The United Nations (UN) General Assembly voted overwhelmingly in favour of a political declaration to combat non-communicable diseases (NCDs) and promote mental health on Monday, with 175 member states voting in favour, only the United States and Argentina voting against, and Paraguay as the only abstention.

The declaration was due to have been adopted by consensus at the UN High-Level Meeting (HLM) on NCDs on 25 September, but the US baulked at the last minute, which meant that the declaration had to be referred to the UN General Assembly for a vote.

Welcoming the adoption, the World Health Organization (WHO) said in a statement that this is the  “first such declaration addressing NCDs and mental health together, and marks a unique opportunity to accelerate global progress with a set of specific global targets for 2030”.

For the first time, three global targets have been set for 2030: 150 million fewer tobacco users; 150 million more people with hypertension under control; and 150 million more people with access to mental health care.

The declaration also sets “ambitious, measurable process targets” for national systems to implement by 2030, the WHO added. These include at least 80% of countries with policy, legislative, regulatory and fiscal measures in place; at least 80% of primary health care facilities stocked essential medicines and basic technologies for NCDs and mental health; and at least 60% of countries with measures to cover or limit the cost of essential NCD and mental health services.

‘Preventable risk factors’

NCDs claim 18 million lives prematurely each year, while mental health conditions affect over a billion people globally. 

“NCDs are often driven by preventable risk factors such as unhealthy diets, tobacco use, alcohol consumption, physical inactivity, and air pollution – many of which also negatively impact mental health,” said the WHO.

“NCDs and mental health conditions are increasing in every country, affecting every community. That makes them urgent issues not only for public health, but also for productivity and sustainable economic growth.”

The NCD Alliance described the declaration as “a significant milestone for the global NCD agenda” that “introduces new, action-oriented targets to accelerate progress on prevention, care, and investment”.

However, the alliance also expressed regret that the “procedural objections of a small number of member states have delayed the adoption of the declaration”.

“Implementation must now be swift, sustained and matched with the necessary resources,” said NCDA director of policy and advocacy Alison Cox.

US opposition

Addressing the HLM in September, US Health and Human Services Secretary Robert F Kennedy Jr claimed that the declaration went too far in recommending measures like taxes on unhealthy products.

However, the declaration simply suggests that countries “consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances”.

Bizarrely, Kennedy also claimed that the US “cannot accept language that pushes destructive gender ideology” or “accept claims of a constitutional or international right to abortion”. 

The declaration does not mention abortion, and simply states that NCDs need to be mainstreamed into “sexual and reproductive health programmes” – a move aimed at the integration of health services, particularly as cervical cancer is a substantial risk factor for women that can be treated easily if diagnosed early.

The declaration’s only reference to gender calls for “mainstreaming a gender perspective”, describing this as “crucial to understanding and addressing health risks and needs of women and men of all ages”. Women are far more likely than men to be obese, while men are more prone to NCDs such as liver and lung cancer.

Access to medicines

Dr Maria Guevara, Médecins Sans Frontières (MSF) international medical secretary, commended the declaration for including “access to affordable health products as a key part of responding to diabetes, mental health conditions, and cervical cancer”.

However, MSF added, “meaningfully addressing the disproportionate effect of NCDs and mental health conditions on people living in low- and middle-income countries requires tangible action to improve access to medical tools” – including those that enable them to manage their conditions on their own.

“Concretely, this means that people managing diabetes must have access to affordable and sustainable supplies of insulin pens and glucose monitoring tools; people managing chronic mental health conditions must have access to affordable and sustainable supplies of long-acting antipsychotic formulations and other pharmaceuticals for anxiety, depression, psychosis and other mental health conditions,” said MSF

“Access to human papillomavirus (HPV) vaccination and cervical cancer screening as an essential prevention tool is key, and people living with cervical cancer must have access to quality chemotherapy as well as other treatment modalities”.

Borjana Pervan, the World Heart Federation’s Chief Operating Officer, urged member states to commit to a target of 50% global hypertension control by scaling up access to affordable hypertension medications to 500 million more people globally by 2030.

“This would prevent at least 75 million deaths by 2050 and deliver net economic gains of $212 billion annually. It is also crucial that member states prepare to take greater action regarding the consumption of alcohol, tobacco and sugar-sweetened beverages, especially through fiscal policies,” said Pervan.

Air pollution

The Clean Air Fund (CAF) noted that while the declaration highlights air pollution as a major driver of NCDs and calls for action across highly-polluting sectors, it “fails to endorse the existing WHO target to halve air pollution-related deaths, despite evidence that clean air action is affordable and achievable”.

“The political declaration sets a laudable goal of 150 million fewer people using tobacco by 2030. But it fails to recognise that bad air quality is now a bigger driver of premature death and disease than tobacco, with around 8 million deaths per year attributed to air pollution,” said Nina Renshaw, CAF’s head of health.

The target endorsed by Ministers of Health at the World Health Assembly in May 2025 requires governments to halve the health impacts and deaths related to human-made air pollution by 2040 (relative to 2015), prevent ing 3-4 million deaths per year worldwide.

Image Credits: WHO/A. Loke.