People in all but about 20 countries have a higher risk of dying prematurely from a noncommunicable disease (NCD) than from infectious and parasitic diseases, maternal and perinatal conditions, and nutritional deficiencies combined. The risk of dying from an NCD is highest in low-and middle-income countries, especially in sub-Saharan Africa for both sexes and in central Asia and eastern Europe for men. Progress towards Sustainable Development Goal (SDG) target 3.4 is markedly different across countries. At current rates of decline in NCD mortality, SDG target 3.4 is expected to be met for women in 35 countries (19% of all countries) and men in 30 countries (16%). Most of these are high-income countries with already-low NCD mortality and countries in central and eastern Europe. A further 50 countries (for women) and 35 countries (for men) would achieve the target with a modest acceleration of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women and men in 15 and 24 countries, respectively. Another 86 countries (for women) and 97 (for men) are progressing too slowly, and need to implement policies that significantly increase the rates of decline, if they are to meet SDG target 3.4. NCD deaths beyond the age range and causes of death included in SDG target 3.4 cause a larger mortality burden in low-and middle-income countries than in high-income countries. Health policies should address NCDs beyond the causes and age groups covered in SDG target 3.4, so as to "leave no one behind". Substantial reduction of NCD mortality requires policies that significantly reduce tobacco and alcohol use and blood pressure levels, and provide access to efficacious and high-quality preventive and curative care for NCDs in the context of UHC. 86 countries (46%) for women and 97 (52%) for men need the implementation of policies that significantly increase the rates of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women and men in 15 (8%) and 24 (13%) countries, respectively. NCD causes and age groups other than those included in the SDG target 3.4 are responsible for a higher risk of death in low-and middle-income countries than in high-income countries. For countries to substantially reduce NCD mortality requires policies that significantly reduce tobacco and alcohol use and blood pressure levels, and provide efficacious and high-quality preventive and curative care for NCDs, including timely diagnosis and treatment of hypertension, diabetes, and treatment-amenable cancers, and treatment pathways that improve the survival of those with acute and chronic NCDs.

for the Lancet NCDI Poverty Commission Study Group Executive summary"As we embark on this great collective journey, we pledge that no one will be left behind. Recognizing that the dignity of the human person is fundamental, we wish to see the goals and targets met for all nations and peoples and for all segments of society. And we will endeavour to reach the furthest behind first."Transforming our world: the 2030 agenda for sustainable development 1

The Sustainable Development Goal (SDG) target 3.4 is to reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030 relative to 2015 levels, and to promote mental health and wellbeing. We used data on cause-specific mortality to characterise the risk and trends in NCD mortality in each country and evaluate combinations of reductions in NCD causes of death that can achieve SDG target 3.4. Among NCDs, ischaemic heart disease is responsible for the highest risk of premature death in more than half of all countries for women, and more than three-quarters for men. However, stroke, other cardiovascular diseases, and some cancers are associated with a similar risk, and in many countries, a higher risk of premature death than ischaemic heart disease. Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4. To investigate the options available to each country for achieving SDG target 3.4, we considered different scenarios, each representing a combination of fast (annual rate achieved by the tenth best performing percentile of all countries) and average (median of all countries) declines in risk of premature death from NCDs. Pathways analysis shows that every country has options for achieving SDG target 3.4. No country could achieve the target by addressing a single disease. In at least half the countries, achieving the target requires improvements in the rate of decline in at least five causes for women and in at least seven causes for men to the same rate achieved by the tenth best performing percentile of all countries. Tobacco and alcohol control and effective health-system interventions—including hypertension and diabetes treatment; primary and secondary cardiovascular disease prevention in high-risk individuals; low-dose inhaled corticosteroids and bronchodilators for asthma and chronic obstructive pulmonary disease; treatment of acute cardiovascular diseases, diabetes complications, and exacerbations of asthma and chronic obstructive pulmonary disease; and effective cancer screening and treatment—will reduce NCD causes of death necessary to achieve SDG target 3.4 in most countries.

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