NCD Countdown 2030: Efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target in low- and middle-income countries

As of 2019, most countries were off track to achieve the Sustainable Development Goal 3.4 target (SDG 3.4), which calls for a one-third reduction in premature mortality from noncommunicable diseases (NCDs) between 2015 and 2030. In this Health Policy paper, we synthesise a range of evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help countries get back on track for SDG 3.4; country-level applications would require additional analyses and consideration of the local context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We illustrate how cost-effectiveness data and other information can be used to define locally tailored packages of interventions to accelerate rates of decline in NCD mortality across 123 low- and middle-income countries. Under realistic implementation constraints, the majority of countries could achieve the NCD target, or at least get very close to it, using some combination of these interventions; the greatest gains would be for cardiovascular disease mortality. Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023-2030; this investment could avert 39 million deaths and generate an average net economic benefit of US$2.7 trillion, or US$390 per capita. While specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks like tobacco smoking, harmful use of alcohol, and excess sodium intake would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally-tailored NCD package. By 2030, ministries of health would need to be devoting about 20% of their budgets to high-priority NCD interventions. Our report concludes with a discussion of financing and health system implementation considerations and reflections on the NCD agenda beyond the 3.4 target and beyond the SDG period