Spain’s growing NCD burden: Can harm-reduction strategies turn the tide?

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in Spain, imposing a significant economic burden through healthcare expenditures and productivity losses. Despite existing national strategies, a gap persists between public health knowledge and enacted policy, particularly concerning harm reduction, which is inconsistently applied across risk factors such as tobacco use, diet, and alcohol consumption. This study provides the first integrated quantitative assessment of the systematic application of harm reduction strategies across these areas in Spain. This analysis applies the Preventable Risk Integrated ModEl (PRIME) model, a comparative risk-assessment framework, parameterized with nationally representative Spanish data from the Global Burden of Disease study, health surveys, and dietary research- which were adjusted for underreporting biases. Counterfactual scenarios were developed by modelling the replacement of alcohol, conventional tobacco, and foods high in salt and saturated fat with existing, commercially available lower-risk alternatives. Our analysis estimates that the adoption of these harm reduction strategies could prevent approximately 1.23 million NCD cases annually. The projected economic gains total €18.32 billion, including €10.19 billion in direct healthcare expenditures and €8.13 billion from productivity gains. Tobacco-related risk reduction is associated with the greatest impact, preventing an estimated 0.53 million cases and yielding €5.59 billion in economic savings, followed by salt reduction at €4.10 billion. These findings offer novel empirical evidence that a pragmatic and consistent application of harm reduction, particularly in tobacco control, where it is currently resisted, could provide considerable health and economic benefits for Spain.