Equity integration in NCDs and risk factor policies across 17 European countries in 2025

Non-communicable diseases (NCDs) account for most deaths (91%) and disabilities (87%) in Europe. Both the burden of NCDs and the distribution of their key behavioural risk factors (RF) are unequally experienced across population groups, contributing to persistent health inequalities. This study examines how national policies on NCDs and their key behavioural risk factors address health inequities across Europe. Cross-sectional questionnaire-based analysis of policy documents related to the main NCDs (cancer, cardiovascular disease, diabetes and chronic obstructive pulmonary disease) and their common behavioural RF (tobacco, alcohol, diet and physical activity) in 17 European countries. Policy documents in place between May and August 2025 were analysed descriptively with a focus on equity integration. Four main equity indicators were developed: mention of health inequalities, inclusion of equity actions, routine monitoring of inequalities, and adoption of a Health in All Policies approach. An equity cluster score was created by summing these indicators (range 0–4), representing the number of equity dimensions included in each country’s policy. A total of 87 country responses were analysed (27 NCDs policies and 60 RF policies). Equity integration was higher in RF policies than in NCDs (average equity cluster: 3.3/4 vs 2.8/4). The most frequently identified indicator was the mention of health inequalities (96.6%), while routine monitoring of inequalities was the least common (48.3%). The policy areas with highest equity consideration were physical activity in RF (equity cluster average: 3.6) and cancer in NCDs (equity cluster average: 2.4), since it is the only NCD that had considerable specific policy documents. Integration of equity perspective varies across countries and policy areas. Efforts should be made to improve routine monitoring of inequities, and to design actions that address the burden of inequalities, with special focus on NCDs policy documents.

Key messages

• An equity assessment of non-communicable diseases and risk factor in European policies provides a roadmap for governments to strengthen equity integration in public health policy.

• Equity integration in non-communicable diseases policies lags behind risk factor policies, with routine monitoring being the weakest dimension, revealing critical gaps for policy action.