Abstract


               
                  Background


                  Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. The WHO proposed 19 “Best Buy” policies to prevent NCDs, mainly addressing four leading risk factors: tobacco, alcohol, unhealthy diets and insufficient physical exercise. Yet, little is known about how implementation has changed over time and the role of geopolitical factors. This study addresses that crucial gap.


               
               
                  Methods


                  We calculated policy implementation scores for all 194 WHO member states from the 2015, 2017 and 2020 WHO NCD Progress Monitor Reports. We analyzed global trends across the three years for all countries and by geopolitical group and used linear regression to assess association with health, economic and political indicators.


               
               
                  Results


                  The global average implementation score in 2020 was 47.0% (SD 19.8%), compared to 44.9% (SD 19.1%) in 2017 and 39.0% (SD 19.3%) in 2015. Implementation scores varied by income level (p < 0.001), with high-income countries' average implementation score over twice that of low-income countries (59.7% vs. 28.9%). Implementation improved for all policies in 2015-2020 except the three alcohol policies which decreased. Implementation scores were associated with the proportion of deaths due to NCDs (β 0.8, 95% confidence interval 0.7-0.9, p < 0.001); however, on average, countries with a greater increase in the proportion of deaths due to NCDs were less likely to implement NCD policies (p < 0.001).


               
               
                  Conclusions


                  Implementation of policies to prevent NCDs is improving over time, but the average implementation score remains below 50% and progress is uneven. Our findings suggest the need to increase implementation of recommended interventions, particularly in low- and middle-income countries and where the proportion of NCD deaths is growing fastest, and to urgently address the decreasing level of implementation of alcohol interventions.


               
               
                  Key messages


                  Implementation of recommended, cost-effective policies to prevent NCDs is improving but remains low, and alcohol policies are decreasing. Low-income countries, and countries where the proportion of deaths due to NCDs is growing the fastest, are least likely to have recommended policies in place to prevent NCDs.