The final political declaration for the United Nations High-Level Meeting (HLM) on NCDs is substantially weaker than the zero draft, no longer referring to taxing sugar-sweetened beverages – while describing higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

However, targets for reducing tobacco use and increasing access to hypertensive management and mental health care have survived the negotiations.

Health Policy Watch can exclusively reveal the final declaration (see link below), after negotiations between the 193 UN member states were concluded last week. The declaration is due to be adopted  at the HLM on 25 September.

READ: Political Declaration of UN High-Level Meeting on NCDs

The zero draft target of “at least 80% of countries” implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages to levels recommended by the World Health Organization (WHO) by 2030 is completely absent from the final draft.

The declaration has also removed virtually all references to WHO recommendations. This is apparently at the insistence of the United States, which withdrew from the WHO when Donald Trump became president in January, sources close to the talks told Health Policy Watch.

The WHO has developed a wealth of evidence-based strategies to address the group of killer conditions – including cardiovascular disease, cancer, diabetes and hypertension – that are driving deaths globally.

Only 19 of the 193 UN member states are on track to achieve the earlier goal of reducing NCD mortality by one-third by 2030 (Sustainable Development Goal 3.4).

Tangible targets

Alison Cox, the NCD Alliance’s policy and advocacy director, told a media briefing on Wednesday that the alliance “warmly welcomes” the declaration’s “time-bound and tangible targets”, particularly 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030.

“The fact these targets have survived a tough negotiation progress is evidence that this declaration represents political commitment to faster action,” said Cox.

The three previous UN HLMs on NCDs (since 2011) “have stopped short of including this kind of specific measure”, she added.

She also welcomed two other targets related to access to NCD medicines and care, and financial protection policies to cover patient care.

The first aims for “at least 80% of primary health care facilities in all countries have availability of WHO-recommended essential medicines and basic technologies for non-communicable diseases and mental health conditions, at affordable prices, by 2030” (clause 63).

The second target is for “at least 60% of countries have financial protection policies or measures in place that cover or limit the cost of essential services, diagnostics, medicines and other health products for non-communicable diseases and mental health conditions by 2030.

“These two targets would be critical in delivering care while reducing the growing amount of out-of-pocket expenditure,” said Cox, adding that around 1.3 billion people have been pushed into poverty by health spending. 

Influence of health-harming industries

However, Cox decried the dilution and weakening of commitments to “well-established, evidence-based interventions”, particularly the removal of excise taxes on harmful products.

This was likely to be the result of “the health-harming industries, who lobby governments so hard – industries like tobacco, alcohol, ultra-processed food and sugar sweetened beverages, and indeed, fossil fuels”, said Cox.

“We’ve heard from early this year that representatives of these companies were seeking meetings with governments in their capitals and with their missions in New York, and it’s very frustrating because these interactions are often not documented and they’re not transparent, yet we can see these interests represented in the outcome of this negotiation process.”

Cox said that while the alliance did not know which countries had pushed for references to taxes to be dropped, many countries in the European Union opposed additional taxes on alcohol because they have a large wine industry.

The declaration also makes no mention of action against food high in salt, fat and sugar, which Cox described as “a missed opportunity”.

Government under-spending on NCDs

Cox was speaking at the launch of an NCD Alliance report published on Wednesday on financing for NCDs, which found that most countries are “dangerously underspending” on the leading cause of death worldwide, according to the NCD Alliance.

Countries should spend 1.1% to 1.7% of their gross national income (GNI) on NCDs to provide universal coverage – but currently spend just 0.26% to 0.46% of GNI, according to the report.

The report, compiled by University of Washington researchers, exposes “the scale of the chronic underinvestment that we’ve seen in NCDs for decades”, said Katie Dain, NCD Alliance CEO.

A significant proportion of government spending on NCDs goes to medicines, with a wide variation in medicine prices across countries.

Dr David Watkins, lead author of the report, models potential cost-savings of 20% to 50% if the best prices were available globally. 

“Ministries of Health and Finance must act decisively on these findings,” said Watkins. “This analysis provides governments with data to support smarter investment on NCDs, mental health, and neurological conditions in their policies and budgets. It’s not just about increasing investment but about making health budgets go further.” 

Image Credits: Thomas Stellmach/Flickr, Unsplash.