Noncommunicable diseases, such as cancer, cardiovascular diseases and diabetes, are the leading cause of death and disability in the WHO European Region. They account for more than two thirds of the burden of disease in Europe and affect people differently depending on their income, where they live, their age, disability, gender and ethnic background. A large part of this burden is preventable.
The Joint Action on Cancer and other NCDs prevention – Action on Health Determinants (JA PreventNCD) was created to help European countries work together to reduce this burden. Running from 2024 to 2027, the project supports strategies and policies that address common risk factors at both personal and societal levels, strengthens monitoring of NCDs and their risk factors and aims to reduce inequalities by engaging decision makers, professionals, civil society and communities. With 25 participating countries, more than 100 partner institutions and a substantial EU4Health budget, the Joint Action represents one of the most ambitious collaborative efforts on NCD prevention and health promotion in Europe to date. It is part of the EU4Health programme and contributes to the EU “Healthier Together” NCD initiative.
At the halfway point of the Joint Action, a special issue of the Scandinavian Journal of Public Health brings together a series of papers that describe the scientific and strategic foundations of JA PreventNCD and its approach to scaling up NCD prevention and health promotion across Europe. The issue highlights the frameworks, structures and approaches that underpin the Joint Action and will guide its work in the coming years. It is being published at a time when the European Union is stepping up its focus on prevention, including through initiatives such as EU4Health, “Healthier Together” and a forthcoming EU cardiovascular health plan that will also address diabetes and obesity.
To explore this in more detail, the JA PreventNCD communication team sat down with Scientific Coordinator Knut-Inge Klepp to discuss why this special issue matters, how it reflects where the Joint Action stands today and what comes next.
At the midpoint of JA PreventNCD, a special issue of the Scandinavian Journal of Public Health is being dedicated to the Joint Action. Why was it important to publish this collection of papers now, and how would you describe the role of this issue in the overall life cycle of the project?
Writing a set of background papers presenting the rationale, design and key concepts of the work to be carried out as part of JA PreventNCD was important for several reasons.
First, the project is unique in terms of its size and scope. While there have been many joint action initiatives co-funded by the European Commission, our impression was that the larger public health community often was not aware of the outcomes and that there is a potential for larger impact of these joint efforts.
Second, a collective presentation in the form of a special issue presenting all the planned work was seen as an appropriate and transparent way of sharing the ambitions, opportunities, but also challenges in organizing and implementing such a project over a short time (4 years), involving 108 partners across 25 countries.
Third, the process of writing this set of papers had a positive effect within the project, as it required that we critically re-examined the underlying assumptions and expected outcomes of our planned work.
Finally, we estimate that the number of colleagues directly involved in the project is close to 1000, and we believe that this special issue helps all of us to see our own – often limited contribution – as part of a larger effort.
The papers in the special issue focus on how JA PreventNCD is organised and how the work is being planned across countries and work streams. What do you see as the most important scientific and strategic foundations that are made visible here, and are there particular elements you would especially like policymakers or practitioners to notice?
The key strategic element may very well be the ‘joint’ aspect. The analysis has been that health promotion and NCD prevention efforts across Europe have suffered from fragmentation and lack of policy coherence both across EU member states, but also between policy levels, i.e., at the European, national and local levels. Contributing to enhance a ‘joint’ understanding of the challenges, theoretical foundation of the work, shared methodology and scale-up of promising and proven effective interventions and policies are among the main elements.
In your paper in the special issue, you describe six technical work streams that span the range from societal-level policies (such as regulation, taxation and healthy living environments) to more individual-level interventions for people at risk. Why was this design chosen, and how does it help JA PreventNCD address both structural determinants and individual risk in a coherent way?
This was done to reflect the invitation to submit proposals from the Commission, where it clearly was stated that “the aim of the joint action is to reduce the burden of cancer and other NCDs and common risk factors, both at a personal and societal level”. As much of the current research literature tends to focus on individual level interventions, it was vital for the PreventNCD consortium to secure a strong emphasis on societal level – or population-based - strategies. Addressing the full portfolio of relevant policies and interventions was seen as crucial in order to contribute to reduced fragmentation of the prevention field.
The commentaries from WHO Europe, the European Commission (DG SANTE) and Professor Harry Rutter highlight the urgency of accelerating population-level NCD prevention, strengthening surveillance, addressing commercial determinants of health and investing in prevention through initiatives such as EU4Health and “Healthier Together”. How does JA PreventNCD align with these priorities, and how can it help countries move in this direction?
PreventNCD was created as a direct response to the EU4Health program and the “Healthier Together- EU Non-Communicable Diseases Initiative”. In addition, the Europe's Beating Cancer Plan provided guidance when designing the project. Our overarching objectives, i.e., improving joint capacities, data and monitoring systems, contribute to reduced social inequalities, and engaging with and supporting key actors, provide a framework for moving in this direction.
Equity, commercial determinants and youth engagement all feature strongly in the Joint Action. How are these themes woven into the work of JA PreventNCD, and how are they reflected in the papers included in the special issue?
Equity is a cross-cutting topic embedded in all our work. In addition, we have a special work stream (or work package) on this topic, and this work is laid out in the paper by Bucciardini and colleagues. We have established a Youth Advisory Group with broad representation from participating countries, and their role, in particular related to sustaining the actions post-project, is outlined in the paper by Gabrijelčič Blenkuš and colleagues. Various aspects of the role of private sector in NCD prevention, including commercial determinants, are also addressed across work streams, but are highly relevant for the work on taxation and regulation as presented in the paper authored by Helleve and colleagues.
The Joint Action is soon entering its second half. How will the frameworks, methods and structures described in the special issue guide the work in the remaining two years? Are there particular areas where you expect to see the greatest progress?
During the first year of the project, much attention was given to establishing the project, including detailed planning and forming collaboration within and outside the consortium. Now, towards the end of the second year, we see the initial results are coming in. Just last month we presented several findings at the European Public Health Conference in Helsinki. This dissemination work will intensify in the coming two years. In particular, results from the large number of pilots will become available, supporting joint monitoring systems and enhancing our understanding of factors critical for policies and interventions that may contribute to reduce the observed inequality in health. The European commission is about to launch their Cardiovascular Health Plan, and we are keen to see how our frameworks, methods and structures may help implement this plan over the next two years.
JA PreventNCD involves 25 countries and more than one hundred partners from across Europe and brings together work at local, national and European levels over a four-year period. What have you learned so far about working in this kind of multi-country, multi-level collaboration, and how does that experience feed into the plans for the next phase?
First of all, we have learned that there is an enormous amount of expertise and experience within the consortium. This, paired with willingness to share and work together to solve the challenges we face, constitutes ‘the gold’ of the consortium. We also see that the problems encountered are very similar across countries, calling for joint solutions. As public health policies and solutions are ‘owned’ by several different sectors (including transportation, agriculture, education and finance), ways of fostering close collaboration across these sectors is one aspect that feeds into the plans for the next phase.
Once JA PreventNCD comes to an end, what would you like its legacy to be for NCD prevention in Europe? If you imagine looking back in a few years, what would make you feel that this Joint Action truly made a difference?
Many things, but to mention a few: that policies and action on NCD prevention and health promotion is more widely seen as an investment in economic and social well-being, with substantial co-benefits for other sectors of society; that we have in place a comprehensive policy framework to guide Member States in NCD prevention and health promotion at all governance levels; and that we have contributed to build a knowledgebase pointing to effective strategies for reducing social inequalities in health.
If you could send one key message to decision makers who read this special issue, what would you like them to take away about NCD prevention, and about the role that initiatives like JA PreventNCD can play?
Non-communicable diseases (NCD), while representing the major part of the disease burden Europe encounters, are largely preventable. And we know how to do it. Joint action across Europe is a key to reducing this burden and to enhance equity.
The JA PreventNCD communication team thanks Knut-Inge Klepp for sharing his reflections on the special issue and on the road ahead for the Joint Action.
The special issue of the Scandinavian Journal of Public Health offers a snapshot of the scientific and strategic foundations of JA PreventNCD at the midpoint of the project. It brings together the thinking, structures and approaches behind the Joint Action and makes them more visible. As JA PreventNCD moves into its second half, this foundation will be crucial for translating evidence into action and supporting countries to implement effective policies that strengthen prevention and reduce inequalities.
This work is closely aligned with broader EU efforts such as the EU4Health programme, the “Healthier Together” initiative and the recently published EU Cardiovascular Health Plan (the Safe Hearts Plan).
