Transforming action on cancer and noncommunicable disease in Europe

Europe faces a huge and growing threat from noncommunicable diseases, the leading cause of death and disability in the region, with over 1.8 million avoidable deaths every year. Over 60% of these deaths arise from preventable causes for which the greatest risk factors are alcohol and tobacco use, unhealthy diets, physical inactivity, and exposure to air pollution [1]. However, progress to address these drivers of disease has been far too slow and is increasingly under threat. The recent 4th UN High Level Meeting on NCDs in September 2025 was severely compromised before it started as a result of industry lobbying [2], but even the watered-down draft declaration failed to be approved following its rejection by the United States. [3]
These backward steps take place at a watershed moment for public health in Europe and beyond, as governments around the world struggle to address the threats of conflict, environmental degradation, and faltering economies, with public health being forced to take a back seat to demands for security and economic growth. This is understandable, but it is mistaken. A healthy population, and healthy environment, are pre-requisites for both: without them Europe will neither thrive nor be able to defend itself.
The major risk factors for NCDs result from the activities of a number of powerful industries - including tobacco, ultra-processed food, and fossil fuels - which expend significant effort and resources on influencing policy to defend their profits. [4] Public health policy faces constant challenges from actors protecting their vested interests. While some of this activity is overt, much of it functions through less direct paths, shaping public and political discourse, [5,6] and influencing the practice of science. [7] Public health policy also has a tendency to default to individual level actions despite all we know about the structural nature of the dominant threats to health. [8,9]
Risk-stratified personalised interventions may, nevertheless, make an important contribution to population health [10-12], but these kinds of approaches are likely to be far more effective if they are designed and implemented in ways that maximise synergies with action on wider systems of social and structural drivers of health. Individualised approaches must not divert attention away from more equitable, more cost-effective, but often more politically challenging, action to create healthy physical, socio-cultural, political, and economic environments that benefit everyone. [13,14] A focus on individual level approaches risks widening health inequalities, whereas structural actions tend to narrow them. [15]
The European Union Joint Action on Cancer and Noncommunicable Disease Prevention (JA Prevent NCD) provides a powerful opportunity to help transform action on NCD and cancer prevention across Europe. [16] As laid out in this supplement, the JA represents a hugely important set of actions to address these major threats to human health, well-being, and equity. Linking health improvement activities across Europe should reduce fragmentation both within and between member states, and the deep integration of action to tackle inequity that runs as a thread through the entire project has the potential to drive significant reductions in health inequalities. The focus on cross-sectoral, multilevel actions to build capacity, support communities, and embed sustainability has the potential to generate hugely valuable knowledge to support more effective policies at local national and European levels.
Prevention cannot be confined to health ministries alone, and the deep commitment within the Joint Action to engaging communities in the process of improving and maintaining health, intervening across the life course, and creating truly joint action across Europe, are some of its greatest strengths. The project rightly emphasises the importance of empowering young people, and it is gratifying to see the ways in which learning from previous European projects such as Co-Create [17] have been embedded in the joint action, notably through the establishment of the youth advisory group.
The project is, crucially, a joint action, not a research project. That is an important strength, but if it is to create long term impact beyond the four years it runs it will also need to generate robust knowledge that can reliably support sustained change, including policy change. We know what needs to be done to tackle the scourge of noncommunicable disease [18,19], but all too often it does not happen. The Joint Action provides a unique platform that supports communities and member states to work together, across Europe, to show how to achieve and sustain the vital outcomes of health and wellbeing that are so urgently needed for a secure and thriving continent.