of medication, and up to two errors per patient have been reported in medication documentation in discharge summaries in Australia (Roughead, Semple and Rosenfeld, 2016[18]). Additionally, patients living with certain NCDs such as diabetes have an increased risk of chronic kidney disease development and progression, which can increase the potential for harm as dosing requirements change given many medications are cleared through the kidneys. Regular medication review is important to reduce those harms in particular at transition points such as hospital to home.
Several mechanisms exist to promote appropriate prescribing, including clinical guidelines, digital innovations, drug utilisation review and audit and feedback mechanisms. Health information infrastructure is key to improving medication safety, with innovations in digitisation such as drug administration systems and e‑prescribing coupled with improvements to data infrastructure such as electronic health record (EHR) capacity, bar coding, and post-marketing surveillance having significant potential to improve medication safety.
Source: Slawomirski et al. (2025[41]), “The economics of diagnostic safety”, https://doi.org/10.1787/fc61057a-en.
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