Reorienting Health Systems to Tackle Noncommunicable Diseases

Health needs are expected to evolve based on three population-based transitions: (i) demographic transition, (ii) epidemiological transition, and (iii) nutritional transition. Populations worldwide are undergoing an aging process, thereby accelerating a shift in the nature of the dominant disease—from communicable diseases, reproductive health diseases, and diseases of the young to noncommunicable diseases (NCDs) that are related to older societies. Similarly, changing dietary profiles lead toward a more consistent pattern of NCDs and away from malnourishment-related communicable diseases.

Some unexpected patterns for these transitions have made adapting to change even more challenging. Asia and the Pacific is experiencing rapid aging, with the Republic of Korea, Singapore, Thailand, and the People’s Republic of China as the top four fastest aging countries in 2015–2025 and Viet Nam in the top 10. This speed of demographic change has considerable impact on disease patterns. Further, the prevalence of NCDs has begun at earlier ages than in the past and increasing global evidence has shown that NCD risk factors for children, adolescents, and young adults have increased over the last few decades. Similarly, expected gains in reducing malnutrition are somehow evolving into substantial increases in obesity.

A recent paper summarized three critical characteristics that differentiate NCDs from CDs:

1. Long latency – Unlike most communicable diseases, NCD conditions/symptoms manifest far more slowly, which can delay contact with the health care system for years.
2. Chronicity – While most communicable diseases can be often treated in a short span of time, most NCDs lead to chronic conditions that need to be managed over a long period and across a range of health care facilities.
3. Common etiologies (genetic, environmental, and behavioral) – Many communicable diseases have drivers that are amenable to direct interventions (vector control, barriers, or vaccines), but most NCDs are driven by a combination of genetics, environmental drivers, and behavioral factors.

Effectuating change is not easy especially since health systems evolved and developed for hundreds of years to respond largely to communicable diseases. There is increasing evidence, however, that health systems can be adapted and reformed using 5 policy instruments that are amenable to change: health financing tools, provider payment tools, healthcare organization and delivery, healthcare regulations, and lifestyle-related health care policies.

Seven thrusts—three in the area of public health and four in the healthcare space—can be used to tackle type 2 diabetes and related noncommunicable diseases.

Public health

1. Use fiscal policy (tax and subsidy) as a public health tool. For type 2 diabetes, the challenge is twofold. Taxing sugar can play an important role in lowering consumption, but most countries currently subsidize the main food drivers of the disease (sugar and flour). A serious intervention can involve developing targeted alternatives that are designed to help the poor, while reducing disease prevalence for the whole population.
2. Rethink prevention. Regulatory tools can address the growth of processed foods and fast food. With the help of medical professionals, standards can be set for potentially dangerous food ingredients, as well as accurate and easy-to-understand food labeling. Aggressive regulation can also target advertising of the types of foods that drive diabetes and other NCDs.
3. Empower and support population for behavior change. Educate the people and empower them to help them navigate the challenging food environment, including supporting communities of practice (e.g. diabetes.co.uk) and new technologies (e.g. continuous glucose meters).

Healthcare system

1. Defragment health financing resource generation and pooling. A universal financing and pooling health care system approach incentivizes early detection for the whole population and for early interventions after diagnosis.
2. Turbo charge screening for early detection. The single most effective intervention is early detection. For type 2 diabetes, a recently published paper identifies 15 clinical symptoms (plus family history that has high correlation with insulin resistance) and can be used to quickly identify people at risk.
3. Incentivize strategic purchasing for health sector improvement and better resource allocation. Strategic purchasing institutions can be established to prioritize best buys in NCD prevention, early detection, and cost-effective services across levels of care.
4. Improve data systems and institutions for dynamic policy development and accountability. Desegregated and timely data on prevalence, early detection, and compliance of NCDs can be used for planning and for accountability. Moreover, better electronic medical record systems that tap big data and artificial intelligence tools can aid the medical profession in the early identification of potential population segments at high risk.

Reorienting health systems to adapt to the NCD challenge is not a simple task and can be difficult for most countries. A sustained and successful way forward has to take into account unique country needs and existing capacities.

Two principles apply to every country and all NCDs. First, since the drivers of NCDs are multi-sectoral in nature and are impacted by multiple stakeholders, health authorities need to broaden the policy lens and work with multiple sectors of the economy (e.g. tax authorities and food industry groups), while empowering the population. Second, given the timescale of NCDs (long latency of development and the long care-related chronicity), early detection is critical. Early detection improves outcomes and lowers costs, as most cost-effective treatments for NCDs tend to be in earlier stages of disease. For early detection to be institutionalized, health systems need to eliminate barriers in health financing, build the capacity of health care providers, and create financial and non-financial incentives that are system compatible.

Asian Development Bank. 2023. Regional Technical Assistance. Strengthening Integrated Primary Health Care Management of Noncommunicable Diseases.

A. L. Soucat, S. Gaudin, and A. S. Yazbeck. 2025. Correcting Market and Government Failures in Tackling the Global Growth of Type 2 Diabetes: Application of WHO’s Common Goods for Health Approach. Health Systems & Reform. 11 (1).

A. S. Yazbeck. 2025. Can a 19th Century French Medical Debate Provide Guidance on How to Tackle Type 2 Diabetes? Health Systems & Reform. 11 (1).

A. S. Yazbeck, S. N. Nguyen, and M. L. Escobar. 2025. How Health Systems World-wide Fail Type 2 Diabetics. Health Systems & Reform. 11 (1).

W. Savedoff et al. 2025. Development Assistance for Health and the Challenge of NCDs Through the Lens of Type 2 Diabetes. Health Systems & Reform. 11 (1).