Comparison of Premature Deaths from Non-Communicable Diseases Among BRICS Countries

1. Introduction

In 2021, noncommunicable diseases (NCDs) caused over 43 million global deaths (with 73% occurring in low- and middle-income countries). Part of the global deaths include 18 million deaths that are considered premature. Of these, 82% occurred in low- and middle-income countries (Jamison, 2024; Global burden of disease Report, 2021).

The World Health Organization (WHO) leads global efforts to reduce premature deaths by one-third by 203 and by 50% by 2025. Despite global improvements in reducing premature mortality (dying between ages 30-70) from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, these remain leading causes of death. There are 19 million annual deaths due to cardiovascular diseases, 10 million deaths due to cancers, 4 million deaths due to chronic respiratory diseases and 2 million deaths due to diabetes (Global burden of disease Report, 2021).

 In 2019, the World Health Assembly extended the WHO Global Action Plan to 2030 and initiated an Implementation Roadmap (2023–2030) to accelerate progress by focusing on nine impactful global targets for NCD prevention and management. Based on the WHO World health statistics, 2024, NCD service coverage has improved for hypertension treatment (WHO, 2024). Detailed in the Global health 2050 report, published by the Lancet Commission in October 2024, the report highlights global progress across countries and recommends focused health investments for targeted health interventions to promote quality of life and well-being to reduce 50% of premature deaths by 2050. The World Health Organization (WHO) developed a global monitoring framework that was adopted in 2013 which aims to promote advocacy, political commitment, and global action, which has nine global targets and 25 indicators, to track progress in preventing and controlling major NCDs, thereby addressing risk factors and strengthening health systems (WHO, 2024). 

The WHO periodically evaluates countries' capacities to prevent and control noncommunicable diseases (NCDs) through the NCD Country Capacity Survey (NCD CCS). This global survey helps monitor progress and achievements in strengthening responses to the NCD epidemic. There are concerns that these targets will not be met noting the current trends. Based on the WHO world health statistics 2024 reports. Of the 32 numeric global health-related SDG targets reviewed, none of the countries have achieved these although most show a positive trajectory.

The aim of the desk review is to compare progress towards reaching NCD targets and reducing premature deaths among the current BRICS countries. The purpose is to highlight and promote the sharing of lessons and knowledge within the partnership and across the regions using BRICS as an example of upper middle-income countries, as defined by the World Bank. This is the first review and comparison on NCD including the new members of the BRICS.

2. Methods

A literature review was conducted, of key documents and databases and used to extract the data for comparison. The document review includes the Global Health 2050 Report, the WHO NCD global monitoring framework, the World Bank economic reports, WHO NCD capacity survey posted on the WHO global health.

In addition, population, economic and Universal Health Coverage (UHC) data was also extracted from the indexmundi.com, by country of interest, where necessary and captured in a Microsoft Excel worksheet. The data is presented in Table 2 below, by country with the main data components for comparisons. The key data components included: demographic, economic, NCD mortality, and nine NCD global targets from the WHO NCD framework (WHO, 2021).

2.1. Inclusion criteria

·       Data published from 2019 to December 2024

·       The focus is on NCD premature deaths and nine global targets for PPD as stipulated in the WHO framework.

·       Selected socio-demographic data, including population, national gross domestic product per capita, out-of-pocket health expenditure and UHC index.

·       BRICS countries were included in this review, namely: Brazil, Russia, India, China, South Africa, Egypt, Ethiopia, Indonesia, Iran, and the United Arab Emirates (UAE). This partnership was formed to coordinate economic and diplomatic policies and promote diverse global influence on international institutions. BRICS controls about 41% of global GDP and 50% of world’s population (Niaki,2025).

Table 1: BRICS countries by economic status as defined by the World Bank

Source: World Bank Country and Lending Groups – World Bank Data Help Desk

3. Results

Table 2: Comparison of progress of BRICS countries towards reducing premature deaths and achieving NCD targets.

3.1. Demographic, Economic and Universal Health Care Status

United Arab Emirates (UAE) has the highest gross domestic product (GDP) per capita among the BRICS countries, followed by Russia at USD 11 000 and China at USD 10 000 GDP per capita. The two bottom countries with lowest GDP per capita are India and Ethiopia at USD 2,000 and USD  800 per capita respectively. Russia, UAE, and Brazil are top three countries among BRICS with the highest health expenditure through out-of-pocket payments per capita, while, Ethiopia has the lowest at USD 10.

China, UAE, and Iran are top three BRICS countries with the highest UHC coverage index, at 82, 78, and 77 respectively, while, India, Indonesia and Ethiopia have the lowest UHC coverage index at 61, 59 and 38, respectively. This indicator measures the average coverage of essential services through a single index score based on 14 indicators across four domains: reproductive, maternal, newborn and child health (RMNCH); infectious diseases; NCDs; and service capacity and access (WHO indicator definition, 2025).

3.2. Mortality and probability of premature deaths due to NCDs

In terms of mortality data, Russia has the highest crude death rate at 14.6, followed by South Africa at 9.4, India at 7.30 and China at 7 per 1000 population, while UAE had the lowest crude death rate at 1.58 per 100.000 population.

Russia and Iran are the two top BRICS countries with the highest p-scores at 24% and 21% respectively, while China has the lowest p-score of 5%. The P-scores calculate the percentage of excess deaths relative to expected deaths for a given period, with a low score suggesting better performance (Our World in Data, 2024; The Economist, 2022).

Indonesia (70 years), India (54 years) and Brazil and Egypt (43 years) have the longest time to reduce PPD by 50%, while Russia (26 years), South Africa (29 years) and Ethiopia (30 years) are bottom three BRICS countries with the shortest time to reach the target. 

The value of mortality changes relative to the value of national income change per year is estimated based on disease-specific mortality risk changes and the proportion of change in full income due to mortality risk reduction. In this context, Iran, China, and Ethiopia are the top three BRICS countries with the highest value of mortality changes relative to national income changer per year. South Africa, Russia, and Egypt are the bottom 3 BRICS countries with the lowest value of change in gross national income per year, while Brazil reported a slightly decreasing national gross income, with value of change on the negative (Jamison, 2024).

Ethiopia leads at 5.4% in terms of value of mortality change relative to the national income value of change per year, followed by South Africa at 5.1%, and Russia at 2.9%, while Brazil, China, Egypt, Indonesia, and Iran had the least value of mortality change. The regional data, linked to these countries, shows an increase in mortality rates during the same period.

3.3. Progress on reducing the National Non-Communicable Diseases (NCD) Country Status

Regarding the National NCD targets, only Indonesia has partially achieved this indicator, which requires, a set of time-bound national targets for NCDs and does not cover two of the three areas addressed in the 9 voluntary global targets and the WHO Global Monitoring Framework, while the vast majority (9 BRICS countries) had fully achieved this target.

 Brazil and Russia are the only two BRICS countries with high-quality vital registration system that captures deaths and the causes of death routinely and certified using International Classification of Diseases (ICD) code for submission to the WHO Mortality Database. Six (China, Egypt, India, India, Iran, South Africa, and UAE) of the BRICS countries had partially achieved this requirement. Ethiopia and Indonesia did not achieve this indicator.

China, Russia, Egypt, and Iran are the top 4 of the BRICS countries with highest percentage of deaths from NCDs, while Ethiopia has the lowest percentage of deaths (40%) from NCDs.

Egypt at 28% has the highest probability of premature mortality from NCD compared to UAE which has the lowest percentage at 9%. India, Indonesia, and Russia had 24% PPD and South Africa at 22% while China and Brazil are at 16% and 15%, respectively.

Egypt has the highest NCD age-standardized death rate at 795 while UAE has the lowest at 329 per 100 000 population in 2019, respectively. China ranks fifth within the BRICS counties for this indicator, while it ranks first with highest percentage of deaths due to NCDs.

Four (China, Indonesia, Iran, and Russia) of the BRICS countries had fully achieved the requirements of conducting the risk factor surveys. The risk surveys include physical measurements and biochemical assessments covering the key behavioral and metabolic risk factors for NCDs and conducted at least every 5 years. Egypt, Ethiopia, India, Indonesia, South Africa, and UAE risk factor partially achieved the risk factor survey indicator (i.e., excludes other risk factors and the surveys are infrequent) (WHO 2025).

3.4. NCD reduction in public health Actions

Six (Brazil, China, Egypt, India, Indonesia, Iran and AE) of 10 countries had a national integrated NCD plan or policy, addressing the four main NCDs (cardiovascular diseases, diabetes, cancer, chronic respiratory disease) and their main risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol), as required by the WHO framework. Only two countries and South Africa and Russia had partial plans (not multisectoral or addressing all 4 main NCDs and risk factors, while Ethiopia did not have a plan aligning to the WHO definition of this indicator.

Brazil is the only country within BRICS that has fully achieved the indicators related to reducing tobacco demand with total taxes set at 75% or more of the retail price of tobacco products, has mass media campaigns, smoke-free policies, has large graphic health warnings/plain packaging, and has bans on advertising, promotion and sponsorship. Russia is the second leading country to achieve this indicator as it has fulfilled 4 and partially achieved the sub-components of this indicator related to retail price tax. The other eight BRICS countries have partially achieved this indicator.

Iran is the only country within BRICS that has fully implemented public health actions against the harmful use of alcohol, increasing the restrictions for access, has an advertising bans or comprehensive restrictions on use of alcohol and an increased excise tax, while other BRICS countries have partially achieved this indicator.

Russia and UAE are the only two BRICS countries that have fully implemented national policies to reformulate foods and beverages which are high in salt, saturated fatty acids, trans-fatty acids, sugars and have restrictions in terms of marketing unhealthy diet to children and against breast milk substitutes. Six countries had partially achieved this indicator, while two countries Egypt and Ethiopia did not achieve this indicator, as they did not have any of the policies related to the sub-components of this indicator.

Four (Egypt, Ethiopia, South Africa, and Iran) of the 10 BRICS countries had partially achieved the indicator related to the public education and awareness campaign on physical activity, while six remaining BRICS countries fully achieved this indicator.

Eight of the 10 BRICS countries had guidelines for Management of Major NCDs, however, only Russia and UAE had partially achieved this indicator, as they only had guidelines for 2 of the 4 main NCDs.

In terms of drug therapy and counseling to prevent heart attacks and strokes, only Iran, Russia and UAE had fully achieved this indicator. Four of BRICS countries did not have these services, while three countries did not respond or stated they did not know in their response to this indicator.

4. Discussion

4.1. Main findings

The countries within the BRICS partnership do have variations in terms of population size, economic status that also affect health care coverage and health expenditure, which in turn may impact on their capacity to respond effectively to reduce the impact of NCD in their countries.

Only 1 country-UAE had PPD less than 10%. Most countries had PPD 15% and above. Other studies have reported that the overall PPD is 21.9% in developing countries, which is 1.5 times greater than the risk of individuals from the high-income countries. Similarly, with the crude death rate per 100 population as well as the age-standardized mortality rate was also higher in BRICS countries located in Africa as compared to UAE, which has the highest GDP per capacity and highest UHC coverage index and lowest probability of premature mortality from NCDs. This aligned with the literature, reporting that the highest burden of NCDs in developing countries.

4.2. What is known?

WHO, the World Bank, The Economist all provide data that allows comparisons among countries based on geo-location, economic status, WHO regional classifications. These institutions also publish reports on the status of world health, an example, which provide comprehensive overview of public health actions employed across countries for NCD prevention and control. Research institutions across the globe have provided information and correlations of risk factors for NCDs, as well as provided guidelines and policies on prevention and control, including examples of behavioral change interventions. Sharing of efforts across countries facilitates consideration and adaptation of effective interventions to achieve the NCD targets set for both 2030 and 2050 (WHO, 2021, 2025, World Bank, the Economist, 2024).

The World Bank report on enhancing longevity (2024), advocates for Investing in health and wellbeing across lifespans to transform aging population to save 150 million lives in low- and middle-income countries by 2050 and yield substantial economic benefits (Jha, 2024).

Studies have also noted that reducing avoidable mortality from major non-communicable diseases (NCDs) and injuries through targeted interventions including multisectoral actions across health care levels and community structures has significant economic, education, equity, and health system implications. There is also data to estimate the economic value of reducing mortality by cause, which can guide multi-sectoral priority setting and inform high-level policy discussions on budget and strategic resource allocation (Verguet, 2024; Steinbach, 2024; Haacker, 2023; Case, 2022; NCD Countdown Collaborators, 2022; Watkins, 2020; Jamison, 2018).

All these metrics and tactics provide a framework for evaluating investments in health and longevity, emphasizing the socio-economic benefits of targeted interventions. (Norheim,2024; Allen, 2017; Steinbach, 2019; Knutson, 2023, Verguet, 2024 and Bukhman,2020.)

4.3. What this study adds

This is the first desktop review to compare the burden and outcome of NCS among BRICS countries. This comparison study suggests simultaneous tracking of a combination of both demographic, economic, and health indicators when comparing health outcomes among countries, in recognition of socio-determinants of health, to prevent assumptions regarding similar capacities and abilities just because countries collaborate and have similar aspirations.

Table 2 depicts the summarizes data by country based on this partnership. This is a more appropriate way of visualizing the unequal distribution among BRICS countries of NCS related indicators including the PPD from NCDs. With greater push to ensure data-driven policies, this desktop review also promotes these comparisons to inform BRICS partnership health-related policies and guidelines as well as resource mobilization. This also makes it easy to identify areas for improvement and collaboration through sharing of best practices within the partnership. (Allen, 2017).

5. Limitations of the Study

The main strength of this study is the use of several of the secondary data published with well-defined methods of collection and indicators that are clearly defined and endorsed at global level, including NCD premature mortality, to allow the first comparison of NCD burden and risk of premature death for individuals among the newly expanded BRICS partnership.

The main weakness is that the data is secondary, extracted from WHO database and other international databases reflecting the variations of vital registration systems and health information systems capacities. Hence data quality and verification are limited. Secondly, we have selected limited indicators and have not considered other indicators related to inequities and equalities that may be affecting the burden of NCDs and related PPD rates.

6. Conclusion

This paper highlights variations of the progress made in reducing the NCD burden and PPD among BRICS countries. This is the very first comparison conducted on the subject matter among BRICS countries. The comparison identifies countries among BRICS highlighting within and between countries variations of progress, in reducing PPDs and overall NCDs.

 The summary table can be used as the baseline for future studies to compare progress among BRICS countries. Data on PPD and NCDs has potential to help governments and organizations identify the most pressing health challenges, point out areas for country governments priority setting, assist with planning to meet national and global targets and commitments and guide the allocation of domestic resources.

The study also highlights the importance of countries submitting reliable and high-quality data to WHO for such comparison to occur and to guide the creation of targeted interventions, policies or programs promoting health behaviors and campaigns to address specific health risks within each country.

This study provides an opportunity to evaluate the effectiveness of policies and programs among BRICS countries and has potential to guide areas for cooperation and enable countries to learn from each other's successes and challenges in tackling NCDs for continuous improvement.

It also highlights the need to strengthen health systems, enhance the sustainability and equity of health services and promote effective financing models as critical priorities to contribute to the successful achievement of NCD targets by 2050.

Author contribution statement: SM conceptualized, conducted literature review, collated the data, and drafted the manuscript.

Funding: None

Conflict of Interest: None

Ethics: not applicable, data secondary already published from public platforms

Data availability: Comprehensive data extracted from the WHO Global Observatory has the NCD Data and selected data for th

e paper included in table 2. Readers can access it by requesting the original version from the author via email.

Artificial Intelligence (AI) generated text statement: This study has not used any generative AI tools or technologies in the preparation of this manuscript.