Non-communicable diseases (NCDs) continue to rise across OECD and EU countries despite decades of policy effort. Since 1990, the prevalence of cancer, chronic respiratory and cardiovascular diseases has increased markedly, while diabetes prevalence has nearly doubled in the OECD. This growing burden is driven by rising obesity rates, improved survival, and population ageing. Beyond health impacts, NCDs impose substantial economic and social costs, reducing productivity, increasing health expenditure, and constraining economic growth. Modelling using the OECD SPHeP NCDs model shows that aligning risk factors and survival rates to top-quartile country performance could significantly reduce premature mortality, lower health spending, and boost GDP. Obesity offers the greatest potential, while prevention delivers larger and broader benefits than treatment alone. Effective NCD strategies rest on empowering individuals, creating health-promoting environments, and strengthening prevention-oriented health systems.
The Health and Economic Benefits of Tackling Non‑Communicable Diseases
Abstract
Investing in NCD prevention is investing in social and economic prosperity
NCDs profoundly undermine people’s health, well-being and the wider economy. OECD modelling shows that four major NCDs: cancer, cardiovascular diseases, chronic obstructive pulmonary disease (COPD) and diabetes increase the risk of mental ill‑health by up to 25% and will account for around 4 in 10 premature deaths over the next 25 years in the OECD and EU. Their impact extends beyond health, lowering wages, reducing productivity and increasing pressure on health systems: eliminating these NCDs would reduce health spending by 41% and contribute to a 3.8% increase in annual GDP on average over the period 2026 to 2050 (40% and 3.9% respectively in the EU).
Much of the NCD burden is avoidable, with prevention delivering greater benefits than improvements in disease management, as measured through improvements in survival. For example, aligning key risk factors to the top 25% of OECD and EU countries (Top Quartile) yields substantially larger reductions in premature mortality and stronger economic benefits than improving the management of patients who have already developed cancer or CVDs. If all OECD countries achieved the Top Quartile risk factor levels, the OECD model estimates that GDP would be 1.3% higher and premature mortality would be 11.4% lower (1.4% and 11.5% respectively in the EU). By contrast, improvements in patient management aligning both cancer and CVD survival would only reduce premature mortality by 3.2% and increase GDP by 0.1% (5% and 0.1% respectively in the EU).
Tackling obesity offers the greatest opportunity to reduce the NCD burden. If all countries in the OECD were to achieve the Top Quartile obesity prevalence, this would reduce the total NCD incidence by 11%, premature mortality by 5.6%, and total health expenditure by 3.3%, on average over 2026 to 2050 (7.0%, 3.6% and 1.6%, respectively, for the EU). It would also increase the total OECD workforce output by the equivalent of 4.5 million full-time workers and raise the annual GDP by 0.6% on average (495 000 and 0.6% respectively for the EU).
All countries can achieve substantial improvements by concentrating on just one or two top priorities. On average across the 51 countries analysed, addressing the country’s leading priority alone delivers around 50% of the total potential impact on cases, healthcare expenditure and GDP. Tackling the top two covers roughly 75%, while the top three account for about 90% of the total. For premature mortality, which is affected by both risk factor and survival rates, addressing the top two priorities generates 50% of the impact on average.
To effectively tackle NCD risk factors, comprehensive strategies are useful to address the full range of underlying determinants. Any successful approach should be anchored in three interconnected pillars: empowering individuals through information and education; shaping environments that make healthier choices easier; and building responsive health systems that deliver both prevention and care.
Decades of efforts have not yet succeeded in reversing the rising trends in non-communicable diseases (NCDs) (Box 1.1). Despite international commitments, national policy initiatives and health promotion programmes, the burden of NCDs has continued to rise across OECD and European Union (EU) countries. Between 1990 and 2023, the prevalence of cancer1 and chronic obstructive pulmonary disease (COPD) has increased by 36% and 49% in the OECD (39% and 41% respectively in the EU), while the prevalence of cardiovascular diseases (CVDs) has increased by more than 27% (21% in the EU). Diabetes prevalence rose even more: by 86% in the OECD, and 64% in the EU (Global Burden of Disease Collaborative Network, 2024[1]). As a result, NCDs now represent one of the greatest challenges to population health: in 2023, one in ten people in the OECD had diabetes, and one in eight lived with CVD (one in twelve and one in seven respectively in the EU).
NCDs are long-lasting health conditions, that typically develop slowly and progress over time. NCDs include CVDs (such as heart attacks and strokes), cancers, chronic respiratory diseases (such as COPD), and diabetes. These conditions are the leading cause of death worldwide (IHME, 2025[2]).
In this report, the analyses on NCDs refer to on four disease groups: CVDs, cancers, COPD, and diabetes. This aligns with Sustainable Development Goal (SDG) 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”, which looks at cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases (United Nations, n.d.[3]).
As there are a large number of different cancers and CVDs, not all could be covered in the OECD SPHeP NCDs model. The model focusses primarily on public health amenable diseases: those that are related to risk factors and more susceptible to prevention through public health interventions. The cancers covered in the model account for 71% of all cancer deaths in the OECD, and 88% of all risk factor-related cancer deaths. The CVDs included in the model account for 78% of all CVD-related deaths in the OECD, and 87% of all risk factor-related cancer deaths (IHME, 2025[2]).
There are three main reasons why the burden of NCDs continues to grow.
First, in many countries, progress in reducing certain risk factors, such as air pollution, smoking, harmful alcohol consumption, and physical inactivity, has been undermined by steep increases in obesity.2 Analyses using the OECD Strategic Public Health Planning for Non-Communicable Diseases (SPHeP-NCDs) model (Box 1.2) show that, for the OECD as a whole, the positive impact of reductions in air pollution, smoking, harmful alcohol use and physical inactivity since 2010 are completely wiped out by the negative impact of increasing obesity prevalence (Figure 1.1). Across the 51 countries in the analysis, 57% have seen NCD incidence increase due to changes in risk factors, while in 43% it decreased. The primary driver of increasing NCD incidence is obesity, while improvements are driven mostly by reductions in air pollution and smoking.
Impact of progress on risk factors between 2010 and 2022 (or most recent year) on the number of new cases of four major NCDs per year, on average over 2026-2050, for 38 OECD countries combined
Note: The results compare the annual number of new NCD cases in a business-as-usual scenario (which continues 2022 risk factor levels into the future) to one in which risk factors are kept at 2010 levels, reflecting the number of new NCD cases per year on average over 2026-2050. In other words, in this case there will be 233 677 more new NCDs per year in the OECD than if risk factors remained at 2010 levels. The results are adjusted for changes in population size. The impact of physical inactivity and diet on NCDs does not reflect the impact of physical activity and diet on body weight, as this is covered under obesity. The totals exclude the small changes in NCDs that are not a result of a risk factor-disease link, but that are due to the impact of risk factor changes on the population size. An EU specific figure is available in Chapter 2, Annex 2.A and a G20 specific figure in Annex Figure 2.B.1.
Source: OECD SPHeP NCDs model, 2025.
Model structure
The OECD SPHeP-NCDs model is an advanced systems modelling tool for public health policy and strategic planning. It is used to predict the health and economic outcomes of the population of a country or a region up to 2050. The model produces a comprehensive set of key behavioural and physiological risk factors (e.g. smoking, obesity, physical activity, harmful alcohol consumption, unhealthy diet, air pollution) and their associated NCDs and other medical conditions. The model covers 51 countries, including OECD Member countries, G20 countries, EU27 countries and OECD accession and selected partner countries.
For each country, the model uses demographic and risk factor characteristics by age‑ and sex-specific population groups from international databases. These inputs are used to generate synthetic populations, in which each individual is assigned demographic characteristics and a risk factor profile. Based on these characteristics, an individual has a certain risk of developing a disease each year. Incidence and prevalence of diseases in a specific country’s population were calibrated to match estimates from international datasets.
Model outputs
For each year, a cross-sectional representation of the population can be obtained, to calculate health status indicators such as life expectancy, disease prevalence and disability-adjusted life years using disability weights. Healthcare costs of disease treatment are estimated based on a per-case annual cost, which is extrapolated from national health-related expenditure data, using a payer perspective. The additional cost of multi-morbidity is also calculated and applied. The extra cost of end-of-life care is also considered.
The labour market module uses relative risks to relate disease status to the risk of absenteeism, presenteeism (where sick individuals, even if physically present at work, are not fully productive), early retirement and employment. These changes in employment and productivity are estimated in number of full-time equivalent workers. The impact of demographic changes and labour force participation and productivity are translated into a change in gross domestic product (GDP) using the Cobb-Douglas production function, consistent with the OECD long-term economic forecast model (Guillemette and Turner, 2017[4]) and other established long-term models such as the World Bank Long Term Growth Model (Pennings and Loayza, 2022[5]). The GDP model also assumes that, in the long run, capital intensity remains constant, as the capital stock adjusts over time to increases in labour in order to restore its initial level.
For more information on the OECD SPHeP-NCDs model, see the online technical documentation, available at: http://oecdpublichealthexplorer.org/ncd-doc.
Second, improvements in survival mean that more people live for longer periods with chronic conditions. Case fatality rates for acute myocardial infarction (heart attacks) have decreased 23% between 2010 and 2022 across 15 OECD countries with data, and the fatality rate from stroke dropped 14% (OECD, 2025[6]) (Figure 1.2). Similarly, between 1995 and 2014, the proportion of people alive five years after their lung cancer diagnosis (5‑year survival rate) increased from 10% on average across 7 OECD countries, to 19% (Arnold et al., 2019[7]). In the same period, the 5‑year survival rate of colorectal cancer has gone from 52% in 1995, to 66% in 2014.
30‑day mortality (in- and out of hospital, linked data) after acute myocardial infarction and ischaemic stroke, selected countries with trend data, deaths per 100 patients
Note: In this figure, the OECD15 average represents a simple (i.e. unweighted) mean across 15 OECD countries.
Source: OECD Health Statistics 2025, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html.
These improvements in survival are an unequivocal public health success, but they also result in greater numbers of people requiring ongoing disease management. The rising prevalence of NCDs also increases the number of people living with multiple chronic conditions at the same time. Multimorbidity has a direct impact on people’s quality of live, as people with two chronic conditions score lower on well-being, mental health and social functioning (OECD, 2025[8]). Moreover, dealing with multiple chronic conditions is more complex and resource‑intensive for health systems than caring for a single illness (Box 1.3).
While healthcare policy, research, professional training and clinical guidelines have traditionally focussed on single diseases, results from the OECD Patient-Reported Indicator Surveys (PaRIS) stress that multimorbidity – people living with two or more chronic conditions – is a massive challenge in healthcare, particularly in primary care. Managing these conditions is far more complex and resource‑intensive than dealing with a single illness, putting pressure on healthcare systems and healthcare professionals to deliver high-quality, co‑ordinated, people‑centred care.
Treating multiple conditions can lead to overlapping or conflicting approaches. For example, people with multiple chronic conditions often take numerous medications. The more conditions a person has, the more complex and riskier their medication regimen becomes. This increases the likelihood of medication safety incidents and makes self-management more complex. Among people aged 45 and over who visited their primary care practice, the likelihood of someone taking five or more medications increased significantly with the number of NCDs: from less than 10% among people without an NCD, to 30% among people with one NCD and more than 60% among people with two or more NCDs (Figure 1.3).
Proportion of PaRIS respondents taking five or more medications, stratified by NCD status
Note: For this analysis four NCDs were included: cancer, CVD, chronic respiratory diseases (CRD, which include COPD) and diabetes. 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. In this figure, EU11, OECD17 and PaRIS19 averages are reported as simple (i.e. unweighted) means across member countries who took part in the survey.
Source: OECD PaRIS 2024 Database.
In addition, people with multiple conditions are less confident in managing their own care. In almost all countries covered by PaRIS, people with more NCDs reported a lower confidence in their ability to manage their own health and well-being. For the health system, this means that they require more information and support from their primary care physicians.
Third, population ageing means that more people are reaching the ages at which NCDs are most common. Even if risk factor prevalence and survival rates remain constant, the number of new NCD cases is expected to grow by 31% in the OECD (and 29% in the EU) between 2026 and 2050, as the incidence would increase from 1 936 per 100 000 people per year to 2 518 (2 141 to 2 755 in the EU) (Figure 1.4). The prevalence of multimorbidity is projected to increase even more: by 75% in the OECD and 70% in the EU. The growing NCD burden will also lead to steep increases in healthcare costs, increasing per capita spending on NCDs in OECD countries by more than 50%, from USD PPP 646 to USD PPP 994 in the OECD (USD PPP 607 to USD PPP 938 in the EU).
Increase in the number of NCDs, and the prevalence of multimorbidity, between 2026 and 2050
Note: Projections are based on current population size, and current age‑ and sex-specific incidence and mortality rates of the four NCDs. This analysis only looks at 4 groups of NCDs: CVDs, cancer, diabetes and COPD – both for the number of new cases and for the prevalence of multimorbidity. In this figure, EU, OECD and G20 averages are reported as simple (i.e. unweighted) means across member countries.
Source: OECD SPHeP NCDs model, 2025.
The growing burden of NCDs is not only a public health challenge but also an economic and societal one. Effective action to prevent and manage NCDs should be seen as an investment in quality of life, productivity, and economic growth. For policymakers, understanding the wider economic and societal impact of NCDs is vital to making the case for sustained investment in the prevention and treatment of NCDs.
NCDs are a major cause of premature mortality (deaths before the age of 75) (OECD/Eurostat, 2022[9]). Premature mortality reduces life expectancy, but it also places psychological and financial strain on households and communities. The four NCDs covered in the OECD SPHeP NCD model (Box 1.1) will account for an estimated 44% of premature mortality across the OECD (46% in the EU) on average over 2026-2050, with cancers and CVDs alone accounting for around 40% (Figure 1.5). However, this is an underestimation, as this analysis only includes cancer and CVDs that are linked to behavioural risk factors or are otherwise amenable to public health interventions. When all cancers and CVDs are considered, the four NCDs accounted for 62% of all premature deaths in the OECD in 2023 (70% in the EU) (IHME, 2025[2]). Action on NCDs can also improve mental health, as NCDs have been shown to be associated with a higher risk of depression (Box 1.4).
Premature mortality (deaths in people under the age of 75) due to public health amenable cancers, CVDs, diabetes and COPD, as a percentage of total premature mortality, average over 2026‑2050
Note: the results compare premature mortality in a business-as-usual scenario to one in which the four NCDs are eliminated, and reflect the change in premature deaths from NCDs, averaged over 2026-2050. As the model focusses on public health-amenable conditions, it does not cover all cancers and CVDs. Therefore, the burden presented is an underestimation of the total premature mortality burden from those diseases. In this figure, EU, OECD and G20 averages are reported as simple (i.e. unweighted) means across member countries.
Source: OECD SPHeP NCDs model, 2025.
NCDs diminish overall quality of life and increase the likelihood of developing depression. OECD analysis of Survey of Health, Ageing and Retirement in Europe (SHARE) data shows that – even when adjusting for confounders such as age, sex, socio-economic status, country, smoking status, and frequency of alcohol consumption – people with NCDs were more likely to go on to develop depression than people without NCDs. Depression in the survey was defined as having experienced at least four of the following 12 symptoms in the four weeks prior to the interview: depressed mood, pessimism, suicidality, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment and tearfulness People with cancer or diabetes have a 15% increased risk of developing depression, 17% for heart failure, 21% for stroke and 25% for chronic lung disease. Moreover, the data shows that the risk increased with the number of NCDs. While people with one NCD have a 21% increase in the risk of depression, people with two NCDs have an 42% increased risk, and people with three or more NCDs a 50% increased risk of depression.
There are several biological, psychological and social factors that can explain a potential causal relationship between NCDs and depression. Psychologically and socially, loss of sense of self, social isolation from fatigue and lack of energy that drive loss of pursuit of normal activities, limitations to mobility, activities of daily living and chronic pain have all been associated. Fear and uncertainty of the incurable and unpredictable nature of certain NCDs contribute, as do beliefs about their NCDs and ability to self-manage their NCD. Biologically, neurodegeneration associated with certain NCDs and side effects of treatments associated with others can also play a role. An inverse relationship is also plausible, with depression increasing the risk of NCDs, for example by reducing motivation to exercise.
Source: Everard et al. (2025[10]), “Exploring the relationship between non-communicable diseases and depression”, https://doi.org/10.1787/02a1cfc5-en.
Men bear a disproportionally large share of the NCD burden. In addition to biological factors (Regitz-Zagrosek and Gebhard, 2022[11]), men and women have different risk profiles for NCDs due to differences in behaviours. Men are generally more likely to engage in risky behaviours such as smoking and harmful alcohol use, and they are more prone to being overweight. While women are more likely to be insufficiently physically active, the difference with their male counterparts is relatively small (OECD, 2025[6]; WHO, 2025[12]). As a result, the premature mortality rate from NCDs for men in the OECD is 77% higher than that of women. In the EU, the premature death mortality rate from NCDs is almost twice as high for men compared to women, with some variation depending on NCDs. For instance, OECD modelling suggests premature mortality is almost 40% higher in men than women for cancer, and 71% higher for diabetes.
The economic impact of NCDs is equally substantial. If there were no NCDs, annual health expenditure would be 41% lower over the next 25 years in the OECD (40% in the EU). Moreover, through reduced labour force participation and productivity, NCDs reduce the workforce output by the equivalent of up to 18 million full-time workers in the OECD and 5 million in the EU, eliminating the equivalent of almost two full-time workers for every 100 working-age individuals in the OECD and EU. At the macroeconomic level, premature mortality and lower productivity are projected to reduce the average GDP of OECD and EU countries by nearly 4%, on average over 2026-2050 (Figure 1.6).
The reduction in annual GDP due to NCDs, expressed as percentage of GDP, on average over 2026‑2050
Note: the results compare the GDP in a business-as-usual scenario to one in which the four NCDs are eliminated, and reflect the change in the annual GDP, averaged over 2026-2050. In this figure, EU, OECD and G20 averages are reported as simple (i.e. unweighted) means across member countries.
Source: OECD SPHeP NCDs model, 2025.
The challenge of addressing NCDs is complex, given the multiple risk factors and the wide range of policy entry points. However, clear priorities can be identified by assessing the relative impact of different risk factors on health and the economy, and by benchmarking performance against leading OECD and EU countries. Here, priority areas for action are identified by aligning NCD risk factor prevalence and NCD survival rates to level achieved in the top 25% of OECD and EU countries, for each age and sex group. This Top Quartile approach shows the areas with the greatest potential for improvement (Box 1.5).
To understand the potential for improvement, NCD risk factor prevalence rates and NCD survival rates for each country were aligned to the top 25% levels observed across OECD and EU countries, for each age and sex group (Figure 1.7). Rather than eliminating all risk or aligning to the very best performance, this approach can be considered a realistic goal for most countries.
Importantly, under the Top Quartile scenario a non-insignificant amount of risk remains. Firstly, aligning to the Top Quartile means countries that are already in the Top Quartile group will see no impact for that risk factor in that age and sex group. For others, it will reduce risk factor levels but only to the level of the Top Quartile, rather than fully eliminating them. Secondly, as NCDs develop over time, historic exposure to risk factors will continue to have an impact on the future NCD burden. Thirdly, reduced risk factor exposure may only delay the onset of NCDs for some individuals.
Countries can achieve meaningful health and economic gains by addressing NCD risk factors
If all OECD countries achieved the Top Quartile risk factor prevalence (an ambitious but achievable target), annual premature mortality would be 11.4% lower, total healthcare expenditure 6.2% lower and annual GDP 1.3% higher on average, over 2026-2050 (11.5%, 4.6% and 1.4%, respectively, in the EU).
While these numbers may appear modest at first glance, the impact on health and the economy is substantive. A 11.4% drop in premature mortality means one person in the OECD is saved from an early death every minute (and every 3.5 minutes in the EU). A 6.2% decrease in healthcare expenditure is a total annual saving of USD PPP 317 billion, equivalent to more than the total healthcare expenditure of Italy (USD PPP 67 billion in the EU, equivalent to the healthcare expenditure of Austria) (OECD, 2025[13]; World Bank, 2024[14]). This is more than the average spending on all preventive care, which is around 3% of overall health spending across OECD countries. A 1.3% increase in GDP across the OECD is nearly USD 1 trillion in additional economic output annually – comparable to adding the entire economies of Sweden and Portugal to the OECD’s GDP (1.4% across the EU equates to USD PPP 342 billion, equivalent to adding more than the entire economy of Finland to the EU’s annual economic output (World Bank, 2024[15])).
While there is considerable variation between countries, no country is in the Top Quartile for all risk factors, and for all countries there are potential health and economic gains. Even if the economic impact may be modest in some cases, the fact that prevention benefits individuals and yields measurable economic gains makes it valuable in itself.
Tackling obesity offers the greatest opportunity to reduce the NCD burden
Addressing obesity would have the largest impact on reducing NCD incidence in the OECD – accounting for more than half (51%) of the 6.7 million NCD cases that could be avoided per year by aligning risk factors to the Top Quartile level (42% of the 1.8 million NCDs in the EU). This is particularly driven by the impact of obesity on the incidence of cardiovascular disease (Figure 1.8).
Impact of aligning risk factor prevalence to the Top Quartile level, expressed as the number of NCD cases avoided per year, broken down by risk factors and NCDs, total for the OECD, average over 2026-2050
Note: the results compare the number of new NCDs per year in a business-as-usual scenario to one in which all countries achieve the Top Quartile risk factor levels and reflect the change in new NCD cases per year, averaged over 2026-2050.
Source: OECD SPHeP NCDs model, 2025.
If all countries in the OECD were to achieve the Top Quartile obesity prevalence, this would reduce the total NCD incidence by 11%, premature mortality by 5.6%, and total health expenditure by 3.3%, on average between 2026 and 2050 (7.0%, 3.6% and 1.6%, respectively, for the EU). It would also increase the total OECD workforce output by the equivalent of 4.5 million full-time workers and raise the annual GDP by 0.6% on average (495 000 full-time workers and 0.6% of GDP for the EU).
Other risk factors also play significant roles. Smoking has a disproportionately large effect on premature mortality due to its strong link to cancer. Harmful alcohol use has a substantial economic impact because, in addition to contributing to a wide set of health conditions, it tends to have a larger detrimental effect on productivity and labour force participation than many other risk factors.
Prevention delivers larger health and economic benefits than cure
To improve health and economic outcomes, there are different levels at which policy can act. Primary prevention aims to stop diseases before they occur, by promoting healthy lifestyles and reducing environmental risks. Once a disease has already developed, the focus should be on treating it early and effectively, to prevent complications or death. The quality of care for NCDs is partially reflected in the survival rates of those who become ill. As survival rates vary significantly across countries, there remains substantial scope to improve care for NCDs, in addition to preventing NCDs in the first place. This would reduce premature mortality from NCDs, which would in turn also increase labour force output and GDP.
Aligning both cancer and CVD survival rates in OECD countries to the Top Quartile would reduce the annual premature mortality by about 3.2% and increase GDP by 0.1% (5% and 0.1% respectively in the EU), (Figure 1.9), on average over 2026-2050. However, aligning risk factors such as obesity and smoking to the Top Quartile yields larger reductions in premature mortality. Moreover, the impact of addressing these risk factors on workforce participation and GDP is significantly greater than the gains achieved through improved survival rates. While better survival outcomes contribute meaningfully to health improvements, the economic benefits of reducing key risk factors are far more substantial.
NCD cases prevented (thousands and as a percentage of total new NCD cases), premature deaths avoided (thousands and as a percentage of total premature deaths), health expenditure saved (USD PPP billions and as a percentage of total health expenditure), workforce output increase (full-time equivalents), GDP increase (% of GDP), if all countries achieve the Top Quartile level for risk factor prevalence and for CVD and cancer survival rates, total for OECD countries, per year, average over 2026‑2050
Note: Cancer and CVD survival reflect improvements in diseases management, whereas the other indicators capture gains arising from reduced risk‑factor prevalence through prevention and health promotion measures. The results compare a business-as-usual scenario to one in which all countries achieve the Top Quartile risk factor prevalence or survival rates. Cases of NCDs are specific for the four NCDs, while the impact on premature mortality, health expenditure, workforce output and GDP is a combined effect of the risk factor on all diseases (e.g. including the effects on other diseases like dementia and alcohol use disorders and including comorbidity effects) and on productivity. The increase in health expenditure shown for improved survival rates represent the increased cost of people living with NCDs for longer and does not include any expenditure required to improve the survival rates. CVDs and cancer account for 90% of deaths from NCDs, and survival rates for COPD and diabetes were therefore not considered. In this figure, percentages are calculated using OECD-wide totals, capturing the total impact across OECD countries rather than a simple average of country-level effects.
Source: OECD SPHeP NCDs model, 2025.
This difference arises from several key reasons. First, the results suggest that there is less scope for improvement in survival rates. As they are already relatively similar across high-performing countries, aligning to the Top Quartile survival rate only delivers limited additional gains. In other words, there is less left to gain. Second, behavioural and metabolic risk factors affect multiple diseases simultaneously, so their improvement has a wider impact on overall health. Finally, risk factors also have a direct influence on productivity and economic performance, especially in the case of harmful alcohol use, which is closely linked to absenteeism and reduced work efficiency. As a result, tackling risk factors produces broader benefits for both public health and the economy than improving survival rates alone.
All countries can achieve big results by focussing on one or two key NCD and risk factors priorities
While the greatest potential for the OECD and EU as a whole lies with obesity, country-specific priorities vary. But regardless of which risk factors take precedence and what outcomes are considered, all countries can achieve substantial improvements by concentrating on just one or two top priorities. On average across the 51 countries analysed, addressing the country’s leading priority alone delivers around 50% of the total potential impact on cases, healthcare expenditure and GDP (Figure 1.10). Tackling the top two covers roughly 75%, while the top three account for about 90% of the total. For premature mortality, which is affected by both risk factor and survival rates, addressing the top two priorities generates 50% of the impact on average. These findings highlight the importance of setting clear priorities and allocating resources effectively to maximise impact.
Proportion of the total impact – arising from bringing all risk factor prevalence and CVD and cancer survival rates to the Top Quartile level – that is achieved by the top three priority areas
Note: Improved survival rates do not affect the indicator on cases of NCDs and increase healthcare cost as people live longer with these conditions. Categories are shown in order of their relative importance in the country. In this figure, EU, OECD and G20 averages reflect the overall impact of addressing shared priorities across countries within each group respectively, which can result in a lower value than the average of country-specific priorities.
Source: OECD SPHeP NCDs model, 2025.
In around two out of three countries, obesity provides the greatest opportunity to reduce the number of new cases of NCDs, health expenditure and increase GDP. Smoking, diet and air pollution are also common risk factor priorities. When it comes to reducing premature mortality, obesity remains the top priority in about half of all countries, but CVD survival rates also play a major role. In 11 countries (22%), it is the top priority to reduce premature mortality, and in more than half of all countries it is in the top three. Cancer survival rates are also in the top three of nearly half the countries, but often as a secondary or tertiary priority.
It is important to note that, while focussing on the risk factors where the largest health and economic gains can be achieved is important given the growing burden of NCDs and strain on health systems, this should not lead to neglecting other risk factors that may have a smaller aggregate impact but still carry significant consequences for certain groups. A balanced strategy should therefore combine population-level prioritisation with targeted interventions for vulnerable or high-risk groups. There may also be other societal co-benefits from addressing certain risk factors (Box 1.6). Similarly, while most gains may come from strengthening primary prevention, investment in secondary and tertiary prevention remains essential to ensure timely access to care and better outcomes for those already affected by disease.
Healthier diets would reduce emissions by the equivalent of 58 million cars in the OECD
There are strong links between diets and emissions of carbon dioxide (CO2), methane (CH₄), and nitrous oxide (N₂O). About one‑third of all anthropogenic (human-caused) emissions linked to food systems (Crippa et al., 2021[16]). In the Top Quartile scenario, where consumption rates of meat, fruit, vegetable and whole grain are aligned to the best 25% of countries across the OECD and EU, this is estimated to reduce emissions by 243 Mt of CO2‑equivalent per year, for the OECD as a whole (56 Mt for the EU). This is the amount of emissions associated with more than 58 million gasoline‑powered passenger vehicles (US EPA, 2023[17]) or the number of cars in Germany and the Netherlands combined (13 million in the EU). Further information on the dietary module is available in the SPHeP model documentation (OECD, 2026[18]).
Addressing harmful alcohol use could prevent 5% of premature deaths due to homicide and road traffic accidents in the OECD
Harmful alcohol use has a direct impact on societal safety, as it can lead to road traffic accidents and violence due to its effects on cognitive function, co‑ordination, and behaviour. If all countries were to align total alcohol consumption to the level observed in the best performing 25% of OECD and EU countries, this would prevent a total of 5 367 premature deaths due to road traffic accidents per year in the OECD (2 113 in the EU). This is 4.8% of the total premature mortality from road traffic accidents (6.2% in the EU). It would also prevent 2 358 premature deaths due to interpersonal violence each year in the OECD, 4.8% of the total premature mortality from this cause (327 and 5.9% in the EU). Variation between countries is driven both by current total alcohol consumption and premature mortality rates.
Source: OECD SPHeP NCDs model, 2025.
Although the policy mix will differ across countries depending on their specific risk factor profiles and health priorities, there are three interlinked pillars that underpin all successful NCD strategies: empowered individuals, supportive environments, and responsive health systems (Figure 1.11). These three pillars are mutually reinforcing. 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.
Pillar 1: Empowering individuals through information and education
Sustained progress depends on individuals having the knowledge, motivation, and skills to make healthier choices. Information should go beyond simply raising awareness of risks, by fostering motivation through personal and social incentives, and equipping people with the skills to translate intentions into action. Information, motivation, and behavioural skills should be reinforced across all layers of society, from interpersonal relationships to public policy (Figure 1.12).
Examples of health information and education delivery following the Information-Motivation-Behavioural skills (IMB) model and the socio‑ecological model
Note: Examples are illustrative and non-exhaustive.
Source: OECD analysis, based on models from McLeroy et al. (1988[19]), “An Ecological Perspective on Health Promotion Programs”, https://doi.org/10.1177/109019818801500401 and Fisher and Fisher (1992[20]), “Changing AIDS-risk behavior”, https://doi.org/10.1037/0033-2909.111.3.455.
Pillar 2: Creating environments that support healthier choices
Environments where people live, work, and learn strongly influence their risk of NCDs. Policies that create health-promoting environments, by reducing barriers, addressing the impact of social, environmental, economic, commercial and market factors, and making healthier options more accessible, are therefore key to supporting behaviour change and shifting social norms. Every decision about food systems, transport, housing, education, employment, and digital environments influences health outcomes. Countries can benefit from learning from international experiences and adapting proven approaches to their own contexts.
Many environmental policies to promote healthy behaviours also contain an element of education and information. For example, food and menu labelling provide 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 1.13) (OECD, 2019[21]; OECD, 2021[22]). 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 ratios, 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[22]; OECD, 2019[21]). 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[21]), The Heavy Burden of Obesity: The Economics of Prevention, https://doi.org/10.1787/67450d67-en and OECD (2021[22]), Preventing Harmful Alcohol Use, https://doi.org/10.1787/6e4b4ffb-en.
In addition to environmental and informational measures, regulatory and price‑based policies can play a critical role in shaping 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 low-cost 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[23]; OECD, 2021[22]; OECD, 2019[21]; OECD, 2024[24]). 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 46% average reduction in sugar in soft drinks in scope of the tax between 2015 and 2020 (UK Government, 2025[25]). However, these types of policies also involve the highest degree of interference with individual choice (Sassi and Hurst, 2008[26]).
Previous OECD work on promoting healthier lifestyles shows that multi-pronged approaches consistently deliver greater impact and better value for money (OECD, 2019[21]; OECD, 2021[22]). 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[21]; OECD, 2021[22]). 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.
Pillar 3: Building responsive health systems that deliver prevention and care
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: Primary care providers play a critical role in promoting healthier lifestyle choices, but this potential is often underused. Among people aged 45 and over who visited their primary care practice, less than one‑third of daily drinkers receive counselling on alcohol use, and only about half of all daily smokers receive cessation advice (Figure 1.14).
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. 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 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. 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: Population-based screening programmes are essential for early detection of cancers, yet uptake varies widely. In 2023, only 57% of eligible women across OECD countries were screened for breast cancer, with coverage ranging from 15% in Greece to 83% in Sweden. Primary care can play a key role in providing and increasing screening uptake, as well as screening for complications of NCDs through reminders, training, and quality audits.
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.
Patient-centred disease management: NCDs often require the co‑ordinated management of multiple conditions and active patient involvement, increasing the need for integrated and people‑centred health systems. However, results from PaRIS show that there is still some way to go in creating people‑centred health systems (Figure 1.15). On average, patients aged 45 and over who visited their primary care provider in the survey 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, 2026[27]; OECD, 2025[8]).
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. 19 countries participated in the PaRIS survey, of which 18 OECD countries. 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 who took part in the survey.
Source: OECD (2025[8]), 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. This is particularly important for people with multiple NCDs, who are often on a large number of different medications at once.
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← 1. Changes in cancer prevalence were calculated by changes in the prevalence of neoplasms as categorised by IHME (IHME, 2025[29]).
← 2. Obesity is a chronic, relapsing disease arising from complex biological, behavioural and environmental drivers, and it is also a major risk factor for a wide range of non‑communicable diseases. In this publication, obesity is defined as a body mass index (BMI) of 30 or higher, in line with internationally adopted NCD targets (Global Burden of Disease Collaborative Network, 2024[1]; WHO, 2025[28]). However, it should be noted that overweight (a BMI of 25 or higher and less than 30) also poses health risks. Obesity as a risk factor in this study includes the impact of physical activity and diet on BMI. The impact of physical inactivity and diet on NCDs does not reflect their impact on BMI, as this is already covered under obesity.