Lung health now: a global call to action

There is also a matter of urgency for the financial sustainability of our health systems. The prevalence of CRDs is rising, and with it, the pressures they pose on health systems. Without investment in effective interventions, COPD alone is predicted to cost the global economy $4.3 trillion between 2020 and 2050. The same is true of lung cancer. Even with declining smoking rates in many countries, the incidence and mortality rates of lung cancer are still growing, requiring urgent action to detect cases as early as possible and offer optimal treatment to improve prognosis and survival.

Why is an integrated approach to lung health essential?

While the lung diseases mentioned above each have their own natural history, diagnosis and treatment needs – and consequently should have their own care pathways – they also share some common risk factors and challenges relating to ideal prevention and management.

• Smoking: Tobacco use still kills more than 8 million people globally every year, with smoking responsible for 2 million lung cancer deaths worldwide in 2021. However, the prevalence of lung cancer in people who have never smoked is also on the rise, particularly in women.
• Air pollution: Rising air pollution and decreasing air quality are factors in all diseases of the lungs. In 2021, air pollution was the second leading risk factor for death in all age groups, including children under five, and was responsible for an estimated 1 million deaths worldwide. Globally, air pollution is thought to be responsible for 29% of lung cancer deaths and 43% of deaths from COPD.
• Links to health inequalities: There is an intrinsic link between lung diseases and social disadvantage. Traditionally underserved populations are more likely to be exposed to smoking, occupational risks and air pollution, increasing their risk of poor lung health. For instance, people at the lowest socioeconomic levels are up to 14 times more likely to develop respiratory diseases than people at the highest levels. Recent data from England also suggest that COPD is a major cause of the observed gap in life expectancy between the most affluent and most deprived communities. For lung cancer, people of lower socioeconomic position appear to be more likely to develop and die from the disease, which may be attributed to a lower likelihood of receiving established and next-generation treatment, and higher rates of comorbidities and smoking.
• The toll on health systems and cost to society: Both asthma and COPD manifest as flare-ups, which are distressing for people living with the disease and often lead to emergency hospital admissions. And as with many cancers, treatment costs for advanced lung cancer are much greater than at earlier stages of the disease – but lung cancer is the most costly cancer globally. It has a significant societal cost in terms of poor quality of life for people with the condition and their carers, and also in terms of lost productivity; lung cancer accounts for approximately 20% of cancer-related lost productivity in Europe.
• Inequities in access to optimal diagnosis, treatment and care: A common barrier for all lung conditions is a lack of access to early diagnosis, and guideline-recommended treatment and care – both between and within health systems. For example, barriers to early presentation and diagnosis of lung cancer are common, and include limited roll-out of screening for high-risk populations, limited awareness of lung cancer symptoms and treatment, poor relationships between GPs and patients, and limited access to services and care. Regional studies also suggest that people with CRDs who live in areas of greater deprivation have a higher risk of hospitalisation, unplanned emergency admissions, and death. Data from the US also demonstrate that Black Americans with asthma are twice as likely to be hospitalised, five times as likely to require emergency care and three times as likely to die from asthma as their White counterparts.

The opportunity: what governments can do

The picture that the data above paint makes it evident that policy leadership – in the form of political commitment anchored in clear policy targets and comprehensive respiratory strategies – is needed to improve lung health. As they seek to implement the World Health Assembly resolution in their own countries, governments should also take a multi-sectoral, holistic approach that combines long-term population health initiatives with health system changes to improve the equity and quality of care. This is necessary given the intersection of lung health with other policy areas, including climate change, health system sustainability and health inequalities.

Policy commitments should also focus on embedding system changes that will optimise prevention, detection and care for everyone at risk of lung ill health. There have been considerable advances in the way many CRDs are diagnosed and treated in recent years, with huge potential to improve people’s daily lives. Progress has also been seen in the integration between primary and secondary care, empowering people with the tools to support self-management and monitor their condition. One way to think about this is to advance the three Es of good CRD management: evidence-based, early and equitable.

In lung cancer, possibly the most important change has been the ability to shift detection of the disease to an earlier stage with an effective and safe screening tool: low-dose computed tomography (LDCT). The evidence is compelling: LDCT screening can reduce mortality by at least 20% in people with a high risk of lung cancer; it is highly cost-effective and even more efficient than many other cancer screening programmes, in that it requires fewer CT scans to detect one case of cancer. Ongoing research is also looking at the role LDCT programmes can play in co-locating with screening for other conditions, such as COPD or coronary arterial calcification. However, some countries may not have sufficient resources to roll out an LDCT programme. Therefore, additional avenues for early detection also need to be explored – such as managing incidental pulmonary nodules optimally, including the utilisation of AI to detect potential malignancy – until at-scale implementation of these programmes is realised to transform lung cancer from a mostly fatal condition to a mostly treatable, even curable, one for future generations.

A line in the sand for lung health

The resolution offers a blueprint for countries to drive real change for millions of people affected by lung conditions, and promote better lung health for future generations. With a concerted effort by governments and organisations from all sectors to prioritise and champion respiratory health, we can drive improvements in diagnosis and care to ensure better outcomes and improved quality of life for everyone living with lung conditions.

Many thanks to all the HPP team members who contributed to this blog: Suzanne Wait, Aislinn Santoni, Jessica Hooper, Helena Wilcox and Emily Medhurst.