“This is the most important year in the history of non-communicable diseases (NCDs),” declared Richard Horton, editor of The Lancet, at the World Heart Federation’s (WHF) 2025 Summit on the eve of the World Health Assembly (WHA).

ON 25 September, the United Nations (UN) hosts the Fourth High-Level Meeting (HLM) on NCDs and mental health. The world’s biggest killer is a major focus of this week’s World Health Assembly, as WHO, member states and civil society gear up for the September event.  In the lead-up, the WHA also approved new initiatives promoting the better integration of kidney health,  lung health, as well as vision impairment and hearing loss into primary healthcare systems. 

But industry interference, lack of funds and poor policies and enforcement at country level remain critical obstacles in the pathway to raising the level of ambition for the High Level Meeting – and effectively reducing NCDs. To date, only 19 countries are on track to meet the global target of reducing NCDs by a third by 2030.

Out of the 19 countries on track, ten are European nations, as well as high-income New Zealand, Singapore, and South Korea.

“Progress has stalled since 2015,”  a spokesperson for NCD Alliance (NCDA) told the WHA’s Committee A on Friday. “This stagnation is not due to a lack of evidence, but as a result of under-investment in health systems and health-harming industry interference.”

UN’s ‘zero draft’ declaration

The Zero Draft of the HLM’s political declaration focuses on three key priorities: tobacco control, hypertension and improving mental health care. It proposes global targets of: 150 million fewer people using tobacco, 150 million more people controlling their hypertension and 150 million more people having access to mental health care by 2030.

NCDA CEO Katie Dain said that the positives of the draft are concrete targets, situating health as part of the broader development nexus and elevating mental health issues, as well.

The draft advocates for countries to impose excise taxes on tobacco, alcohol, and sugar-sweetened drinks at levels recommended by the World Health Organization (WHO) to help achieve this – a policy that is gaining more global traction now in light of the drastic funding cuts for global health.

The NCDA and other civil society groups have been advocating for such taxes for several years as they offer a” triple win of raising revenue, reducing consumption of unhealthy products, and so reducing health costs”, said Alison Cox, the alliance’s director of policy and advocacy.

The NCDA also wants a tax on ultra-processed food high in fat, salt, and sugar and  “corrective taxes on fossil fuels” – as well as “subsidy reforms that support access to healthy, sustainable diets and clean energy sources”, according to its response to the Zero draft.

Taxes – and bribes

While many see taxes as a panacea, Dr Viroj Tangcharoensathien of the International Health Policy Program in Thailand, warned that poor governance in some low- and middle-income countries (LMICs) has enabled harmful industries to bribe officials to undermine taxes.

Around 42% of high income countries have met the 75% tobacco tax rate recommended by WHO, in comparison to only 12% in LMICs and 3% in low–income countries, he told the WHF summit.

Dr Tom Frieden, a former director of the US Centers for Disease Control, who now heads Resolve to Save Lives, told the summit that “only 13% of people live in countries where there’s adequate tobacco taxation.”

Fieden added that Issues undermining effective NCD taxes include “bribes from the killer industries to the people who make decisions; payment of farmers to go grow tobacco when it’s not economically viable but they want the tobacco farmer lobby in the country; payment to ‘astroturf groups’ in country to lobby [and] payment to news entities to cover taxation as if it’s a form of extortion.” 

Climate and NCDs – deepening linkages and demands for WHO support

Over the past week at the WHA, WHO member states have described both their NCD problems, how they are addressing them, and the help they need – with the underlying lament being the lack of resources.

Several countries spoke about climate-related issues that are both exacerbating the NCD burden as well as hampering access to treatment – in extreme weather scenarios for instance. 

Three-quarters of deaths in countries in WHO’s Western Pacific region are from NCDs, but “the adverse effects of climate change, frequent natural disasters and other competing priorities have impeded progress on all aspects of NCD prevention and control”, Samoa told the WHA, speaking for the region’s nations.

Assistance for Small Island Developing States (SIDS) in the Pacific and other regions, needs to address “the environment-nutrition nexus”, added Samoa.

Notably, a new WHO draft action plan on Climate Change and Health is up for consideration by member states at this WHA session. Despite the huge demand from many low- and middle-income member states for WHO support to address burgeoning climate-related health impacts, a final debate on the new WHO action plan was delayed until Monday, after a major oil producing state started to raise last minute objections, Health Policy Watch, has learned.  

Sight, hearing, kidney and lung health

On Friday, the WHA also approved three resolutions that aim to: improve the detection of vision impairment and hearing loss at primary healthcare leavel, as well as ensuring better integration of kidney health and lung health prevention, diagnosis and treatment into PHC.

Member states also supported 17 November being observed as World Cervical Cancer Elimination Day to increase global awareness of the only cancer that can be prevented by a vaccine.

Around 9% of the global population lives with kidney disease, one of the fastest-growing causes of death globally that is projected to become the fifth leading cause of death by 2050, according to the WHO, WHA delegates also noted in the debate. 

That issue, as well, is closely associated with climate change in largely unrecognized ways. Namely, outdoor workers’ exposures to rising temperatures exacerbates risks of dehydration and heat stress, which over time, can lead to kidney failure. 

The problem of growing heat stress is worldwide – including high-income countries such as the USA, where the state of Texas, in 2023, cancelled rules requiring outdoor workers to get regular water breaks. Concerns about kidney failure among outdoor workers returning home from Gulf countries have also gained traction, as per a 2022 report by the Vital Signs Project, by a coalition of NGOs in Nepal, the Philippines, Bangladesh and the United Kingdom, which aim to raise awareness about migrant worker deaths in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the UAE. 

Air pollution a major driver of NCDs

Related to that, air pollution is also one of the world’s biggest drivers of NCDs, including heart disease and high blood pressure as well as  chronic lung disease and lung cancers. And yet it has remained a kind of “orphan” issue in the NCD agenda, with no target for reducing harmful air pollution exposures proposed in this year’s High Level Draft Declaration either.

In fact, more than half of the 7 milllion deaths from air pollution are in fact due to cardiovascular diseases, namely heart disease and stroke, according to a World Heart Federation analysis released during last year’s World Health Assembly.  Already, cardiovascular disease is the world’s top killer, claiming more than 20 million lives each year.

And “this will only get worse” over the next 15 years, warned the World Bank’s Helena Naber at a clean air event in Geneva on Friday, reporting on the results of a new Bank analysis.

“Even if countries successfully implement all their energy climate and air pollution control policies and measures that are announced or planned now over the next 15 years, by 2040 we will still see a rise of 21% in the number of people who are exposed to pm 2.5 levels above [the WHO guideline] of five micrograms per cubic meter, and this will be due to combined effects of population growth and economic expansion – and as a percent increase, the highest will be in Sub-Saharan Africa.”

While the ballooning array of NCDs is a challenge, even for the most advanced countries, for low and middle income countries, the combined effects of dirty air, unhealthy foods, alcohol and tobacco are even more devastating in low and middle income countries that lack the health system resources to cope.  

Meanwhile, low-income countries such as Cameroon told the WHA that the increase in NCDs, particularly diabetes, has come with “exorbitant costs and unequal access to innovative technology, medication and treatment”. 

Ambitions for the UN High-Level Meeting

Poland, representing the European Union, told the WHA it wants “an ambitious, human rights and evidence-based political declaration” at the HLM to reverse the lack of progress on NCDs.

“We call for a comprehensive approach to NCDs and mental health across the life course. This includes health promotion, prevention, early detection, diagnosis, treatment, rehabilitation and palliative care,” said Poland.

Denmark, representing the Scandinavian countries, Iceland, Estonia, Lithuania and Latvia, expressed three ambitions for the HLM declaration: that it strengthens prevention and health promotion; addresses risk factors behind NCDs and poor mental health, including tobacco, nicotine products, alcohol and unhealthy foods; and protects people in vulnerable situations. 

In this regard, it wants children and adolescents protected “from harmful digital exposure and irresponsible marketing of alcohol, tobacco, nicotine and unhealthy foods”.

Portugal called for “reshaping” where people live and make decisions. “Healthier food systems, active mobility and protection from harmful exposures must become the norm. This requires active engagement, not just of health ministries, but also education, urban planning, transport and the private sector,” Portugal told the WHA.

Australia acknowledged the complexities: “NCDs must be addressed by tackling the wider determinants of health,” but “the risk factors are complex, interconnected and extend far beyond individual health behaviours.”

Addressing the WHA on Friday, the World Heart Federation appealed for more ambitious targets to address cardiovascular disease, including “targeted action to treat 500 million more people with hypertension by 2030 and for 50% global hypertension control by 2030; at least 50% excise tax on tobacco, alcohol and sugar sweetened beverages, and the adoption of WHO air quality guidelines”.

A range of other non-state actors addressing the WHA called for an end to “siloed approaches to NCDs” – although they, too, are organised in silos.

NCDA CEO Katie Dain told the WHF summit that the HLM needs to “be about implementation of what works, investment and financing, particularly with a strong call for health taxes, and integration of NCDs” into PHC and universal health coverage.

But the challenges are enormous, particularly in light of dwindling finances. 

“It is only during a crisis that you can make disruptive change,” said Gavi CEO Sania Nishtar. “This crisis [of unprecedented financial disruption] is a moment for us to revisit the duplications, the fragmentation, the mission creep that crept into the system over time.

“We need a ‘one-window’ [health] system” for a woman who comes to a primary health care facility via public transport and needs her contraceptive, child immunisation and NCD needs addressed all at once, Nishtar told the WHF summit.

-Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: Sven Petersen/Flickr, WHO, United Nations , WHO, Denys Argyriou/ Unsplash, Josh Olalde/ Unsplash, Chetan Bhattacharji, WHO / Blink Media, Neil Nuia.