Researchers reveal why global gains against chronic diseases are stalling – News-Medical

Report on Global Progress Towards Sustainable Development Goal 3.4: Non-Communicable Disease Mortality Trends (2010-2019)

This report summarizes a comprehensive analysis of non-communicable disease (NCD) mortality across 185 countries from 2010 to 2019. The findings are evaluated in the context of the United Nations Sustainable Development Goals (SDGs), specifically Target 3.4, which aims to reduce premature mortality from NCDs by one-third by 2030. The study reveals that while overall declines in premature NCD deaths were observed, the rate of progress has faltered, jeopardizing the achievement of SDG targets due to uneven regional performance and the emergence of new health threats.

Methodology and Scope of Analysis

The analysis was conducted using data from the World Health Organization (WHO) Global Health Estimates 2021, with a focus on evaluating progress between 2010-2019 and comparing it to the preceding decade (2001-2010).

Key Methodological Points:

• Primary Outcome: The study measured the unconditional probability of dying from an NCD between birth and age 80, providing a standardized metric independent of population age structures.
• Data Scope: The analysis included 185 countries. A detailed cause-and-age decomposition was performed for a subset of 63 countries with higher-quality mortality data.
• SDG Alignment: While the primary analysis covered ages 0-80 and all NCDs, it was designed to complement and provide a broader context for SDG Target 3.4, which focuses on ages 30-70 and four main NCD categories (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes).
• Exclusion Period: The years 2020-2021 were excluded to avoid the confounding effects of the COVID-19 pandemic on NCD mortality patterns.

Key Findings: A Faltering Trajectory for SDG Target 3.4

While a majority of countries recorded a decline in NCD mortality, the pace of improvement slowed significantly after 2010, indicating a loss of momentum in the global effort to meet SDG 3.4.

Overall Global and Regional Trends

1. General Decline: From 2010 to 2019, the probability of dying from an NCD before age 80 decreased in 82% of countries for females and 79% for males.
2. Slowing Momentum: Compared to the 2001-2010 period, approximately 45% of countries demonstrated smaller declines or a reversal of progress, particularly in high-income Western nations, Latin America, and parts of Asia.
3. Regional Disparities:
   • Strongest Progress: The most significant reductions were observed in Central and Eastern Europe (especially for males, linked to alcohol control policies) and among females in Central Asia, the Middle East, and North Africa.
   • Weakest Progress: Pacific Island nations showed the smallest declines, despite having high initial NCD mortality rates. The United States had the smallest drop among high-income Western countries.
   • Reversals: In some nations, such as India (for females) and Papua New Guinea (for males), progress reversed, erasing earlier gains and moving them further from SDG targets.

Cause-Specific Drivers of NCD Mortality

Progress toward SDG 3.4 was not uniform across diseases. Improvements in some areas were often counteracted by worsening trends in others.

• Positive Contributors (Driving Progress):
  • Circulatory Diseases: Reductions in deaths from ischemic heart disease and stroke were the single largest contributors to improved NCD mortality in over 60% of countries analyzed.
  • Cancers: Favorable trends were noted for colorectal, cervical, stomach, breast, and prostate cancers. Declining male lung cancer mortality was also a significant factor, particularly in high-income countries.
• Negative Contributors (Impeding Progress):
  • Emerging Threats: Rising mortality from pancreatic and liver cancers, as well as neuropsychiatric conditions like Alzheimer’s disease and alcohol use disorders, dampened overall progress.
  • Diabetes: The impact of diabetes (including related chronic kidney disease) was highly varied, offsetting gains in many regions and posing a significant challenge to achieving SDG 3.4.
  • Chronic Respiratory Diseases: Unlike the generally positive trend for lung cancer, trends for Chronic Obstructive Pulmonary Disease (COPD) were mixed and often unfavorable.

The Critical Role of Age Demographics

The study highlights that progress on NCDs cannot be achieved by focusing on younger populations alone. Changes in mortality rates among older adults (ages 65-80) were the primary driver of national trends, both positive and negative. Stagnation or setbacks in this age group were sufficient to stall national progress toward SDG targets, even when improvements were made among working-age populations.

Conclusion and Recommendations for Accelerating SDG Progress

The decline in NCD mortality during the 2010s demonstrates that progress is possible. However, the widespread slowdown indicates that current efforts are insufficient to meet the 2030 targets outlined in the SDGs. The weakening momentum is attributed to a combination of factors, including plateaus in intervention coverage, fiscal constraints, and widening health inequalities.

To regain momentum and achieve SDG Target 3.4, the following actions are recommended:

• Adopt a “Learning Health System” Approach: Implement systems for continuous monitoring of interventions, benchmarking performance against regional leaders, and evaluating policies in real-time to adapt strategies effectively.
• Reinforce Proven Interventions: Sustain and expand efforts in tobacco control, reduction of metabolic risks (e.g., hypertension, obesity), and alcohol control.
• Strengthen Health Systems: Enhance both primary and specialty care to manage the complex and rising burden of diseases like diabetes, liver cancer, and neuropsychiatric conditions.
• Improve Data Systems: Expand high-quality death registration and cause-of-death certification, particularly in low- and middle-income countries, to enable accurate tracking of progress toward the SDGs.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article is centered on this goal. It discusses global trends in mortality from non-communicable diseases (NCDs) such as cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases. The analysis of premature deaths, health inequalities between regions, and the effectiveness of health interventions directly relates to ensuring healthy lives and promoting well-being for all at all ages.
• SDG 17: Partnerships for the Goals: This goal is implicitly addressed through the article’s emphasis on data. The study’s reliance on the WHO Global Health Estimates and its caution that “many low- and middle-income countries have low- or very-low-quality mortality data” highlights the need for strengthening data systems. The call for “expanding death registration and cause certification” aligns with SDG 17’s targets on enhancing capacity-building and the availability of high-quality, timely, and reliable data.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 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. This is the central target of the article. The study explicitly states its analysis was designed “to complement SDG target 3.4, which focuses on ages 30–70 years and four causes (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes).” The entire research quantifies progress and setbacks related to this target.
2. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. The article directly connects this target to NCD mortality by highlighting that “Alcohol control policies in Eastern Europe, notably Russia, helped drive some of the steepest global declines in NCD mortality” and that “alcohol use disorders, contributed unfavorably in many countries, dampening progress.”
3. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. This is implied through the discussion on lung cancer and the call for “sustaining tobacco…control.” The article notes that lung cancer mortality “declined for males in 92% of countries,” a direct outcome of tobacco control efforts.
4. Target 17.18: By 2020, enhance capacity-building support to developing countries… to increase significantly the availability of high-quality, timely and reliable data. This target is relevant due to the article’s explicit mention of data limitations. The authors “caution that many low- and middle-income countries have low- or very-low-quality mortality data, which increases uncertainty about the precise magnitude of change,” pointing to the need for improved data infrastructure as outlined in this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease. The entire study is a detailed measurement of this indicator. The primary outcome is “the unconditional probability of dying from an NCD,” and the analysis decomposes changes across specific causes like “ischemic heart disease,” “stroke,” “colorectal, cervical, stomach, breast, and prostate cancers,” and “diabetes,” which are the core components of this indicator.
2. Indicator 3.5.2: Harmful use of alcohol. While the article does not provide specific alcohol consumption data, it uses mortality as a proxy to measure the impact of alcohol use. It refers to “crisis-level deaths linked to heavy drinking” and the success of “alcohol control policies,” implying that the level of harmful alcohol use is a critical factor being measured to explain NCD mortality trends.
3. Indicator 3.a.1: Age-standardized prevalence of current tobacco use among persons aged 15 years and older. This indicator is implied. The article’s analysis of lung cancer mortality trends, which “declined for males in 92% of countries,” serves as an outcome measure for the effectiveness of tobacco control. The call to sustain “tobacco…control” suggests that monitoring the prevalence of tobacco use is essential for continued progress.
4. Indicator 17.19.2: Proportion of countries that… have achieved 100 per cent birth registration and 80 per cent death registration. This is directly implied by the article’s conclusion, which calls for “expanding death registration and cause certification.” The statement about “low- or very-low-quality mortality data” in many countries points to a deficit in this specific indicator, which measures the foundational data required for the study’s analysis.

4. SDGs, Targets and Indicators Identified in the Article

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