NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries.
NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries.
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DOI：
10.1016/s0140-6736(21)02347-3
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发表时间：
2022-03-26
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通讯作者：
NCD Countdown 2030 collaborators
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作者：
NCD Countdown 2030 collaborators
大多数国家在实现可持续发展目标（SDG）具体目标3.4方面进展甚微，该目标要求从2015年到2030年将非传染性疾病（NCD）导致的过早死亡率降低三分之一。在这份卫生政策文件中，我们综合了与干预措施有关的证据，这些干预措施可以在未来十年内减少主要非传染性疾病造成的过早死亡，并且可以在所有收入水平的国家实施。我们的建议旨在作为通用指南，帮助123个低收入和中等收入国家实现可持续发展目标3.4;国家一级的应用需要对当地实施和利用情况进行额外的分析和考虑。在与COVID-19相关的卫生系统中断的背景下，保护现有投资并扩大这些干预措施尤为重要。我们展示了如何使用成本效益数据和其他信息来定义本地定制的干预措施，以加快非传染性疾病死亡率的下降速度。在现实的实施限制下，大多数国家可以通过综合使用这些干预措施来实现（或几乎实现）非传染性疾病的目标;最大的收益将是心血管疾病死亡率。在世界每个地区实施最有效的一揽子干预措施将需要在2023- 2030年期间平均每年增加180亿美元;这笔投资可以避免3900万人死亡，并产生平均2.7万亿美元的净经济效益，即人均390美元。虽然具体的临床干预途径因国家和地区而异，但减少吸烟、有害使用酒精和过量钠摄入等行为风险的政策几乎适用于每个国家，占任何适合当地的非传染性疾病一揽子计划的健康收益的近三分之二。到2030年，各国卫生部需要将其预算的20%用于高度优先的非传染性疾病干预措施。我们的报告最后讨论了可持续发展目标3.4之后和可持续发展目标期间之后的筹资和卫生系统实施考虑因素以及对非传染性疾病议程的思考。
Most countries have made little progress in achieving the Sustainable Development Goal (SDG) target 3.4, which calls for a reduction in premature mortality from non-communicable diseases (NCDs) by a third from 2015 to 2030. In this Health Policy paper, we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4; country-level applications require additional analyses and consideration of the local implementation and utilisation context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We show 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. Under realistic implementation constraints, most countries could achieve (or almost achieve) the NCD target using a 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 2023–30; this investment could avert 39 million deaths and generate an average net economic benefit of $2·7 trillion, or $390 per capita. Although specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks, such as 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 contribute 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 SDG target 3.4 and beyond the SDG period.