Adult smoking prevalence stands at 46.0% (2020) — the highest of all eleven countries in the 4P-CAN consortium — alongside a youth prevalence of 20.0%. Comprehensive smoke-free measures are in place, though compliance levels remain unknown. Plain packaging has not been implemented, and health warnings cover only 35% of cigarette packaging, well below the EU standard of 65%. Vending machine sales are banned, but internet sales are not restricted. Cigarettes have become less affordable since 2012, suggesting that price increases may be exerting some market pressure, though the persistently high prevalence indicates that fiscal measures alone have been insufficient.

A standard blood alcohol concentration limit applies of 0.5 g/L for drink driving and sets the minimum legal drinking age at 18. Still wine carries no excise duty (0 EUR per hectolitre), consistent with other wine-producing countries in the region, while ethyl alcohol is taxed at 553 EUR per hectolitre. As a non-EU country, the country is not bound by EU-level alcohol policy harmonisation, and the overall alcohol regulatory landscape is less comprehensively documented than in the consortium's EU member states.

HPV vaccination was introduced for girls in 2009 — relatively early among non-EU consortium countries and ahead of both Bulgaria and Romania. However, vaccination has not been extended to boys. HPV vaccination coverage for girls stands at 46% for the first dose and 40% for the last dose. Hepatitis B vaccination is mandatory, with coverage at 86% — adequate but below the WHO target of 95%. The country operates an electronic cancer registry since 1995, with approximately 165,000 persons registered by the end of 2020, providing a foundation for cancer surveillance even as broader data integration challenges persist.

Annual cancer-related economic losses remained relatively stable of EUR 20.5–22 million until 2020, followed by a dramatic escalation to EUR 35 million by 2023 — a 56.5% increase compared to 2021. Productivity losses drove this surge, rising from EUR 17.46 million in 2021 to EUR 27.11 million in 2023, a 55.3% increase in just two years. The average cancer mortality rate among the economically active population is 110 per 100,000. While the number of active persons has remained effectively flat (CAGR of -0.1%), labour productivity growth of 4.6% and net wage growth of 5.9% have amplified the economic cost of each premature death. The cumulative nine-year burden is estimated at approximately EUR 216 million, and modelling suggests that a comprehensive prevention scenario could yield annual savings of EUR 8 million.

Healthcare expenditure stands at 7.3% of GDP (2019), below the EU average of 9.9% and below the South-East European average on a per capita basis (USD 1,314 PPP). Out-of-pocket payments account for 40.4% of total health spending — the highest proportion in South-East Europe — placing a disproportionate financial burden on patients and their families. Cancer is the second most common cause of death, responsible for approximately one in five deaths. All tertiary cancer care is centralised solely in Skopje, creating a significant geographic equity barrier for patients outside the capital. Systemic challenges include weak inter-institutional coordination, incompatible software systems across Community Primary Health centres that prevent unified data exchange, and an electronic cancer registry that, despite operating since 1995, remains poorly integrated with other health information systems. A 2023 scandal at the Oncology Clinic involving the diversion of medications to the black market through "fictional patients" underscored the governance vulnerabilities within the system.