Published on Investing in Health

Why we won’t fully realize universal health coverage without addressing the challenge of noncommunicable diseases

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The rise of noncommunicable diseases worldwide, particularly in low- and middle-income countries, poses one of the biggest and most underestimated threats to achieving universal health coverage The rise of noncommunicable diseases worldwide, particularly in low- and middle-income countries, poses one of the biggest and most underestimated threats to achieving universal health coverage. Photo: Nugroho Sunjoyo/World Bank.

Today, as we inch ever closer to the 2030 deadline for achieving the UN Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) remains an unrealized ambition for many countries. Gains have been made, according to the latest Global Monitoring Report: service coverage—one indicator of UHC progress—has expanded, for instance, which suggests some improvement globally. But the numbers also show there is much more work to be done, particularly when it comes to expanding noncommunicable disease (NCD) service coverage. A rapid assessment conducted by WHO in 2020 found that more than half of the countries reported interruptions to NCD services during the pandemic.

While the global pandemic has put UHC progress in peril, it is the unrelenting rise of NCDs worldwide, particularly in low- and middle-income countries (LMICs), that poses one of the biggest and most underestimated threats to a person’s ability to access high-quality, life-sustaining health services. The cost of NCDs to human capital development and preservation and economic growth is growing, with the World Economic Forum study suggesting NCDs may account for $50 trillion in GDP losses by 2030.

A partnership to help tackle NCDs

That’s why the World Bank, along with partner Access Accelerated, is helping countries understand the link between NCDs and human capital, and assisting in developing strategies to address the erosion of human capital caused by premature adult morbidity and mortality due to NCDs.

That work has been taking many forms. For example, in Vietnam, we jointly supported improving the quality and utilization of grassroots health services, with a focus on the community level for poorer and disadvantaged people, especially those with NCD conditions. Our project has supported the construction and renovation of more than 550 commune health stations and 14 district health centers. Almost 5,000 health staff in 13 provinces will receive on-the-job training on managing NCD patients. In East Asia and the Pacific, we have supported our client countries to design and implement sugar-sweetened beverage (SSB) taxes through policy advice and we developed a new global database of SSB taxes. In North Macedonia, we facilitated informing the new primary healthcare (PHC) service delivery model by assessing the continuum and quality of care for diabetes and hypertension, the two conditions driving the burden of NCDs and associated care costs in the country.

Expanding equitable access to care, ensuring financial-risk protection, and ensuring that no one is left behind are critical components of UHC.  Our partnership has supported a community-based approach to reaching vulnerable populations, including in El Salvador, where strategies are being adopted to address suicide among adolescent youth—a demographic that is at particular risk of mental health issues.

Reducing the NCD burden

The stark reality is that each year, 41 million people die from an NCD—no other disease causes as many deaths.  Around 86% of these deaths occur in LMICs. And the situation is worsening, as deaths from NCDs are expected to climb to 52 million by 2030.

NCDs exact a heavy toll on society as patients and families struggle with the devastating medical, emotional, and financial consequences and economies suffer debilitating effects. More than 60% of people living with non-communicable diseases have experienced catastrophic health expenditures as a result of a diagnosis, with millions being pushed into poverty each year.

The scope of the problem may seem overwhelming, but we know that UHC is a solution. Indeed, NCDs and UHC are inextricably linked. When we reduce the NCD burden, we foster a healthier population and reduce pressure on health systems.  Likewise, to improve access to quality NCD services, we need robust health systems, expanded health service coverage, and reduced out-of-pocket expenditure. We also need to foster new ideas about how health services can be delivered, and leverage innovations such as digital health solutions to help move the NCD, PHC, and health system agenda forward.

UHC and NCDs are different sides of the same coin—neither can be addressed without also addressing the other and prioritizing just one will get us nowhere. A targeted and strategic approach is essential to informing investment that yields the greatest impact. It won’t be easy, but collaboration and multi-sectoral partnerships are a good place to start.


Jaime Bayona and Martin Bernhardt contributed to this blog.


Megumi Maruyama

Dr. Megumi Maruyama, Global Health Officer, Sumitomo Pharma

David Wilson

Program Director, Health Nutrition and Population practice of the World Bank

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