Over the past century, the global burden of disease has shifted from infectious diseases to NCDs. Despite sustained efforts, NCD prevalence continues to rise across OECD and EU countries. Since 1990, rates of cancer, chronic respiratory and cardiovascular diseases have increased substantially, while diabetes prevalence has risen particularly sharply. This persistent growth is driven by three interrelated forces. First, gains from reductions in smoking, air pollution and harmful alcohol use have been offset by worsening obesity trends, now the dominant driver of rising NCD incidence. Second, major improvements in early detection and treatment have increased survival, resulting in more people living longer with chronic and multiple conditions, increasing care complexity and costs. Third, population ageing will further accelerate NCD incidence, multimorbidity and health expenditure. Without decisive action, the health and economic burden of NCDs will continue to escalate in the coming decades.
The Health and Economic Benefits of Tackling Non‑Communicable Diseases
Abstract
The growing NCD burden will escalate unless decisive action is taken
Over the past century, global health has undergone a profound transformation. Once dominated by infectious diseases, illness and death are now primarily caused by NCDs. These long-lasting conditions are the result of genetic, environmental and behavioural risks.
Despite national and international efforts to reduce NCD risk factors, the burden of NCDs continues to rise. Between 1990 and 2023, the prevalence of cancer and COPD has increased by 36% and 49% in the OECD, respectively (by 39% and 41% respectively in the EU), while the prevalence of 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. 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).
Three key factors explain this persistent growth. First, while some risk factors such as smoking and air pollution have improved, obesity levels have worsened in many countries. Analyses using the OECD Strategic Public Health Planning for Non-Communicable Diseases (SPHeP-NCDs) model show that, for the OECD, the positive impact of reductions in air pollution, smoking, harmful alcohol consumption and physical inactivity since 2010 are completely wiped out by the negative impact of increasing obesity levels. Across the 51 countries in the analysis, the primary driver of increasing NCD incidence is obesity, while improvements are driven mostly by reductions in air pollution and smoking.
Second, thanks to advances in early detection, treatment, and disease management, survival rates have improved markedly over recent decades. Between 2010 and 2022, the fatality rate from heart attacks in 15 OECD countries dropped from 10.1% to 7.8% (a 23% reduction) while stroke fatality rates fell by 14%. Cancer survival has also improved: between 1995 and 2014, five‑year survival for lung cancer nearly doubled (from 10% to 19%) and colorectal cancer survival increased from 52% to 66%. While these are unequivocal successes, it does mean that more people now live longer with chronic conditions, increasing demand for care and monitoring.
Moreover, multimorbidity (having multiple chronic diseases) is becoming more common and poses major challenges. People with multiple chronic conditions report poorer mental health and social functioning. For healthcare providers, multimorbidity increases complexity and cost. For example, the risk of medication errors rises sharply with the number of conditions: fewer than 10% of people without an NCD take five or more medications, compared to over 60% of those with two or more.
Thirdly, rising life expectancy, a major public health achievement, has also contributed to the expanding NCD burden. As people live longer, they are more likely to develop chronic diseases. This demographic shift will continue in the coming decades. Even if risk factor trends 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. The incidence rate would increase from 1 936 per 100 000 people per year to 2 518 in the OECD, and from 2 141 to 2 755 in the EU. 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).
Over the past century, the global health landscape has undergone a profound transformation. While infectious diseases once dominated as the primary cause of illness and death, advances in medicine, sanitation, and public health have significantly reduced their impact. In their place, NCDs have emerged as the defining health challenge of the 20th and 21st centuries, driven by changes in population ageing, urbanisation, and lifestyles (Box 2.1).
NCDs are long-lasting health conditions. Unlike infectious diseases, they 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[1]).
NCDs arise from a complex interaction of genetic, physiological, environmental, and behavioural risk factors. The primary modifiable risk factors are smoking, harmful use of alcohol, unhealthy diet, and physical inactivity, which contribute to obesity, high blood pressure, raised blood sugar, and abnormal blood lipids. An important environmental cause is air pollution, in particular inhaled particulate matter (PM).
While prevention through addressing risk factors is critical, effective management of NCDs is equally important to reduce disability and avoid life‑threatening complications. Early detection, timely treatment, and continuous care help prevent severe outcomes such as heart failure, kidney disease, blindness, amputations, and premature death.
In this report, the analyses on NCDs refer to 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.[2]).
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 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[1]).
The rise in NCDs has forced health systems to adapt beyond acute care toward chronic disease management and prevention. In 1986, the Ottawa Charter for Health Promotion marked an early global call to action on lifestyle‑related risks. The adoption of the Framework Convention on Tobacco Control in 2003 (WHO, 2003[3]) was the first binding global agreement on a risk factor. Broader strategies on diet, physical activity, and harmful alcohol use followed, and the UN High-Level Meeting on NCDs in 2011 made it clear that these were not just health issues but also development priorities. Since then, NCDs and their risk factors have been embedded in the Sustainable Development Goals, reflecting the fact that NCDs are now one of the biggest global health threats.
Despite international and national action on NCDs, their burden has continued to grow (Figure 2.1). Between 1990 and 2023, the prevalence of cancer and COPD has increased by 36% and 49% in the OECD, respectively (and by 39% and 41% respectively in the EU), while the prevalence of CVDs has increased by more than 27% (21% in the EU). Diabetes prevalence has grown 86% in the OECD, and 64% in the EU. As a result, NCDs now represent one of the greatest challenges to 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).
Prevalence of CVD, COPD, diabetes and cancer (% of population) over time, in the OECD and the EU
Note: labels show the change in prevalence between 1990 and 2023.
Source: Global Burden of Disease Collaborative Network (2024[4]), Global Burden of Disease 2023, https://vizhub.healthdata.org/gbd-results/.
There are three main reasons for the growing prevalence of NCDs. Firstly, while some progress has been made on certain risk factors, others have significantly worsened. Secondly, as survival rates have improved, people live with chronic diseases for longer. Thirdly, population ageing means more people reach the ages at which NCDs are most prevalent.
Prevention of NCDs primarily focusses on addressing key modifiable risk factors: smoking, harmful alcohol consumption, obesity, unhealthy diets, low physical activity and air pollution. Many countries have made undeniable strides in addressing these NCD key risk factors. Smoking prevalence is being curbed. Total alcohol consumption is down in many countries. Air quality is improving. However, other risk factors have significantly worsened. Obesity levels have increased in nearly all countries, and still too few people get enough physical activity (Table 2.1) (Box 2.2).
Risk factor prevalence for 2023 or nearest year (2020 for air pollution), compared to 2010 or nearest year (2015 for vegetable consumption)
Note: Colours indicate whether the country performs better (green) or worse (red) versus the other countries. Arrows indicate whether the risk factor has increased or decreased vs. 2010 or nearest year (X indicates that data were not available). EU and OECD averages for each indicator represent unweighted averages and exclude countries with missing values for that indicator. Share of population who are daily smokers (%); alcohol consumption in litres per person per year; share of population who are obese (%, self-reported); share of population consuming vegetables daily (%); share of population engaging in insufficient physical activity (%); mean population-weighted exposure to PM2.5 (microgrammes per cubic metre). While daily vegetable consumption is shown to represent diet, there are other dietary risk factors, such as low fruit and whole grain consumption, and high red meat, processed meat and sodium consumption.
Source: OECD Health Statistics (2025[5]), https://www.oecd.org/en/data/datasets/oecd-health-statistics.html; OECD data on exposure to air pollution (2025[6]), https://www.oecd.org/en/topics/environmental-statistics-accounts-and-indicators.html; WHO Global Health Observatory data on physical activity (2025[7]), https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-insufficient-physical-activity-among-adults-aged-18-years-(crude-estimate)-(-).
The OECD SPHeP NCDs model requires highly detailed data, broken down by year, age, and sex, for all 51 countries it covers. As a result, it relies on international datasets such as those from WHO, IARC, IHME, and NCD-RISC rather than on OECD Health Statistics. When comparing these data sources, several important differences are worth keeping in mind:
Differences in metrics: OECD Health Statistics may report indicators that are not directly comparable with those used in international sources (e.g. daily smokers vs. current smokers).
Differences in measurement methods: Some variables (such as obesity) are self-reported in OECD Health Statistics, whereas international sources often use measured data.
Differences in data construction: OECD Health Statistics draw directly from national sources, whereas other data sources calculate harmonised estimates, including imputation where national data are missing.
Differences in granularity: The OECD SPHeP NCDs model incorporates more detailed inputs (e.g. specific BMI values, linked to specific relative risks, or smoking data by age group), while OECD Health Statistics provide higher-level aggregates (e.g. percentage of the population that is obese, percentage that smokes).
Differences in time trends: The OECD SPHeP NCDs model uses annual risk factor data, which may fluctuate year-to-year. It may go up and then down again. This can result in trends that look different from a simple comparison of two points in time, such as 2022 versus 2010.
Due to the difference in data sources and methods, the values reported in the OECD Health Statistics and those used in the OECD SPHeP NCDs model can be different. However, similar trends across countries can be observed (see Annex A for a comparison of the different datasets).
Analyses using the OECD SPHeP-NCD model show that the positive impact of reductions in air pollution, smoking, harmful alcohol consumption and physical inactivity since 2010 are completely wiped out by the negative impact of increasing obesity prevalence (Figure 2.2) (see Annex A for more details on the OECD SPHeP NCDs model). Progress made between 2010 and 2022 in reducing air pollution and smoking will result in 820 000 and 490 000 fewer new NCD cases, respectively, annually over 2026-2050 across the OECD. Together, changes in total alcohol consumption and physical activity levels will prevent another 60 000 cases yearly. However, this benefit is outweighed by worsening obesity levels, which are projected to lead to an additional NCD 1.6 million cases per year over the same period. The combined impact of changes in the six risk factors between 2010 and 2022 will result in 240 000 additional cases of the four major NCDs across the OECD every year. CVDs and diabetes caused by obesity are the foremost driver of this increase in NCD burden. See Annex Figure 2.A.1 for EU results and Annex Figure 2.B.1 for G20 specific results.
Impact of progress on risk factors between 2010 and 2022 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 scenario where 2022 risk‑factor levels continue against a scenario in which risk‑factor levels remain at their 2010 values. Figures show the average number of new cases per year between 2026 and 2050. The estimates for physical inactivity and unhealthy diet exclude their effects on body weight, which are captured under obesity. Totals also exclude the small changes in NCD cases that stem from population‑size shifts rather than direct links between risk factors and diseases. For results for the EU, see Annex Figure 2.A.1 and for G20 see Annex Figure 2.B.1.
Source: OECD SPHeP NCDs model, 2025.
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 (Figure 2.3). In the EU, changes in risk factors since 2010 have lowered the incidence of NCDs, primarily due to improvements in air quality. However, the improvements resulting from reductions in smoking, harmful alcohol consumption and physical inactivity combined are smaller than the worsening in NCD incidence due to obesity (see also Annex 2.A).
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 between 2026 and 2050, split by risk factor
Note: Results are adjusted for changes in population size. The impact of physical inactivity on NCDs does not reflect the impact of physical activity 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. 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.
Despite the rising disease incidence, mortality from NCDs has declined markedly over the past several decades. This has been driven by significant advances in early detection, management and treatment. Improved access to medicines, improved surgical techniques, and innovative therapies have contributed to millions of lives saved.
Case fatality rates for acute myocardial infarction (heart attacks) and ischaemic stroke have improved substantially in recent decades (Figure 2.4). Across 15 OECD countries with data between 2010 and 2022, the fatality rate from heart attacks decreased 23%, from 10.1% to 7.8%. The fatality rate from stroke dropped 14%, from 12.1% to 10.4%. 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[8]). In the same period, the 5‑year survival rate of colorectal cancer has gone from 52% in 1995, to 66% in 2014. Although CVD mortality rates have improved in the EU (Annex Figure 2.A.2), CVD remains the leading cause of morbidity and mortality in the EU (OECD, 2025[9]).
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.
While these improvements in survival are an unequivocal public health success, it does mean that there are more people living with NCDs. OECD’s PaRIS found that currently, among people aged 45+ who saw a primary care professional in the previous six months, 8 in 10 have at least one chronic condition (OECD, 2025[10]). For health systems, this means a greater demand on resources to provide ongoing disease management and treatment for potential complications.
The rising prevalence of NCDs also increases the number of people that have multiple NCDs at the same time. Multimorbidity has a direct impact on people’s well-being: people with two chronic conditions scored five points lower on the WHO‑5 well-being scale (a scale from 0 to 100) compared to those with only one chronic condition, and people with three or more chronic conditions scored 14 points lower (OECD, 2025[10]). Patients with multiple NCDs also report lower mental health and social functioning. Moreover, dealing with multiple chronic conditions is more complex and resource‑intensive for health systems than caring for a single illness (Box 2.3).
While healthcare policy, research, professional training and clinical guidelines have traditionally focussed on single diseases, PaRIS results 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. As well as contributing to higher healthcare expenditure, 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 provider, 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 2.5).
Proportion of PaRIS respondents taking five or more medications, stratified by NCD status
Note: For this analysis four NCDs were included: cancer, CVD, CRD 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 (Figure 2.6). 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.
Proportion of people who are confident or very confident in their ability to manage their health and well-being (%), stratified by NCD status
Note: For this analysis four NCDs were included: cancer, CVD, CRD 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.
Rising life expectancy has been one of the great public health achievements of recent decades, but it has also contributed to a growing burden of NCDs. Higher life expectancy means that more people will live into the ages at which NCDs are most prevalent. While people of all ages can develop NCDs, they are commonly associated with older age groups (WHO, 2025[11]). The incidence of NCDs increases with age because of gradual wear and tear over time, accumulated long-term exposure to risk, weakened immunity, hormonal shifts, and slower metabolism.
Importantly, this trend will continue as populations are expected to continue ageing. While in 2024 19% of the OECD population was 65 years or older, by 2050 this is expected to be 25% – a 36% increase (OECD, 2025[12]). Across the EU, the proportion of 65+ year olds is expected to increase from 22% to 28%. Even if the other drivers of the NCD burden – risk factor levels, survival rates, population size – remain unchanged going forward, the annual number of new NCDs is expected to increase by 31% between 2026 and 2050, on average in the OECD (29% in the EU) (Figure 2.7). The incidence rate would increase from 1 936 per 100 000 people per year to 2 518 in the OECD, and from 2 141 to 2 755 in the EU. In addition, the prevalence of multimorbidity is expected to increase by 75% by 2050, on average in the OECD (70% 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 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 rising NCD burden is associated with significant increased cost for the healthcare system. The per capita healthcare expenditure on the four NCDs included in this analysis is predicted to increase by more than 50% solely due to population ageing, from USD PPP 646 to USD PPP 994 in the OECD, and from USD PPP 607 to USD PPP 938 in the EU (Figure 2.8). At constant population size, this equates to a total increase of USD PPP 532 billion per year, for the OECD as a whole (USD PPP 170 billion for the EU).
Increase in the per capita healthcare expenditure on the four NCDs included in this analysis, between 2026 and 2050
Note: Projections are based on current population size, and current age‑ and sex-specific incidence and mortality rates of NCDs. In this figure, EU, OECD and G20 averages are based on percentage differences using simple (i.e. unweighted) means of the per capita healthcare expenditure in USD PPP of the member countries in each grouping, in 2026 and 2050.
Source: OECD SPHeP NCDs model, 2025.
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Impact of progress on risk factors between 2010 and 2022 on the number of new cases of four major NCDs per year, on average over 2026-2050, for the 27 EU countries combined
Note: The results compare the annual number of new NCD cases in a scenario where 2022 risk‑factor levels continue against a scenario in which risk‑factor levels remain at their 2010 values. The figure shows the number of new cases per year on average over 2026-2050. The estimates for physical inactivity and unhealthy diet exclude their effects on body weight, which are captured under obesity. Totals also exclude the small changes in NCD cases that stem from population‑size shifts rather than direct links between risk factors and diseases.
Source: OECD SPHeP NCDs model, 2025.
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: EU12 represents the average of the 12 countries included for mortality post-acute myocardial infarction, with EU10 representing the average of the 10 countries included for stroke. In this figure, EU12 and EU10 averages are reported as simple (i.e. unweighted) means across member countries shown.
Source: OECD Health Statistics 2025, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html.
Impact of progress on risk factors between 2010 and 2022 on the number of new cases of four major NCDs per year, on average over 2026-2050, for G20 countries combined
Note: The results compare the annual number of new NCD cases in a scenario where 2022 risk‑factor levels continue against a scenario in which risk‑factor levels remain at their 2010 values. The figure shows the number of new cases per year, on average over 2026-2050. The estimates for physical inactivity and unhealthy diet exclude their effects on body weight, which are captured under obesity. Totals also exclude the small changes in NCD cases that stem from population‑size shifts rather than direct links between risk factors and diseases.
Source: OECD SPHeP NCDs model, 2025.