Accelerating actions in primary health care

Noncommunicable diseases (NCDs) are the leading cause of mortality in the Region of the Americas, leading to 6 million deaths in 2021, 2.3 million (38%) of which occurred prematurely in people younger than 70 years (1). The main NCDs are cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, caused by the common risk factors of tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity.

Beyond their impact on mortality, NCDs are also a significant burden on health systems and societies, with an estimated 240 million people in the Americas living with at least one NCD (1). Premature morbidity directly affects personal productivity and the realization of human potential, influencing even from a young age, learning, work and development. Many of the premature deaths and disease-related complications could be prevented or delayed through improved access to services, continuity of care and quality of primary health care that ensures more effective prevention, early detection, diagnosis, treatment coverage and long-term disease management.

In this context, the aging population in the Americas further amplifies the burden of multimorbidity, with many individuals requiring sustained and coordinated management of multiple chronic conditions. Strengthening primary health care should not replicate fragmented, disease-centered approaches, but rather promote integrated, person-centered, quality care. There is a sense of urgency at the local levels of delivery to organize quality services across the continuum of care and realities of individuals, communities and territories by fostering comprehensive strategies that align protection, prevention, treatment, rehabilitation and palliative care. While local adaptation is essential, these efforts must be guided by a prioritized agenda from health authorities, which includes community involvement, to ensure coherence, continuity of care and equitable access across diverse settings.

Nonetheless, significant gaps persist in the availability and integration of quality health services for NCDs, highlighting the need for strengthened primary health care. For example, only 20/35 (57%) countries report having guidelines or protocols for managing the most common NCDs through a primary care approach, and only 9/35 (26%) countries report having drug therapy, including for glycemic control, and counselling for eligible persons at high risk to prevent heart attacks and strokes (2). Additionally, improvements in quality of care are needed to improve health outcomes; and people’s needs, experiences, and preferences, as well as their right to be treated with respect, must be an integral part of NCD service design and delivery.

Coupled with the disruptions in health services and forgone care during the COVID-19 pandemic, which significantly affected people with NCDs, there is an urgent need now to redesign and strengthen quality of primary health care services, prioritizing people with NCDs. Several initiatives to strengthen primary health care for NCDs are being implemented by ministries of health, nongovernmental organizations and academic institutions, as well as private sector organizations. In addition, the Pan American Health Organization (PAHO) has been providing technical cooperation to its Member States on the Better Care for NCDs initiative, building on the experiences of regional implementation of WHO’s HEARTS package, to accelerate improvements in NCD management in primary health care.

This special issue of the Pan American Journal of Public Health seeks to document the results and outcomes of many of these regional efforts to strengthen primary health care for NCDs. This special issue notes examples of interventions aimed at:

• primary health care expansion to increase access, coverage and quality of services for NCDs, including, for example, providing social protection for NCD treatment;

• implementation strategies that improve the proportion of people in primary care settings who are diagnosed, treated and controlled for hypertension, diabetes, cervical cancer and other NCDs;

• the use of digital health and telehealth strategies to improve effective coverage in primary health care services to better manage people with NCDs;

• health literacy, empowerment of people, communities to be part of the codesign of NCD services;

• education strategies for health professionals that increase the competencies and skills of primary health care workers in the diagnosis, treatment and management of NCDs;

• integrated person-centered care models for NCDs that take into account multimorbidity, as well as aging populations, ensuring that primary health care systems move away from disease-specific silos and towards coordinated, continuous, integrated approaches that address multiple chronic conditions comprehensively with quality, and produce better health outcomes.

The timing of this special issue is opportune as global heads of state and government convene at the United Nations in September 2025 for the Fourth United Nations High-level Meeting on NCDs to reaffirm political commitments to a multisectoral response to NCDs, including by expanding access to primary care services for NCDs. At the same time, the PAHO Directing Council of Ministers of Health in the Americas will convene to discuss a new regional plan of action for NCD prevention and control (3) that calls for increased implementation of comprehensive NCD management interventions in primary care to accelerate progress towards the Sustainable Development Goal of achieving a one third reduction in premature mortality by 2030. This momentum is further reinforced by the Alliance for Primary Health Care in the Americas, launched in December 2023 by PAHO together with the Inter-American Development Bank and the World Bank. The Alliance offers a favorable opportunity to ensure that NCDs remain a central element in the strengthening of primary health care in the Region. With renewed political commitments, and the successful experiences noted in this special issue, as well as in the PAHO Good practices in public health portal (4), we hope to inspire rapid scale up of NCD management interventions in primary health care.

Funding Statement

This special issue of the Pan American Journal of Public Health on NCDs in primary health care has been funded by a grant to the World Health Organization by the government of Denmark.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health or the Pan American Health Organization (PAHO).