For every $1 invested in cost-effective “best buys” to prevent non-communicable diseases (NCDs) over the next five years, there would be a four-fold return in social and economic benefits, according to the World Health Organization (WHO).

The WHO’s 29 “best buys” focus on reducing tobacco and alcohol consumption, addressing unhealthy diets and lack of exercise, and strategies to reduce cancer, cardiovascular and chronic respiratory diseases.

Ahead of the United Nations High-Level Meeting (HLM) on NCDs and mental health in New York on 25 September, the WHO released a report on Thursday showing the rewards from implementing these strategies.

If all countries fully embrace the “best buys”, this would save 12 million lives, prevent 28 million cases of heart attacks and strokes and generate economic gains exceeding $1 trillion by 2030.

If investment is sustained for a decade – until 2035 – there could be a seven-fold return on investment.

“We have the tools to save lives and reduce suffering,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday. 

“This is not theoretical. Countries are doing it. Brazil has cut smoking rates in half by steadily increasing tobacco taxes. Mexico’s tax on sugary drinks reduced consumption while raising significant government revenue. Thailand channels tobacco and alcohol taxes into its National Health Promotion Foundation.”

Slowing progress

NCDs are the biggest global killer, while more than one billion people live with mental health conditions. Almost three-quarters of deaths related to NCDs and mental health – 32 million – take place in low- and middle-income countries. 

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

Spending just 0.6% of the gross national income of LMICs could enable 90% of these countries to reach the SDG 3.4 target, according to the WHO.

While over 80% of countries have made progress in reducing NCD deaths since 2010, this has slowed down in 60% of countries from 2019 (in part because of COVID-19) in comparison to the previous decade.

Denmark has recorded the largest improvements, while China, Egypt, Nigeria, Russia, and Brazil have also reduced NCD deaths in both men and women.

“The biggest gains were driven by declines in cardiovascular disease and certain cancers—such as stomach and colorectal cancers for both sexes, cervical and breast cancers for women, and lung and prostate cancers for men,” according to the WHO.

“But pancreatic, liver cancers and neurological conditions contributed to rising mortality in many countries.”

HLM Political Declaration is ‘strongest’ yet

The final UN HLM political declaration is weaker than the zero draft, making higher taxes on tobacco and alcohol “considerations” not recommendations, and dropping any reference to taxing sugary drinks.

However, the targets of 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 have survived the negotiations.

Dr Werner Obermeyer, director of the WHO office at the UN in New York, described the declaration as “a very strong outcome document” when considered holistically.

“There is very strong language in the text on taxation or alcohol and tobacco marketing restrictions, and also in terms of the regulation of food products,” said Obermeyer.

Dr Guy Fones, the WHO lead on NCDs, said the declaration is “the strongest we’ve had… because it has delivered on its call for equity and integration”, crediting the co-facilitators, president of the UN General Assembly and member states for traversing “a very complex path to arrive at the final draft”.

Next week’s HLM is the fourth on NCDs since 2011, but previous declarations have avoided concrete targets.

Last week, Alison Cox, the NCD Alliance’s policy and advocacy director,  “warmly welcomed” the declaration’s “time-bound and tangible targets”, particularly three “150 million” targets.

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

Meanwhile, Vital Strategies said in a media release on Thursday that the declaration “marks significant multilateral commitments to address the world’s leading causes of death, such as cancer, hypertension and lung disease”.

It urged governments to “pivot to urgent action”, describing taxes on tobacco, alcohol and sugary drinks as “among the most effective steps governments can take to prevent disease, save lives and generate sustainable financing”.

Commercial interests

While the “best buys” do not include a tax on sugary drinks, “taxing sugary drinks has full support from WHO, and we believe strongly in this as a very cost-effective intervention”, said Dr Etienne Krug, WHO’s head of health determinants, promotion and prevention. 

“There is a whole series of unhealthy products on the market right now, ranging from tobacco, unhealthy foods, alcohol, etc. Acting against the interests of some of these very powerful companies is not always easy and not always done with the same energy by different governments,” Krug noted.

“But unless we take action to promote healthy products and limit the sale of unhealthy products, we will not make enough progress on tackling NCDs and not fast enough.”