Quick buys for prevention and control of noncommunicable diseases
Research article
Summary
Despite their established effectiveness, uptake of the WHO best buys for tackling non-communicable diseases (NCDs) has been uneven and disappointing.
Researchers introduce the “quick buys”, an evidence-based set of cost-effective interventions with measurable public health impacts within five years.
They reviewed 49 interventions previously established as cost-effective (<$I20,000 per disability-adjusted life-year averted) to identify the earliest possible detectable effect on high-level population health targets.
Using a strict evidence hierarchy, including Cochrane and systematic reviews, the researchers estimated the effects of each intervention against global targets agreed upon by countries. Quick buys were defined as those interventions that could exhibit measurable effects within 5 years, aligning with average electoral cycles in across the WHO European Region.
Of the 49 interventions, 25 qualified as quick buys, including those relating to tobacco (n = 5), alcohol (n = 4), unhealthy diet (n = 3), physical inactivity (n = 1), cardiovascular disease (n = 3), diabetes (n = 4), chronic respiratory disease (n = 1), and cancer (n = 4).
These findings not only offer guidance to policymakers deciding on interventions that align with short-term political cycles but also have the potential to accelerate progress to global health targets, particularly the 2030 Sustainable Development Goal of reducing premature NCD mortality by one-third.
I am constantly asked by the Region’s Member States and health partners, ‘What can we do to reduce the harms of NCDs in our countries – from cardiovascular diseases to cancers – in the most cost-effective way?’” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe, as per WHO/Europe press release.
Thanks to our new research, we can now point to these quick buys that can deliver measurable public health benefits quickly if there is political will to adopt and implement them optimally. These actions can help governments deliver on their health commitments, including key targets under the 2030 Sustainable Development Goals; grow their economies; and ensure that as people live longer across our rapidly greying Region, they also lead healthy lives free from illness and disability.”
Dr Hans Henri P. Kluge, WHO Regional Director for Europe
Highlights of the research
Twenty-five policies and concrete health interventions can, in a relatively short span of time, individually and collectively contribute to addressing the overwhelming burden of chronic illnesses and their major risk factors, including alcohol, in the WHO European Region.
A new paper published in “The Lancet Regional Health – Europe” by NCDs experts at WHO/Europe has for the first time analysed exactly how specific public health measures – so-called quick buys – can have a positive impact on population health across Europe and central Asia in as little as 5 years.
This clearly demonstrates how policy-makers and politicians can achieve measurable results in tackling NCDs and their major risk factors within a single political cycle.
NCDs are the leading cause of death and disability worldwide. In the European Region, they account for 90% of all deaths and 85% of disability, including mental ill health. A significant proportion of NCD deaths are premature (before the age of 70).
An estimated 60% of all avoidable NCD deaths are due to preventable causes and could be addressed by reducing alcohol and tobacco use, unhealthy diets and physical inactivity.
The remaining 40% can be addressed with appropriate treatments, such as rapid response to heart attacks and strokes.
Best buys
WHO has previously identified the best buys – proven, cost-effective measures to address NCDs.
An alcohol policy best buy is an intervention that is not only highly cost-effective but also cheap, feasible and culturally acceptable to implement. A highly cost-effective intervention is one that, on average, provides an extra year of healthy life (equivalent to averting one DALY) for less than the average annual income per person. Analysis by the World Health Organization (WHO) has identified a set of affordable, feasible and cost-effective intervention strategies and its study estimates a global price tag for implementing these measures.
Cost-effective measures for reducing alcohol use include increasing alcoholic beverage taxes, regulating the availability of alcoholic beverages, restricting marketing of alcoholic beverages and drink-driving countermeasures.” (WHO)
Quick buys
The new research shows which of those measures deliver the fastest results. The 25 quick buys include policies targeting key risk factors (tobacco, alcohol, unhealthy diet and physical inactivity) and disease groups (cardiovascular diseases, diabetes, chronic respiratory diseases and cancers).
They include interventions such as increasing excise taxes on tobacco, alcohol and unhealthy foods; reformulating food and beverage products to be lower in salt, sugar and fat; implementing front-of-pack nutrition labelling; pharmacological treatment of hypertension and acute cardiovascular events; and vaccination against human papillomavirus (HPV) and cervical cancer screening.
Alcohol policy quick buys
All three interventions affecting alcohol price and availability had immediate effects.
Increasing excise taxes, enacting and enforcing bans or comprehensive restrictions on exposure to alcohol advertising, and enacting and enforcing restrictions on the physical availability of alcohol had immediate impacts on alcohol per capita consumption in persons aged 15 or older.
Without the rapid increased uptake of these proven interventions, half of all countries globally will miss the Sustainable Development Goal target to reduce NCD-related premature mortality by one third.”
Dr Gauden Galea, lead author of the study and WHO/Europe Regional Strategic Adviser on NCDs
Brief psychosocial interventions for persons with alcohol use disorder and addiction also met the study’s criterion, with detectable impacts under 12 months post-intervention.
However, the researchers could not identify the timing for an effect of the WHO-recommended intervention to enact and enforce alcohol impaired driving laws at sobriety checkpoints on blood alcohol concentrations. Although they identified systematic reviews finding positive effects on alcohol-related car crashes and fatalities, studies were insufficient to support an effect on per capita alcohol consumption.
Remarkably, with three quick buys generating immediate positive effects for society, alcohol policy provides the second most impactful set of quick buys, after the set of best buys on chronic respiratory diseases, which contains 4 measures with immediate positive effect.
| Intervention | Quick buys | Evidence of earliest possible effect on UN-linked targets | UN target/indicator | Source(s) |
|---|---|---|---|---|
| Increase excise taxes on alcoholic beverages | Yes | Immediate19,36 | SDG 3.5.2 Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol | Kilian et al. 202336 |
| Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) | Yes | Immediate37 | SDG 3.5.2 Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol | Siegfried et al. 201437 |
| Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale) | Yes | Immediate36 | SDG 3.5.2 Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol | Kilian et al. 202336 |
| Enact and enforce alcohol impared driving laws and blood alcohol concentration limits via sobriety checkpoints | No | n/a | SDG 3.5.2 Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol | Bergen et al. 201438 |
| Provide brief psychosocial intervention for persons with hazardous and harmful alcohol use | Yes | 12 months | SDG 3.5.2 Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol | Kaner et al. 201839 |
Alcohol policy quick buys overview
- Increase excise taxes on alcoholic beverages
- Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)
- Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale)
- Provide brief psychosocial intervention for persons with hazardous and harmful alcohol use
Comparing with tobacco policy quick buys
Five out of seven tobacco control interventions had evidence of impacts within 5 years in the included review articles.
The fastest effect was for eliminating exposure to second-hand smoke, which had immediately detectable effects.
This was followed by increasing excise taxes and prices, which demonstrated a significant effect at 4 months; followed by nicotine replacement therapy (6 months), graphic health warnings (14 months), and enacting and enforcing comprehensive bans on tobacco advertising, promotion or sponsorship (2 years).
Two interventions did not meet the 5-year threshold for inclusion. Implementing media campaigns to educate the public about tobacco-related harms had an earliest identified effect within 7 years.
Similarly, providing population-wide support, such as brief advice, national toll-free quit lines and m-cessation (using messaging) services to all tobacco users, had an earliest potential effect estimated at beyond 7 years.
| Intervention | Quick buys | Evidence of earliest possible effect on UN-linked targets | UN target/indicator | Review source(s) |
|---|---|---|---|---|
| Increase excise taxes and prices on tobacco products | Yes | 4 months19 | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Wilson et al. 201220 |
| Implement large graphic health warnings on all tobacco packages, accompanied by plain/standardized packaging | Yes | 14 months21 | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | McNeill et al., 2017; Pang et al., 202122,23 |
| Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship | Yes | 2 years24 | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Henriksen 201225,26 |
| Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places, public transport | Yes | Immediate27 | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Frazer et al., 2016a and 2016b28,29 |
| Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and secondhand smoke, and encourage behavior change | No | ≤7 years | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Bala et al., 201730,31 |
| Provision of cost-covered effective population-wide support (including brief advice, national toll-free quit line services and mCessation) for tobacco cessation to all tobacco users | No | >7 years | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Silagy et al., 2001; Lancaster et al. 201732,33 |
| Provision of cost-covered effective pharmacological interventions to all tobacco users who want to quit through the use of nicotine replacement therapy (NRT), Bupropion and Verenicline | Yes | 6 months34 | Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 3.a.1. Age-standardized prevalence of current tobacco use among persons aged 15 years and older | Bergen et al. 201435 |
Towards faster progress
From a public health perspective, all interventions that are cost-effective should be implemented but, in reality, the researchers address the need to convince often sceptical politicians faced with multiple demands for action. Recognising the incentives they face, such as the desire to be re-elected, as well as the time preferences that everyone incorporates in their decisions, it is intuitive that measures that achieve results faster will be more attractive, all else being equal.
In making this case, it is also important to emphasise that interventions that exploit reductions of demand for hazardous products by raising taxes will generate revenue, although the researchers caution against linking these funds for prevention or treatment as it can create perverse incentives to maintain this funding stream.
Out of 49 potential interventions, the researchers identified 25 showing an effect within 5 years, and in some cases immediately, on a UN-linked target. These quick buys have ‘face validity’ as having plausible, rapid effects given the natural history of the NCDs in question. Yet, as with the WHO best buys, they have several important limitations.
It’s high time for action
The study is timely. In September 2025 the United Nations will hold the fourth High-level Meeting on NCDs, where countries’ progress on achieving global NCD targets will be under scrutiny. While demonstrable progress has been made against specific targets in countries across the Region, the Region overall is off track to achieve its commitments.
The clock is ticking,” emphasized Dr Gauden Galea, lead author of the study and WHO/Europe Regional Strategic Adviser on NCDs, as per WHO/Europe press release.
We hope this new study will have a real impact and help alleviate sickness and prevent unnecessary deaths from cancers, cardiovascular and respiratory diseases, and diabetes in our Region. Without the rapid increased uptake of these proven interventions, half of all countries globally will miss the Sustainable Development Goal target to reduce NCD-related premature mortality by one third.”
Dr Gauden Galea, lead author of the study and WHO/Europe Regional Strategic Adviser on NCDs
Barriers and opportunities
While the study’s authors emphasize the importance of implementing all cost-effective interventions to effectively lower the huge health and economic burden of NCDs and their major risk factors, they recognize the very real political challenges faced by health ministries and other policy-makers trying to protect and improve people’s health within tight timespans.
Premature and preventable NCDs are a major national financial burden due to lost productivity.
WHO/Europe’s findings offer guidance to policy-makers deciding on interventions that can deliver rapid public health and economic benefits and that align with short-term political cycles. They also illustrate feasible routes for countries to quickly accelerate progress towards the Sustainable Development Goal global health targets to which they have committed.
Conclusions and future directions
Notwithstanding these limitations, this study to demonstrate the potential for rapid impacts on health and progress toward UN targets marks an important advance and contribution to the global effort to tackle NCDs.
Further, the researchers note that within the WHO European Region, 10 countries (specifically, Belgium, Denmark, Estonia, Israel, Kazakhstan, Luxembourg, Netherlands, Norway, Sweden, and Switzerland) have already achieved the European Programme of Work target of a 25% reduction in premature mortality from NCDs ahead of schedule. They have implemented comprehensive policies, reducing multiple risk factors, reducing preventable and treatable mortality and CVD and cancer mortality.
The researchers note that “quick buys” should not be conflated with “quick wins.” This latter concept is commonly used to denote interventions that are easy to implement, so-called ‘low-hanging fruit’. This set of quick buys may not be easy to implement. Yet they are cost-effective means of attaining rapid population benefit.