Bulgaria plans a new National Program for the Prevention of Chronic Diseases by 2030

A draft National Program for the Prevention of Chronic Non-Communicable Diseases for the period 2026–2030 was published for public discussion on the website of the Ministry of Health. The program envisages investments worth over BGN 17 million, and the deadline for submitting opinions is one month.

The published document states that chronic non-communicable diseases (NCDs) are a leading cause of death and disability worldwide. According to the World Health Organization (WHO), they cause the death of about 43 million people annually, which represents 75% of all deaths not related to the COVID-19 pandemic. The main diseases included in this group are cardiovascular diseases (about 18 million deaths per year), cancer (10 million), respiratory diseases (4 million) and diabetes (over 2 million people, including mortality from kidney complications caused by diabetes).

In Bulgaria, the leading cause of death is diseases of the circulatory system (61.1%), followed by neoplasms (16.5%), diseases of the respiratory system (4.9%), symptoms and signs discovered during clinical and laboratory tests, not classified elsewhere (4.7%) and diseases of the digestive system (4.5%). In 2023, COVID-19 ranks ninth among the causes of death in the country.

The project emphasizes that the main risk factors for the development of NCDs are unhealthy eating, insufficient physical activity and smoking, which are behind 80% of cases of ischemic heart disease, cerebrovascular and other diseases. The second group of risk factors includes high blood pressure, dyslipidemia, diabetes and obesity.

According to Eurostat data for 2022, 16,227 deaths from malignant neoplasms were registered in Bulgaria, which represents 13.7% of all deaths. The "Bulgaria Health Profile" for 2023 indicates that the most common causes of death from cancer in the country in 2021 are lung cancer, colon cancer, breast cancer, prostate cancer and pancreatic cancer. Although the incidence of cancer in Bulgaria in 2022 is below the EU average, and mortality is close to the European one, the country remains one of the two EU members in which an increase in mortality from oncological diseases has been recorded in the last decade — a trend opposite to that in the other countries.

Diabetes is cited as a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin produced. Prolonged high blood sugar levels (hyperglycemia) lead to severe damage to the nervous and vascular systems. The most common form is type 2 diabetes. In Europe in 2021, 61 million adults suffered from diabetes. In Bulgaria, the prevalence of the disease until 2024 reaches 16.55%, and the mortality rate in 2023 is 21.6 per 100,000 people. About 75% of diagnosed diabetics have poor metabolic control, which leads to the development of complications.

The program pays special attention to overweight and obesity, noting that they cause 42% of deaths in adults with type 2 diabetes, 19% of ischemic heart disease, 17% of strokes and 5% of oncological diseases. According to the national representative study of health risk factors from 2020, conducted under the current program 2021–2025, the incidence of obesity is 2.1% in children aged 1–4 years (decrease compared to 2014) and 12.8% in children aged 5–18 years (increase of 2.5% compared to 2014). The high level of obesity among the working-age population remains a serious problem. Data from the WHO European Childhood Obesity Surveillance Initiative (COSI) for the period 2008–2023 show an increase in the proportion of overweight, including severe obesity, especially among boys, students from rural areas and children from families with low socioeconomic status and limited health habits.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world. According to WHO data for 2021, more than 3.5 million people died from it. The Ministry of Health notes that between 5% and 10% of Bulgarians suffer from COPD, but only about 75,000 receive treatment. According to unofficial estimates, the real number of patients reaches over 500,000 people.

The document emphasizes that chronic non-communicable diseases – cardiovascular, oncological, pulmonary and diabetes – are leading causes of death and disability, and limiting risk factors reduces morbidity, mortality and the socio-economic burden on society.

"The development of the program so far over the years shows that it works effectively even in conditions of chronic lack of funds, which hinders the implementation of all planned activities. The accumulated experience should be used, with the initiative being continued in the period 2026–2030 in order to improve the health indicators of the population", the project states.

In 2026, the conduct of a National Study of Health Risk Factors among the population of Bulgaria is planned, which will track the changes in people's health behavior. Among the priorities of the future program are the continuation of the policy to promote a healthy lifestyle, increase health culture and prevent eating disorders and obesity.

In the medium term, the main goal of the program is to maintain the current levels of morbidity, disability and mortality from the main chronic non-communicable diseases. In the long term, a reduction in mortality from ischemic heart disease by 5%, a reduction in the incidence of malignant neoplasms of the breast, cervix and colon by 5% (per 100,000 people), limiting mortality from type 2 diabetes by 5%, stopping the increase in overweight and obesity in children under five and adolescents, stabilizing obesity levels among adults and reducing mortality from COPD by 5% is set. Special attention is also paid to the goal of massively increasing physical activity among the population.