site.btaNon-Communicable Diseases - Major Public Health Challenge for Bulgaria, Causing Economic and Social Damage

In Bulgaria, 52% of all premature deaths (i.e. deaths before the age of 75) are attributable to four non-communicable diseases (NCDs), shows a report by the Organisation for Economic Co-operation and Development (OECD) published here on Wednesday. This includes 20% due to cancer, 28% due to cardiovascular diseases (CVD), 1% due to diabetes and 2% due to Chronic Obstructive Pulmonary Disease (COPD). Men have a higher rate of premature mortality from NCDs than women, at 374 per 100,000 for men and 198 per 100,000 for women.

NCDs affect far more than health outcomes: they influence how people live and work, strain families and communities, and impose a growing burden on health systems and economies, the report highlights. Fewer NCDs would lower health spending, increase workforce productivity, and strengthen economic growth in Bulgaria. If the four NCDs covered in the OECD SPHeP NCDs model were eliminated, total health expenditure would be 40% lower on average, over the period 2026-2050. At the macroeconomic level, reduced premature mortality and increased productivity would translate into a 6.5% boost in annual GDP, on average over 2026-2050. This includes 1.6% due to cancer, 2.3% due to CVDs, 1.5% due to COPD and 1.1% due to diabetes.

If there were no NCDs, the workforce would be healthier and more productive, with lower absenteeism and presenteeism, resulting in a gain equivalent to an additional 123,613 full-time equivalents (FTEs), OECD's report reads.

The challenge of addressing NCDs is complex, given the multiple risk factors and the wide range of policy entry points. However, clear priorities can be identified by assessing the relative impact of different risk factors on health and the economy, and by benchmarking performance against leading OECD and EU countries.

Potential Gains If Bulgaria Tackles NCD Risk Factors

When it comes to premature mortality, the top three risk factor priorities for Bulgaria are obesity, smoking and harmful alcohol use, which together can deliver 69% of the impact.

According to the report, if Bulgaria was to join the top performing 25% of OECD and EU countries across all six risk factors (air pollution, harmful alcohol use, obesity, physical activity, smoking and unhealthy diet) starting in 2026, then on average over 2026-2050, compared to current projections:

• There would be 41,668 fewer new NCD cases per year
• Annual premature mortality (i.e. deaths below the age of 75) would be 16.6% lower
• Total annual health expenditure would be 7.2% lower
• The workforce would gain 49,882 full-time equivalents (FTEs)
• Annual GDP would be 2.7% higher

In terms of economic gains, the top three priorities to reduce healthcare expenditure are air pollution, smoking and obesity, which together account for 78% of the potential impact. When it comes to GDP, tackling smoking, harmful alcohol use and obesity together delivers 76% of the total impact on GDP.

Unless Action Is Taken, NCD Burder Will Grow

The future prevalence of NCDs will be driven by several factors. First, risk factor levels in the population will play a decisive role in the determining the number of new NCD cases. Second, advances in early detection, treatment, and disease management mean that people will live longer with NCDs. While this is an unequivocal public health success, it does mean that there will be more people living with NCDs, increasing the demand for healthcare services. Third, population ageing will continue to increase the NCD burden.

In Bulgaria, even if risk factor prevalence, survival rates and population size remain constant at current levels, OECD analyses indicate that by 2050 there would be a:

• 25% increase in the number of cases of NCDs
• 53% increase in the number of people living with at least two concurrent NCDs
• 47% increase in per capita health spending on NCDs

Efforts to Bring Additional Safety and Emissions Co-Benefits

Tackling NCD risk factors such as harmful alcohol use and unhealthy diet can bring a range of societal co-benefits that extend beyond health including personal safety from reduced homicides and road traffic accidents, in addition to air quality and emissions. For example, aligning diet consumption to the top quartile of countries could reduce emissions by 247.6 million kgCO2-eq, the equivalent of 58,939 gasoline powered cars. Aligning alcohol consumption in Bulgaria to the top quartile of countries could reduce homicides by 10.7% and road traffic accidents by 11.0%.