An anti-smoking campaign in China, the biggest consumer of tobacco products.

As the tobacco industry continues to innovate to preserve its market appeal, the health sector needs to become even more creative – advocating for new regulations to reduce tobacco’s appeal and increase product costs. Among those: limiting nicotine content, banning filter tips, and joining WHO’s new “3×35 initiative” to raise the price of tobacco products by 50%. 

We’re on the brink. For much of the last 20 years, smoking has been in decline worldwide, saving millions of lives, but we are at an inflection point. Trends point to a flattening in the decline of cigarette sales, and Big Tobacco is responding to two decades of public health progress with insidious innovation. If public health practitioners don’t out-innovate the industry now, we’ll be setting ourselves up to lose.

It is a monumental public health achievement that global tobacco use dropped by a third in the last 20 years. More than 5.5 billion people are now covered by some measure that discourages tobacco use, such as advertising bans, higher taxes and quit programs. For the first time, an entire region, Latin America, has smoke-free laws in place.

But we cannot expect the hard-won anti-tobacco laws of today – those that have created smoke-free spaces, banned advertisements around schools and removed flavors from cigarettes which have saved millions of lives – to protect us from the industry’s plans for tomorrow.

Despite its seemingly anti-cigarette rhetoric, the industry is not slowing down on its core product – monetizing addiction. There are too many signals to ignore: Philip Morris International shipped more cigarettes in the first quarter of 2025 than during the same period last year. British American Tobacco just launched a new cigarette brand in Korea. Japan Tobacco International is building a new factory in Morocco.

Industry is innovating around anti-smoking regulations 

Tobacco industry innovation includes a barrage of new tobacco products.

The industry is also innovating its way around current anti-smoking regulations, releasing a barrage of new products like e-cigarettes (vapes), heated tobacco products and nicotine pouches. When laws threaten to restrict or ban these addictive products, tobacco companies try to influence politicians to advocate for them, often as the “lesser evil”. 

These products are increasingly being targeted at the next generation. The industry has lobbied for heated tobacco products to be exempt from the UK’s new Tobacco and Vapes Bill so they can continue to be sold to people who would no longer be able to buy cigarettes. It also wants to continue promoting these products in a wide range of retail outlets, which has included items at children’s eye-level, near sweets in filling stations. 

Meanwhile, there are reports from across the UK of nicotine pouch giveaways at railway stations and tobacco companies sponsoring music events like the Reading and Leeds Festival, where many teens go to celebrate the end of exams.

If nothing is done to counter the industry’s strategies, not only will declines in smoking be reversed, but new epidemics will arise. Indeed, an e-cigarette epidemic already has, with vapes being used more by teens than adults in many countries. We’re risking a future where the next generation won’t have the same protections.

Out-innovating big tobacco 

But tobacco companies aren’t the only ones innovating. New ideas are emerging that can move the needle in the right direction, for good. 

We can require that cigarettes have less nicotine, so that fewer people get hooked for life. We can use technology to blur out tobacco company logos and branding in Formula 1 races, as in France, and address imagery on streaming platforms, like in India. 

We can institute “polluter pays” penalties where tobacco companies compensate for the environmental damage their products cause, like in Spain. We could ban filters to remove a product design element that makes it easier to smoke and eliminate the most littered single-use plastic in the world. We can prohibit the youngest generations from ever being allowed to buy tobacco.

These solutions can be agile and deployed at the national, provincial or city level. The generational end game law, which makes it illegal to sell tobacco to anyone born after a certain date, is being pioneered at the city level in Brookline, Massachusetts, in the United States. A similar law is set to go into effect in the UK soon.

To prevent a backslide into the era of smoke-filled rooms and Joe the Camel, these solutions need to be accelerated and supported in every country.

So there couldn’t have been a better time for the tobacco control community to gather than at the recent World Tobacco Conference in Dublin, Ireland. 

Experts and advocates from around the world convened in a country that itself is wrestling with stalled declines in tobacco use and a rise in youth e-cigarette use. While Ireland aimed to reduce tobacco use to less than 5% by 2025, recent data shows it hovering at 17%. Worryingly, a 2022 survey revealed that two in every five girls and a quarter of boys aged 15-17 had used an e-cigarette.

Convening in Dublin provided an opportunity to double down and renew the push for what we know works: advertising bans, smoke-free laws and – the gold standard – higher tobacco taxes. 

Raising real prices

Following that major meeting, the World Health Organization (WHO) has now launched a big new initiative urging countries to raise real prices on tobacco, alcohol, and sugary drinks by at least 50% by 2035 through health taxes. The “3 by 35” Initiative is based on studies showing that a one-time 50% price increase in these products could prevent 50 million premature deaths over the next 50 years. 

This period between Dublin and the upcoming UN High Level Meeting on Noncommunicable Diseases in September is a time to mobilize action behind these creative new solutions that can counter Big Tobacco well into the future.

The tobacco industry is playing the long game, and we need to, too. No public health win is permanent. If politicians and the public aren’t vigilant, Big Tobacco will continue trying to dismantle laws that protect health, while finding ways to bypass others. The next era of tobacco control requires innovative solutions – they will make all the difference. 

Dr Mary-Ann Etiebet is the President and CEO of Vital Strategies where she leads a team of over 400 people in over 80 countries working to advance long-term solutions for the growing burden of noncommunicable disease and injury.

Image Credits: Johannes Zielcke, Filter.

Delhi traffic officer Ashok Kumar explains the new rules on 1 July.

NEW DELHI – When drivers entered fuel stations on 1 July, they found bright new warning signs and traffic police positioned at the fuel pumps. Old vehicles would be identified by special, new cameras and denied fuel. Drivers  also risked having their vehicles seized for “liquidation.” 

The day marked the beginning of a widespread campaign by central government’s Commission for Air Quality Management (CAQM) in the Delhi region to reduce air pollution.  

Any gasoline-powered vehicle older than 10 years, or a diesel vehicle older than 15 years, was supposed to face action – and at least 80 such vehicles were seized initially.

Although some  6.1 million over-age vehicles are registered, the actual number on the roads is far lower, and some estimate it to be around 400,000. 

However, enforcement quickly fizzled out after the Delhi state government sought a pause following protests on social media. Many of these went viral and were also reported widely in the media. 

Enforcement aided by advanced new cameras

To identify these vehicles at the pumps and on the road, CAQM installed hundreds of advanced cameras with automated number plate recognition (ANPR) linked to a database. 

The ban on such older vehicles circulating in Delhi was first introduced in 2015, but after two days of protests over the enforcement, the Delhi government pressured CAQM to put the operation on hold. 

Chief Minister of Delhi Rekha Gupta tweeted that the decision should be suspended as it was adversely affecting the daily lives and livelihoods of millions of families. She called for a practical, equitable, and phased solution.

Delhi’s environment minister, Manjinder Singh Sirsa, cited several “technological gaps” in the ANPR system in a letter to CAQM posted on X on Thursday. These include that it lacks robustness, there are crucial glitches in the camera placement, sensors aren’t working, and the system is not fully integrated with databases of states neighbouring Delhi. He called for a “holistic approach and implementation” in Delhi and its neighbouring regions. 

However, a source told Health Policy Watch that ANPR was able to identify up to 6,000 overage vehicles per day during tests, and described it as a “foolproof” method. Tests conducted since last December showed that the system has worked well. 

Ironically, a day before the enforcement drive began, Gupta of Prime Minister Narendra Modi’s BJP Party said that the Delhi state government would follow orders of the courts and the CAQM.

Despite repeated inquiries from Health Policy Watch, CAQM did not provide any details on the future of the campaign in Delhi. However, it made it clear in a press release related to curbing pollution in neighbouring Haryana state, that it intends to continue to advocate for the liquidation of the ‘end-of-life’ (EoL) vehicles plan and ANPR cameras. 

The initial campaign in Delhi was supposed to be part of a regional initiative by Indian authorities that aimed to get an additional 4.5 million EoL vehicles off the road starting in two phases in November,  then April 2026. The rollout of ANPR cameras in other states and cities had also begun. 

However, as long as the Delhi State Government opposes enforcement, the agency will find it difficult to continue to clean up Delhi.  

Weak political appetite to tackle air pollution

The call for a pause signals the weak political appetite of the five-month-old Delhi government to take hard decisions to improve air quality in what has frequently been ranked as the world’s most polluted capital over the past decade. 

Even before Sirsa’s letter to CAQM last week, there was a perceptible shift in the party’s tone. In March, Sirsa promised an early crackdown on polluting vehicles that are a major contributor to Delhi’s annual air pollution, particularly in winter:

Older vehicles emit high levels of polluting nitrogen oxide (NOx), sulphur dioxide (SO2) and contribute to the microscopic pollutant, PM2.5. In 2024, PM2.5 levels reached peaks of 732 micrograms per m3 – about 73 times higher than the World Health Organization’s (WHO) 24-hour guideline level. 

But on 2 July after the protests, Sirsa blamed the previous Aam Admi Party (AAP) government for not enforcing the ban earlier:

The protests included many influential voices across the political spectrum. But most ignore health impacts and the fact that the older cars have outdated fuel standards, which means that they are inevitably more polluting, regardless of how well they may have been maintained. 

Health impact of vehicular pollution 

Drivers and passengers in heavy traffic with many polluting vehicles are typically exposed to excessively high levels of oxides of Nitrogen (NOx) from gasoline vehicles, as well as fine particulates, PM2.5 from diesel. 

Even short-term exposure to high levels of those pollutants prompts immediate, physiological responses, including headaches, irritation in the eyes, nose and throat, and difficulties in breathing. 

Chronic, long-term exposure to traffic pollution can have far more severe health effects, worsening asthma and other lung disorders, cardiovascular problems and high blood pressure, leading to premature death. 

Air pollution has also been identified in a new report as being a more significant cause of lung cancer in ‘never smokers’ than previously believed, according to a new study published in Nature. Patients from regions of the world with high levels of air pollution were more likely to have genomic mutations linked to cancer.

In Delhi alone, 7.8 years life years are estimated to be lost from air pollution while the average for India is 3.6 years. 

WHO’s South East Asia region, which extends east from Pakistan to Bangladesh, continues to have the highest overall burden of disease from air pollution, and India is one of the worst-affected countries. A little over two million Indians a year die from air pollution, with the worst effects concentrated in Delhi and other major cities. 

Air pollution is also linked to obesity, diabetes, metabolic dysfunction and genomic damage, points out Dr Sanjeev Bagai, a prominent paediatrician in Delhi. 

“Vehicular pollution is the lesser-mentioned culprit causing serious human harm,” he said in an interview with Health Policy Watch.

Vehicles are a big chunk of Delhi’s air pollution

In the Delhi region, vehicles contribute significantly to the air pollution crisis. According to officials, vehicles emit 78% of the nitrogen oxide (NOx), 41% of sulphur dioxide (SO2), and at least 28% of PM 2.5 particulate matter pollution –  although some estimates put it at 40% and as much as 50% in winter. Much of the NOx also converts to PM 2.5, which is so fine that it can settle deep into the lungs and other organs, causing damage. 

Neither the science nor the policy to get older vehicles off the road are new.  A ban on EoL vehicles has been in force since 2015, when it was first ordered by the nation’s top environmental court, the National Green Tribunal (NGT). The ban was upheld in 2018 by the Supreme Court and in 2024, a powerful panel headed by the country’s top bureaucrat, then Cabinet Secretary Rajiv Gauba, called out the “very slow progress” on implementing the ban. 

Science vs #DelhiFuelBan protests

Many of those criticising the crackdown claim that 10 or 15-year-old vehicles can remain in good condition. For instance, one social media user praised his father’s 16-year-old Mercedes as a so-called “zero pollution” vehicle.

The facts, however, don’t bear that out. Vehicles with the latest fuel standard –  Bharat Stage 6 (BS 6), equivalent to Euro 6 – emit far less pollution than earlier standards, according to a study by the International Council on Clean Transportation (ICCT). 

In its 2024 report, the ICCT said that so far, India’s “leap” from BS 4 to BS  was contributing to “significant reductions in tailpipe emissions.” Even 5- to 10-year-old vehicles with a BS 4 standard are approximately five or six times more polluting, while those that are 10 years or older, with BS 3 and BS 2 standards, can be 10 and 11 times more polluting, ICCT said.

But the claim that well maintained older vehicles are “clean” are being widely promoted, including by this influencer with over 15 million YouTube followers:

Protests across political spectrum

Criticism of the ban has come across most of the political spectrum. An opposition Member of Parliament, Saket Gokhale of the Trinamool Congress, called the ban “ridiculous” and a “major financial hit to the middle class”, affecting six million owners. He has written to the federal transport minister asking for the policy to be withdrawn:

A columnist appealed to Prime Minister Modi, who follows her on X, to allow old vehicles that comply with emission norms. She cites an automobile manufacturers group, which claims that a large number of these vehicles can meet stringent standards. 

Most air quality advocates are silent

On the other hand, the usually vocal air quality advocates were largely silent. The authorities also did not defend the ban once the protests began increasing. 

Approaches by Health Policy Watch to several organisations yielded no response. Amongst the few exceptions were Karthik Ganesan and Arpan Patra of the Council on Energy, Environment and Water (CEEW). 

In an article on Thursday in the Indian Express, they welcomed the measures as being a good, first step shortly before the campaign was suspended. 

“The restriction on the fuelling of end-of-life vehicles in Delhi firmly communicates the government’s intent to curtail pollution… This ban must cascade into the following logical next steps to truly clean up transportation emissions,” wrote Ganesan and Patra.

Until now, the government had largely relied on frequent, mandatory pollution checks on vehicles that pulled into service stations, but these use old technologies that only check for very high levels of smoke particles and carbon monoxide. They don’t capture data on fine particulate matter, nitrogen oxides and sulphates, which are the pollutants most harmful to human health. 

As for more sophisticated testing, there are only two vehicle fitness centres in the entire city of more than 22 million people capable of this.

Meanwhile, studies by the ICCT and others have demonstrated that filtering vehicles by their age rather than rudimentary and outdated emissions tests, is a more reliable means of getting polluting vehicles off the road. 

Cameras installed at Delhi service stations can identify older vehicles by their registration plates. But their use now hangs in the balance after the government suspended implementation of the ban on older vehicles.

Will the new Delhi government ever step up? 

Experts say that enforcing the ban is just one step in reducing Delhi’s air pollution at its source. Public transport is patchy and buses don’t reach many neighbourhoods. 

About 31% of urban neighbourhoods in Delhi fall outside a 500-meter radius of a public bus stop, a threshold recognised as the standard for walkable access under India’s Transit-Oriented Development (TOD) policy, according to a recent study.

If the government does eventually enforce the ban on old vehicles using its updated technology, it will also be expected to enforce other court orders and pollution curbs  like the ban on fire crackers and steps against waste burning. 

If it doesn’t, it will need to contend with the optics. As Ashwini Tewari, the chief of India’s largest bank, State Bank of India, pointed out recently, foreigners want to avoid the Delhi region, including the booming city of Gurgaon on its southern border, where major multinationals like Google, Microsoft, IBM and Deloitte have large offices. 

The quality of the Delhi government’s air pollution mitigation strategies thus has major economic implications at the national as well as local level. 

The record for this new BJP government, which came into power in February, remains very mixed. While it is continuing and extending policies such as more EV buses, it is also is facing criticism for a plan to install so-called ‘modern air purifiers’ in the park of an elite neighbourhood despite a failed earlier experiment with outdoor smog towers. 

The new plan is to install 150 such ‘air purifiers’ over 85 acres. But with Delhi is spread over 366,000 acres, any such initiative will be ineffective, as experience and studies have shown. 

Cutting pollution at source is always a better option, as air quality researchers point out. For now, a series of pollution maps of Paris, showing how a curb on vehicles improved air quality, has gone viral in India. 

Data maps show the effect of vehicle curbs on lower air pollution in Paris

 

Image Credits: Asian News International, Chetan Bhattacharji, University of Chicago, Airparif.

North Darfur capital of El-Fasher from above.

Mass atrocities, rape, famine, sexual and ethnically targeted violence have plagued Sudan’s civil war since it erupted two years ago. With peace nowhere in sight, a new report released by Médecins Sans Frontières (MSF) recounts in devastating detail: nothing has changed. 

Based on interviews with over 80 civilians, MSF data and direct observations from its medical teams, the report documents the violence and humanitarian catastrophe unfolding in El Fasher, the capital of North Darfur, where the Rapid Support Forces (RSF) have encircled hundreds of thousands of people while laying the city under siege.

Mass killings and starvation are underway, MSF found. Food, water, and humanitarian aid are blockaded. Food shops and markets, water towers and pumps, hospitals and healthcare facilities are under constant attack.

The Sudan Doctors Network reports 239 children have died from malnutrition in El Fasher since January as nearly half of Sudan’s remaining population facing acute food insecurity turn to boiling weeds and wild plants to survive.

Gunfire, airstrikes and artillery are already raining down on the city as the warring factions compete for control. But MSF warned further escalation is still possible: an all-out RSF assault on the capital.

“In light of the ethnically motivated mass atrocities committed on the Masalit in West Darfur back in June 2023, and of the massacres perpetrated in Zamzam camp in North Darfur, we fear such a scenario will be repeated in El Fasher,” said Mathilde Simon, MSF’s humanitarian affairs advisor. “This onslaught of violence must stop.”

‘Clean El Fasher’ 

An MSF nurse attends to a patient amid the violence in North Darfur, April 2025. / MSF

Ethnically targeted attacks by the RSF on non-Arab communities, particularly the Zaghawa, are “protracting the ethnic violence that has ravaged Darfur for over twenty years,” MSF said.

“RSF and their affiliates repeatedly shelled neighbourhoods and gathering places of civilians known to be from non-Arab communities, ground attacks were systematically carried out, involving the looting of belongings, killing of civilians and razing of houses and infrastructure,” the report found. “Sexual violence was widely perpetrated, and numerous abductions were reported.”

The RSF is a descendant of the Janjaweed militia that led the Darfur genocide, targeting non-Arabs across the region and killing an estimated 300,000 people from 2003 to 2005. 

Mohamed Hamdan Dagalo, the general known as Hemedti who heads the RSF, led Janjaweed paramilitaries that burned villages, killed civilians and raped ethnic Africans across his native Darfur during the genocide. These crimes led to the indictment of his then-commander and deposed Sudanese president, Omar al-Bashir, by the International Criminal Court for war crimes and genocide.

With the shadow of a repeat of history looming over the province, MSF reported several witnesses testified they overheard RSF soldiers airing plans to “clean El Fasher,” raising the spectre of a second genocide – or that it is already underway.

“Only God knows what will happen in El Fasher,” one man, 41, told doctors. “But if the RSF take El Fasher, they will carry out ethnic cleansing and genocide, like what happened in El Geneina.”

El Geneina, the capital of West Darfur, was systematically cleared of its Massalit population by RSF and allied militias through killing and forced displacement in 2023. The total number dead in the violence is unknown. A UN expert panel estimated between 10,000 and 15,000 people were killed, while Sudanese Red Crescent staff identified 2,000 bodies on the capital’s streets before they stopped counting.

As MSF urges the warring parties to spare civilians and grant access for humanitarian organisations to provide critical aid to people in need, RSF forces took control of the tri-border area with Libya and Egypt in June, gaining control over critical supply routes and threatening to open new fronts in the civil war. 

“As patients and communities tell their stories to our teams and asked us to speak out, while their suffering is hardly on the international agenda, we felt compelled to document these patterns of relentless violence that have been crushing countless lives in general indifference and inaction over the past year,” Simon said.

Despite a UN arms embargo, weapons continue flowing to both sides through neighbouring countries, several of which, including Libya, Chad and the Central African Republic, are major arms trafficking hubs, UN experts say. 

While Egypt and Saudi Arabia back government forces, the UAE, Libya and Russian-linked Wagner Group support the RSF. The UAE has invested over $6 billion in Sudan since 2018, viewing the resource-rich nation as key to expanding its regional influence.

Around 40,000 people have been killed and 13 million displaced since the civil war began in April 2023, according to the latest UN estimates.

Peace, at this juncture, is nowhere in sight.

Nowhere to hide

Over 400,000 people were forced to flee to El Fasher from the Zamzam refugee camp, the largest displacement encampment in Sudan just south of the city, after an RSF ground assault in April that killed more than 500 civilians.

Those who made it to the city “remained trapped, out of reach of humanitarian aid and exposed to attacks and further mass violence,” MSF said – and there is no way out.

“Survivors who managed to flee have undergone further violence along the road, with men being specifically targeted, women and girls being raped and civilian convoys attacked,” the report found. 

“The harrowing level of violence on the roads out of El Fasher and Zamzam means that many people are trapped or take life-threatening risks when fleeing. Men and boys are at high risk of killing and abduction, while women and girls are subjected to widespread sexual violence.”

The millions who successfully flee Sudan find crisis there too.The World Food Programme warned Wednesday that life-saving assistance may soon shut down in the Central African Republic, Chad, Egypt, Ethiopia, Libya, South Sudan and Uganda – all grappling with their own domestic food insecurity needs – as funding cuts and new arrivals overwhelm support systems.

“This is a full-blown regional crisis that’s playing out in countries that already have extreme levels of food insecurity and high levels of conflict,” said Shaun Hughes, WFP’s Emergency Coordinator for the Sudan Regional Crisis. “Refugees from Sudan are fleeing for their lives and yet are being met with more hunger, despair, and limited resources on the other side of the border.”

Rape as a weapon of war

Violence and attacks on healthcare forced MSF to shut down operations in El Fasher and Zamzam camp.

Sexual violence has been a central feature of the violence in Sudan throughout the war. While both the Sudanese Armed Forces and the RSF have been found to commit sexual war crimes, the overwhelming majority are attributed to the RSF and its allies.

The UN Independent fact-finding mission on Sudan and Amnesty International separately found the militia had engaged in widespread sexual and gender-based violence, rape, sexual slavery, and abduction, among other crimes against humanity. RSF forces are further accused of using mass rape as a weapon of war and to assist ethnic cleansing efforts, using rape as a tool to drive fear and force women to flee.

“I have a certificate for first aid nursing. [When they stopped us], the RSF asked me to give them my bag. When they saw the certificate inside, they told me, ‘You want to heal the Sudanese army, you want to cure the enemy!,'” one woman, 27, told MSF. “Then they burnt my certificate and they took me away to rape me.”

No comprehensive statistics on sexual violence in Sudan exist. The latest number on confirmed cases, compiled by the advocacy group Together Against Rape and Sexual Violence and published on 4 June, documented 377 cases of rape since the war began.

Data on rape and sexual assault in war zones are notoriously inexact. In Sudan, survivors face an array of barriers from social stigma, to lack of adequate medical support, and a dysfunctional judicial system with no means to protect or prosecute if they speak out. The Sudanese government’s Unit for Combating Violence Against Women previously warned verified rape cases may represent as little as 2% of the total.

Since the start of the war, the number of people at risk of gender-based violence has more than tripled to 12.1 million people – 25% of the country’s population. The number of gender-based violence survivors seeking services increased 288% in 2024, according to UN Women.

The most harrowing finding came from Unicef in May: 221 rape cases against children were recorded by since the beginning of 2024. The youngest reported survivors were four one-year-olds. Sixteen child rape survivors, including the infants, were under 5 years of age. 

“Children as young as one being raped by armed men should shock anyone to their core and compel immediate action,” said Unicef executive director Catherine Russell.

Unicef found an additional 77 instances of sexual assaults against children, mostly attempted rape cases. Two-thirds of recorded cases were girls, but 33% were boys, which the agency noted requires “specific attention as they may face stigma and unique challenges in reporting, seeking help, and accessing services.”

“Millions of children in Sudan are at risk of rape and other forms of sexual violence, which is being used as a tactic of war. This is an abhorrent violation of international law and could constitute a war crime. It must stop.”

Southern spiral

The violence consuming Sudan threatens to spill across its southern border, where South Sudan, the world’s youngest nation, stands on the brink of a new civil war of its own.

South Sudan won independence from Sudan in 2011, ending the longest civil war in the history of the African continent. Twenty-two years of violence, disease and famine killed 2 million people, the highest civilian death toll since World War II.

Independence was quickly followed by civil war. In 2013, a break-down of the power-sharing agreement negotiated two years earlier resulted in five years of war, killing 400,000 and displacing 4 million before a new power-sharing agreement brokered in 2018 brought fragile peace to the fledgling state.

That agreement collapsed once again in March when President Salva Kiir’s forces arrested his former deputy Riek Machar, mirroring Sudan’s trajectory when two rival generals, charged with overseeing the country’s transition to democracy, instead dragged the country and its 50 million people into all-out war.

Since March, violence against civilians in South Sudan has since reached its highest level since 2020, the UN reported Wednesday, with 1,607 attacks in the first quarter of this year. Those include 739 civilians killed, 679 injured, 149 abducted, and 40 subjected to conflict-related sexual violence between January and March.

The escalating violence is already pushing South Sudanese civilians towards famine. Over 22,000 people are likely already starving, while nearly 60% of the population faces life-threatening food insecurity as a result of the escalating violence, the IPC warned in June.

Armed groups move freely across the porous border drawn only in 2011, with overlapping ethnic militias and historic alliances threatening to erase the fragile line between two conflicts – trapping 61 million people, once again, in a renewed cycle of violence.

“Given this grim situation, we are left with no other conclusion, but to assess that South Sudan is teetering on the edge of a relapse into civil war,” Nicolas Haysom, the UN’s top official in South Sudan, warned when the peace deal collapsed. “It would devastate not only South Sudan but the entire region, which simply cannot afford another war.”

Image Credits: MSF, UN Sudan Envoy.

Nigerian veterinary para-professionals on an animal health training course supported by the UN Food and Agriculture Organization (FAO).

As the world observes World Zoonoses Day, it’s important to remember that human health is intimately tied to the health of animals, wild and domesticated. 

Five years after COVID-19, the world remains alert to health threats that can cross over from animals to people. 

Alongside growing concerns over high-profile spillovers like avian influenza, the silent threat of everyday zoonoses – from salmonella in poultry to leptospirosis in livestock – continues to affect hundreds of millions each year. These infections may not all make front-page news, but their impact on human health is significant and largely preventable. 

Furthermore, these zoonotic diseases are on the rise. Virus jumps from animals to humans are increasing around 5% annually, meaning these pathogens are forecasted to cause four times the number of spillover events in 2050 than in 2020.

Clear trend of rising zoonotic disease spillovers to humans – with fatal consequences.

Given the interconnectedness of human and animal health, the best way to prevent zoonotic disease in people is to stop it from spreading in animals. However, we are currently falling short in this task as the threat of zoonoses appears to be increasing. 

Despite the recent adoption of the world’s first pandemic agreement at the May World Health Assembly, which explicitly recognized the need for integrated approaches known as “One Health”, gaps remain in veterinary infrastructure worldwide. This leaves the door open to another devastating cross-species outbreak. 

To address this, the world must strengthen the veterinary sector, from improved use of animal vaccines and other medicines to increased training and services. Importantly, recruiting and empowering veterinarians on the frontline is a practical and cost-effective way to reduce these risks and protect public health. 

Overall, zoonotic disease incidence represents 60 % of infectious diseases in humans. Common zoonotic diseases, such as salmonella, can originate in unprotected animals. Thankfully, these types of risks can be controlled through veterinary tools, but only if they are available.

Meanwhile, just 13 zoonoses are responsible for 2.4 billion cases of human illness and 2.2 million deaths per year. For example, more than a million people globally are affected each year by leptospirosis, a dangerous and sometimes deadly disease caused by bacteria that transfers from animals to humans.

Emerging zoonotic disease events 1940-2012. The United States and Europe are also hotspots.

According to a new report from the World Organisation for Animal Health (WOAH), cases of avian flu in mammals doubled last year compared to 2023, for instance. In the EU, zoonotic diseases have been found to be on the rise. 

No animal health references in WHO pandemic agreement

Sampling dead animals in the Congo basin for zoonotic diseases that could spark an outbreak – or a pandemic.  The WHO pandemic agreement ignores animal health.

Despite opportunities to agree on and implement preventative measures, they have not been sufficient to address the risk at hand. The World Health Assembly recently adopted the first pandemic agreement, yet the agreement is missing any mention of veterinary medicine and animal health. Without this inclusion, the agreement can never fully fulfil its aim to prevent pandemics.

Disruptions from zoonotic disease outbreaks carry a significant cost to the global economy. The estimated direct cost of the loss of life due to zoonotic diseases is $212 billion annually, not including the costs associated with long-term treatment or ulterior damages. 

Conversely, the estimated cost of preventative measures, including monitoring and surveillance of risks as well as landscape management, is around $20 billion. In other words, preventing these diseases is more than ten times cheaper than dealing with the consequences.

Protecting food security and farmers’ livelihoods, especially in developing countries, is another reason to take a proactive approach to preventing zoonoses. When livestock contract a disease, farmers often must cull their flock or herd to prevent further spread of the illness. This impacts food availability and prices and creates massive losses for farmers.

While difficult to calculate, the estimated loss of animals due to disease varies from 20% globally to 50% in developing countries. Furthermore, the burden of zoonotic disease falls heavily on low- to middle-income countries, where health infrastructure is limited and communities rely heavily on livestock.

Countries must invest in veterinarians and proactive disease control

Kenya
A Kenyan herder, Kibet Ngetich Stephen, is visited by a community health volunteer who checks on the vaccination status of his herds, which can be exposed to anthrax and other deadly diseases due to their mingling with wild animals while out at pasture.

To build more resilience to zoonotic disease outbreaks, there are fundamental actions that must be undertaken. First, countries must invest in their veterinary workforces, training, and infrastructure. Investing in this field allows for well-resourced, trained, and capable veterinary services that can effectively address threats and protect animal health before an outbreak occurs.

In the UK, for instance, a new initiative offers farmers subsidised veterinary visits for multiple herds or flocks to help prevent disease.

Countries must also adopt proactive, rather than reactive, disease control strategies. Improving proactive strategies such as monitoring, detection, and vaccination can prevent or at least minimize the impacts of an outbreak. 

Furthermore, we must enhance public-private partnerships. Taking advantage of the speed at which the private sector can develop urgently needed technologies, such as vaccines, diagnostics and treatments, alongside the expertise of veterinarians and reach of public institutions, can ensure more effective measures against zoonoses.

With diseases like avian flu on the rise and everyday threats like salmonella continuing to impact public health, the world must adopt a coordinated approach to avoid zoonotic outbreaks. The losses caused by animal disease outbreaks are compounded by an order of magnitude when they spread to people. Improving animal health is the best way to protect the health of all.

Carel du Marchie Sarvaas is the executive director of HealthforAnimals, the global animal health association representing manufacturers of veterinary pharmaceuticals, vaccines and other animal health products.  He is a Dutch national and holds degrees from the University of Leiden and Johns Hopkins University.

John de Jong is the president of the World Veterinary Association, and a small animal practitioner in Boston, MA. He is also a former board member of the American Veterinary Medical Association serving as Chair (2015-2016) and as President (2018-2019).

Image Credits: FAO, BMJ, November 2023, ILRI/FLICKR, Sebastien Assoignons/ Wildlife Conservation Society, International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society.

The world faces a global health funding crisis, but John-Arne Røttingen believes the solution goes beyond money. It lies in stronger partnerships between governments, researchers, and citizens.

“Science is not enough to change the world,” said Røttingen, the newly appointed CEO of Wellcome, one of the world’s largest global health foundations. “It must be allied with collaboration and action across society.”

In a wide-ranging conversation on Trailblazers with Garry Aslanyan, Røttingen spoke about his leadership values, his vision for Wellcome, and the pressing need to rethink how global health is funded and delivered. A former head of CEPI and Norway’s global health ambassador, Røttingen said foundations like Wellcome must act as catalysts—not substitutes—for government and private-sector leadership.

“We need to engage governments more directly,” he said. “Ultimately, it is governments that are responsible for the health of their populations.”

Røttingen emphasized the importance of equity in science, calling for more research led by local experts in the Global South. He described visits to research centres in Malawi, Kenya, and Vietnam, where Wellcome supports programs that combine population health with advanced laboratory science.

But trust is also key.

“We need to double down on trust in science,” he said, citing public skepticism during the COVID-19 pandemic. That includes involving communities more directly in setting research priorities.

“We have to tackle problems that are important to people,” Røttingen added.

Røttingen urged the global health community to act fast as external funding shrinks and global crises multiply.

“We have some good indications of where we should go. We just need to act on them—and bring them to life,” he said.

 

Listen to previous episodes of the Global Health Matters podcast with Dr Gary Aslanyan on Health Policy Watch.

Image Credits: Global Health Matters Podcast.

Artificial intelligence can transform global health—but only if developed and deployed with equity in mind.

That was the message from two global health experts featured on the latest Global Health Matters podcast episode, “AI for Equity: Bridging Global Health Gaps.”

“In the future, a physician working in a remote area will have the best cardiologist in the world, the best pneumologist in the world, right next to them—ready to answer any questions,” said Alexandre Chiavegatto Filho, professor of machine learning in health at the University of São Paulo.

His team is developing mobile apps that allow frontline doctors to access AI tools through smartphones, even in areas without electronic medical records.

Jiho Cha, a South Korean parliamentarian and physician, has a similar vision. He believes AI can scale up health services in fragile settings, where doctors are scarce and health systems are overwhelmed.

“AI-powered information systems combined with fintech or blockchain technologies can improve health financing and delivery,” Cha said.

He described how AI can support nurses and community health workers by enhancing diagnostic and decision-making abilities.

However, both experts warned that the same technology could widen gaps if not handled carefully.

“If you leave AI by itself, it’s probably going to increase inequality,” Filho cautioned, noting that algorithms trained on wealthier populations tend to perform worse for low-income groups.

They said the challenge is to ensure AI is trained on diverse, locally relevant data and made accessible in low-resource settings. Otherwise, the digital divide will deepen.

“We have a huge opportunity in our hands,” Filho said. “But we need to make sure AI works where it’s needed most.”

Listen to previous episodes of the Global Health Matters podcast with Dr Gary Aslanyan on Health Policy Watch.

Image Credits: Global Health Matters Podcast.

 

In the most connected era in history, social isolation and loneliness present a growing public health crisis claiming hundreds of thousands of lives a year.

A three-year investigation by the World Health Organization found that loneliness and social isolation contribute to 871,000 deaths worldwide every year, a death toll researchers said places social health in a tier “as damaging as other public health risks” such as air pollution, tobacco and alcohol. 

The landmark report by the WHO Commission on Social Connection, published this week, found that one in six people globally are affected by social disconnection and loneliness, resulting in around 100 deaths per hour. 

“The sheer extent and scale of impact on our health – specifically loneliness – being linked to 870,000 deaths annually was really striking to me,” said Dr Vivek Murthy, co-chair of the commission and longtime champion of the harms of the social isolation “epidemic” in two terms as US Surgeon General.

“I think many people think of loneliness as just a bad feeling,” Murthy said. “But when you see numbers like that, it makes clear that it is massively consequential for our health and well-being.”

The commission found that loneliness and social isolation carry health risks similar to obesity and physical inactivity, increasing the risk of stroke by 32%, heart disease by 29%, and dementia by 50%. The conditions also contribute to diabetes, cognitive decline, and mental health problems including depression, anxiety, self-harm and suicide.

“The impact of loneliness is profound. It is often overlooked, despite being just as damaging as other known public health risks,” the commission wrote. “Make no mistake – connection is not just a nice idea. It is fundamental. Our ability to thrive, both as individuals and as nations, depends on our ability to connect with others.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus noted that “social well-being” has been part of the WHO’s Constitution since the organization’s founding in 1948, “yet the social dimension of health is often overlooked,” a neglect that has persisted for over 75 years despite being fundamental to the WHO’s mission of health for all.

“In this age when the possibilities to connect are endless, more and more people are finding themselves isolated and lonely,” Tedros said. “Apart from the toll it takes on individuals, families and communities, left unaddressed, loneliness and social isolation will continue to cost society billions in terms of health care, education, and employment.”

As an increasing body of scientific evidence surveyed in the WHO report shows the extent of public health harms of social isolation and loneliness, which the Commission determined should be a “third pillar of health” alongside mental and physical health. But stigma stands in the way of main streaming awareness, funding and policy action.

Stigma around social disconnection and loneliness particularly affects people with disabilities, refugees, migrants, LGBTQ+ individuals, and indigenous and ethnic minority groups who may face additional barriers to social connection, the Commission said. 

“We may not always see it because of the shame and stigma, but it is there, taking a profound toll on our health,” Murthy said. In his role as Surgeon General, Murthy issued a warning in 2023 on the US “Epidemic of Loneliness and Isolation,” in which he compared the health risks to smoking 15 cigarettes a day.

“For too long, we have not recognized the importance of social health. We haven’t seen it for what it is – an essential pillar of our health and well-being,” Murthy said. “That must change.”

Who is hit hardest? 

Global prevalence of loneliness by sex and age group, 2014-2023.

The causes of social isolation and loneliness found in the report are in many ways features of modern life. They include digital technologies, low income and education, chronic health problems, living alone, lacking community and friendship networks. 

While loneliness affects all countries, demographics and income groups, the report found young people and those in low-income countries are the hardest hit. Contrary to common assumptions about loneliness primarily affecting older adults in the later stages of life, teenagers aged 13-17 reported the highest levels at 21%. 

For young people, the report’s findings reveal a paradox: despite living in the most connected era in history, technology has become a double-edged sword. The Commission warned of the negative health effects of excessive time spent on social media and screens for the mental health of young people – but they aren’t the first. 

During his second term as Surgeon General, Murthy issued a watershed advisory on the same subject, determining that there are “ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents.”

“At this time, we do not yet have enough evidence to determine if social media is sufficiently safe for children and adolescents,” the advisory said. The warning was necessary, Murthy said, because up to 95% of youth ages 13–17 report using a social media platform, with more than a third saying they use social media “almost constantly.”

“Even in a digitally connected world, many young people feel alone,” said Chido Mpemba, the African Union Youth Envoy who co-chaired the commission. “As technology reshapes our lives, we must ensure it strengthens—not weakens—human connection.”

Global prevalence of loneliness by WHO region, 2014-2023.

The findings also revealed significant regional disparities, with African countries reporting the highest levels of loneliness at 24% – more than double the European rate of 11% – surprising researchers. 

“We didn’t anticipate that rates of loneliness were going to be higher in low-income countries,” said one researcher involved in the study. The commission found that poverty may account for this trend, as limited economic opportunities can lead to social exclusion and encourage migration that breaks existing social networks.

While loneliness rates were similar between males and females overall, significant gaps emerged among specific age groups. Female adolescents showed the highest rates at 24.3%, while older men reported the lowest levels at just under 10%, challenging the dominant political discussion around male loneliness in the era of the manosphere. 

Global momentum builds 

Map of nations with national health policies addressing social isolation and loneliness.

The WHO report follows historic action by the World Health Assembly, which in May 2025 adopted its first-ever resolution specifically targeting social connection as a public health crisis. The landmark decision, co-sponsored by Spain and Chile, aimed to establish social connection as a standalone global health priority rather than a footnote in mental health policy.

“Today marks the first time social connection has been formally considered at the WHA,” Ailan Li, Assistant Director-General for Universal Health Coverage at WHO, told the Assembly following the vote. “This marks a crucial step in reframing how we understand mental and social wellbeing as central to health systems.”

The WHA resolution requests that WHO member states integrate strategies fostering meaningful social connections into national health policies through strengthened data collection systems, public awareness campaigns, and targeted support for vulnerable populations including people with disabilities, refugees, LGBTQ+ individuals, and single-parent households.

Currently, only eight WHO member states have adopted comprehensive national social connection policies: Denmark, Finland, Germany, Japan, Netherlands, Sweden, United Kingdom, and United States.

WHO Member States Recognize Social Connection as a Global Health Priority

Billions in economic costs

Jakob Forssmed, Minister for Social Affairs and Public Health in Sweden, told reporters the benefits his country’s policies have brought, arguing the public policy approach should recognize the economic costs – and benefits of action.

“When it comes to government [approaches], is critical to realize that this affects the economy, has a severe impact on economic life, because if you build trust between people, this will help the economy to grow,” Forssmed said. 

“If you don’t do these things, if you don’t do the work on social connection, you will find the economy go badly, and you will also have increased health costs. You will have more costs for elderly care. You will have more people, more kids in school, failing and things like that,” he added. “It is an investment, also in hard data. This is not just a soft issue. It’s an issue about societal growth, prosperity and well-functioning societies.”

The commission found that the economic costs of loneliness result from a waterfall effect. At a community level, loneliness undermines social cohesion and costs billions in lost productivity and healthcare spending, while teenagers experiencing loneliness were 22% more likely to achieve lower grades or qualifications, and adults struggling with social isolation face employment challenges and reduced lifetime earnings.

A growing body of research backs up the commission and Swedish minister and WHO commission’s view on the economics.

US employers alone lose $154 billion annually due to loneliness-related absenteeism, productivity losses, and turnover, or $1,685 per employee per year, while Medicare spends an extra $6.7 billion annually. In Spain, the estimated cost of loneliness through health-care expenditure and productivity loss in 2021 was 14 billion euros – 1.17% of Spain’s GDP that year.

“We now see that when children are struggling with loneliness and isolation, it negatively affects their educational outcomes,” Murthy explained. “When people are struggling with loneliness and isolation, it impacts how they perform in the workplace. It has a negative impact on engagement, which can have downstream effects on productivity, and a number of other outcomes that ultimately impact our economy.”

When he first became Surgeon General in 2014, Murthy has stated he “didn’t view loneliness as a public health concern.” Now, with the WHO commission report released, he and his colleagues hope to change that view worldwide.

“We now know that loneliness is a common feeling that many people experience. It’s like hunger or thirst. It’s a feeling the body sends us when something we need for survival is missing,” Murthy wrote in his 2023 Surgon General report.

“Given the profound consequences of loneliness and isolation, we have an opportunity, and an obligation, to make the same investments in addressing social connection that we have made in addressing tobacco use, obesity, and the addiction crisis.”

South Africans campaign in favour of a tax on sugary drinks in 2017.

Low-income countries could confront the massive health finance crisis they are facing after the withdrawal of most US-based aid through a 50% increase in the price of tobacco, alcohol and sugary drinks – saving 50 million lives and raising some $1 trillion dollars in vital revenue for strapped health systems, says WHO.

The ambitious WHO initiative “3×35 initiative” to increase by at least 50% the price of all three health-harmful products by 2035 was launched at the Fourth International Financing for Development Conference in Seville, Spain, which ends today.

“Health taxes are one of the most efficient tools we have,” said Dr Jeremy Farrar, WHO Assistant Director-General, Health Promotion and Disease Prevention and Control. “They cut the consumption of harmful products and create revenue governments can reinvest in health care, education, and social protection. It’s time to act.”

Noncommunicable Diseases (NCDs), including heart disease, cancer, and diabetes, account for over 75% of all deaths worldwide, with tobacco, sugary drinks and excessive alcohol consumption amongst the key causes.  A recent WHO assessment of experiences so far suggest that a one-time 50% price increase on all three products could prevent 50 million premature deaths by 2050 – as well as raising $1 trillion by 2035, WHO said.

The assessment is based on two decades of experiences with increased tobacco taxation, and more recently, country experiences with alcohol and sugary drinks taxes, WHO said.

Six out of ten smokers want to quit tobacco – WHO says taxes can help them do so.

Between 2012 and 2022, nearly 140 countries raised tobacco taxes, which resulted in increase of real prices by over 50% on average, showing that large-scale change is possible, said WHO, who launched the initiative along with the World Bank, the Organization for Economic Co-operation and Development (OECD) and about a dozen other civil society partners, including Bloomberg Philanthropies, the NCD Alliance, Vital Strategies and Movendi International, which works to reduce alcohol abuse.

While higher “sin” taxes have been a key component of WHO’s advocacy around NCDs for years, such calls have gained new urgency in the wake of the massive US cuts in global health funding – which have crippled vital health services related to HIV, nutrition, maternal and child health, and reproductive health in many African, Asian and Latin American countries.  See related story here:

USAID Formally Shut Down – Days After Scientists Warn Closure Will Kill 2.4 Million People Every Year

Meanwhile,  75 % of all lower-income countries are spending more on foreign debt payments than on health and education, as countries face even more pressure from forces like the International Monetary Fund (IMF) to make further austerity cuts.

Revenue raising successes in LMICs

Tobacco, alcohol and sugary drinks – evidence suggests it’s among the most effective tools for raising revenues and reducing health costs.

The 3×35 Initiative also marks the first time that the global health agency and its partners have rallied around a concrete target for dramatically raising alcohol, tobacco and sugary drink taxes. Not coincidentally, the initiative also coincides with the lead-up to the Fourth UN High Level Meeting on Noncommunicable Diseases, planned for September 2025, when countries will be asked to support a draft declaration that refers to such taxes as a key lever for reducing NCDs.

WHO’s claim that the tax initiative could raise $1 trillion for countries by 2035 is a projection. But by some measures, it is a conservative one, a WHO spokesperson said.  A 2024 Task Force on Fiscal Policy for Health, led by Michael Bloomberg, founder of Bloomberg Philanthropies, found that an excise tax increase sufficient to rise prices by 20% on all three products would mobilize some $2.2 trillion over five years, of which $1.3 trillion would be mobilised in low and middle income countries. Raising health taxes enough to generate a 50% price rise, moreover, would generate some $3.7 trillion, of which $2.1 trillion would be raised in LMICS.

Assessment by a Bloomberg-sponsored task force found even bigger potential revenues from the tax increases.

Along with the long experience in tobacco taxation, the projection is based on revenue-raising experiences with other health taxes in countries such as Colombia, Mexico, South Africa and Sri Lanka.

In Sri Lanka, the government exceeded its tax revenue target for the first quarter of 2024 in part thanks to two alcohol tax increases of 20% implemented in 2023, said Movendi. Another Movendi review of experiences in low- and middle-income countries including: Botswana, Estonia, Lithuania, Russia, South Africa, Thailand, and the Philippines, also found positive impacts on health, as well as economic benefits, of the tax increases.

As for the new 3×35 initiative, backing from Bloomberg Philanthropies, the World Bank and the Organization for Economic Co-operation and Development (OECD) also involves support for countries who want to take action.

Debunking industry claims

Mexican media campaign warning consumers of the health risks of sugary drinks.

Industry voices can be expected to push back hard against the initiative, with beverage industry voices, for instance, claiming that sugary drink taxes don’t reduce consumption.

“It’s deeply concerning that the World Health Organization (WHO) continues to disregard over a decade of clear evidence showing that taxing sugar-sweetened beverages has never improved health outcomes or reduced obesity in any country,” said Kate Loatman, executive director of the International Council of Beverages Associations, told Reuters.

However, a growing body of evidence in the United States, Latin America, and beyond and globally suggests otherwise.

When sugary drink taxes, for instance, were adopted, there were generally corresponding reductions in consumption, according to the Obesity Evidence Hub.

Two year’s after Mexico’s first sugary sweetened beverage (SSB) tax was first adopted, for instance, there had been a 37% reduction in total volumes of drinks purchased, one study found.  Reductions in purchases were greatest amongst poorer households and households that were formerly high consumers of SSBs. Based on those findings, the tax would prevent 239,900 cases of obesity over a decade, 39% in children, another 2019 study projected, with health-care cost savings four times greater than the costs of implementing the new regulation.

After South Africa introduced a 10% tax on sugary drinks, excluding fruit juices, there was a 57% drop in grams of sugar consumption from purchases of taxed drinks amongst people in lower socio-economic groups.  Manufacturers, meanwhile, reformulated their drinks with lower sugar levels to avoid the tax and respond to new consumer demands.

Image Credits: Kerry Cullinan, Sarah Johnson, Leo Zhuang/ Unsplash, Task Force on Fiscal Policies for Health 2024, Bloomberg Philanthropies, Bloomberg Philanthropies.

Air pollution is barely acknowledged in the draft political declaration for the upcoming fourth UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health. The omission of the world’s leading contributor to disease threatens global progress in tackling heart disease, respiratory diseases, stroke, cancer, and other chronic illnesses.

Since the last UN General Assembly High-Level Meeting on non-communicable diseases (NCDs) in 2018, air pollution has leapfrogged tobacco as a cause of disease and premature death worldwide.

Government representatives negotiating ahead of September’s meeting in New York City must commit to addressing this global health emergency of air pollution as the leading contributor to the global disease burden, causing more than one in ten deaths globally. 

Without clean air action, leaders will miss a golden opportunity to reduce the pressure on healthcare, improve the lives of billions of people living with NCDs, and prevent millions of cases of cardiovascular and respiratory disease, lung cancer, diabetes, mental health and neurological conditions including dementia.

In 2019, 99% of the world’s population was breathing air polluted beyond safe levels, according to WHO’s global air quality guidelines. The 2024 State of Global Air report by the Health Effects Institute shows that outdoor air pollution—driven largely by fossil fuels, transport, waste burning, and agriculture—causes 4.7 million deaths each year, while  household air pollution from cooking and heating with polluting fuels adds another 3.1 million deaths. 

That’s eight million preventable deaths every year—a staggering, unacceptable toll representing real people losing their lives to the very air they breathe.

The declaration of leaders meeting at UNGA must reflect the urgency of the issue, the life-saving potential of clean air, the cost-savings this offers to health services, and clearly call for integrated action on air pollution.

The unquestioned science

Almost everyone on earth breathes polluted air, with an impact far beyond the lungs. Fine particulate matter (PM2.5) enters the airways and is tiny enough to pass into the circulatory system and can reach nearly every organ, where it contributes to heart attacks, strokes, kidney disease, depression, anxiety, and impaired brain development in children. It also increases risks during pregnancy, including of miscarriage, stillbirth and low birth weight.

People living with NCDs are hit hardest. Air pollution causes more than a quarter of all deaths from ischaemic heart disease and stroke, almost half of all deaths from chronic obstructive pulmonary disease (COPD), and nearly a third of deaths from lung cancer, while worsening patients’ quality of life, prognosis and healthcare access. 

Countries are already off track to achieve SDG target 3.4—reducing premature NCD mortality by one-third by 2030. Most will find it impossible to meet this target without real action to reduce air pollution.

The good news is that proven, cost-effective solutions to allow us all breathe easier exist. Ministers of Health unanimously approved an updated WHO global roadmap on air pollution and health at last month’s World Health Assembly, including a target to halve mortality from anthropogenic air pollution by 2040. 

Progress towards the WHO Air Quality Guideline levels for healthy air is already underway in some regions. The European Union recently updated its Ambient Air Quality Directive, while China cut PM air pollution by more than half over the last decade, proving that clean air is compatible with rapid economic development. City mayors from every continent are showing leadership too, with 50 cities committing to stepping up clean air action earlier this year. 

Where the burden hits hardest 

Global map of national population-weighted annual average PM2.5 concentrations in 2020.

Like tobacco, alcohol and other major risk NCD factors, air pollution imposes an acutely unfair burden of disease on the lowest-income countries, and most marginalised communities. Ninety-five per cent of deaths linked to air pollution are of people in low- and middle-income countries, due to toxic pollution and under-resourced health systems. 

Despite the scale of this crisis, air pollution remains drastically underfunded. According to the State of Global Air Quality Funding 2024 report, clean air initiatives received less than 1% of international development funding between 2018 and 2022. This chronic neglect is not just a public health failure—it’s an economic catastrophe, with a toll counted in lost lives and livelihoods worldwide. 

The World Bank estimates that the cost of air pollution at US$6 trillion annually—equivalent to 5% of global GDP—from lost labour income due to illness and premature death, reduced productivity, and increased healthcare expenditures. In some of the hardest-hit countries, especially in South and South-East Asia and sub-Saharan Africa, air pollution costs exceed 10% of national GDP. 

These economic wounds stall development, entrench poverty, overwhelm fragile health systems and reveal a stark disconnect: the world is losing trillions to an entirely preventable crisis while making virtually no investment to stop it.

Fossil fuels: the overlooked driver 

An oil rig operates off the coast of Denmark.

NCD Alliance (NCDA) has voiced strong concerns over the draft political declaration, particularly the absence of any mention of fossil fuels—by far the leading driver of air pollution. Reducing fossil fuel extraction and use, phasing out subsidies, and ensuring just transition to clean energy must be central to NCD prevention efforts, but such commitments are currently absent.

NCD Alliance recommends clearly acknowledging the public health emergency posed by air pollution calls on governments to include an additional tracer target: “at least 80% of countries have adopted air quality standards to align with WHO air quality guideline level by 2030.” 

Air pollution was recognized as a major NCD risk factor by leaders at the last High-Level Meeting on NCDs in 2018, together with mental health and neurological conditions as one of the major NCD groups, creating a “5×5” framework for the NCD response. Since then, the evidence has only grown stronger on health impacts of air pollution, climate change and environmental degradation.

NCDA therefore calls for the stronger inclusion of air pollution, food systems and climate change in the text, and urges leaders to address this important nexus. Failure to do so would ignore emerging risks and lead to missed opportunities for more integrated, efficient, and forward-looking action.

Political momentum building

WHO’s Maria Neira, centre, receiving a health sector call for clean air action, presented by respiratory disease patients and paediatricians, at the WHO Air Pollution and Health Conference, March 2025.

At the 2nd WHO Global Conference on Air Pollution and Health in March 2025, governments and stakeholders endorsed a bold goal: halving the health impacts of air pollution by 2040. That target was formally approved by the 78th World Health Assembly. Achieving it would prevent three-to-four million premature deaths annually—most of them from NCDs. 

This aligns with the Sustainable Development Goals, including SDG 3.4 (reduce premature NCD mortality), SDG 3.9 (substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution), SDG 7.1 (ensure universal access to affordable, reliable and modern energy services) and SDG 11.6 (improve air quality in cities).

Leading health organizations have joined the call to action, singling out air pollution as a deadly yet underfunded and solvable crisis. The Union for International Cancer Control (UICC) has identified air pollution as a missed opportunity to improve cancer survival, noting significant differences in prognosis in more polluted countries and cities.

The World Heart Federation (WHF) has also sounded the alarm on air pollution as an under-addressed driver of cardiovascular disease, with over half of the nearly eight million annual air pollution-related deaths are due to cardiovascular conditions, according to its 2024 World Heart Report. 

WHF urges governments to adopt the 2021 WHO air quality guidelines as legally binding standards and to align clean air targets with climate and urban planning policies. Their message is clear: protecting heart health means tackling pollution at its source—especially fossil fuels—and integrating environmental, health, and economic agendas.

A test of global leadership

The General Assembly hall in the United Nations’ New York City Headquarters.

Omitting air pollution from the NCD agenda is not just an oversight—it’s a dangerous misstep. The upcoming High-Level Meeting is a unique opportunity to correct course. World leaders must explicitly commit to act on air pollution as a major NCD risk factor in their political declaration. 

This should include developing national air quality standards that align with WHO guidelines, curbing emissions from key sources, and evaluating the cost savings from cleaner air to inform health system planning and budgets. Governments and donors must step up with stronger investments in clean air, especially for the most affected communities.

Clean air is not a luxury—it is a human right, especially for people living with NCDs. 

Leaders have the power to reverse this public health failure and economic disaster while delivering clear public health policy success: hospital admissions falling within days and weeks, healthier babies born in the ensuing months, and NCD trends continuing to improve over decades.

The science is beyond doubt, the solutions are proven, and Ministers of Health and Environment have committed on the international stage. The world now needs leaders to recognize the urgency of this crisis and seize this opportunity to save both lives and money. Including air pollution in the NCD agenda is not optional—it is vital.

About the authors

Alison Cox is the Policy, Advocacy and Accountability Director of the NCD Alliance, a global network of civil society organisations dedicated to transforming the fight against noncommunicable diseases.

Nina Renshaw is a career-long advocate for clean air, joining Clean Air Fund as Head of Health in 2022. She has twenty years of experience of international policy and advocacy in diverse fields, including health, environment, economy, transport and international development.

Image Credits: Giorgia Galletoni , CC, Patrick Gruban.

USAID closes days after leading medical journal warned of millions of deaths per year from a halt to operations.

US Secretary of State Marco Rubio announced the official end of USAID, eliminating the world’s largest humanitarian aid agency just days after a landmark study warned the closure would cause 2.4 million preventable deaths every year.

The study published 30 June in The Lancet found USAID-supported programs saved 92 million lives in low- and middle-income countries over the past two decades, including 30.4 million children under the age of five. Without this support, researchers project 14 million additional premature deaths by 2030 – as a result of the closure of the agency founded in 1961.

“Unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030,” warned the 15 authors of the study, led by  researchers at Barcelona’s ISGlobal and five other Spanish institutes, the Institute of Collective Health in Brazil, the Centro de Investigação em Saúde de Manhiça, Mozambique, and the University of California, Los Angeles.

Rubio has ignored such warnings.

In a State Department memo titled “Make Foreign Aid Great Again” announcing the shutdown, Rubio laid into USAID, stating its “charity-based” model was against American interests and that it spawned “a globe-spanning NGO industrial complex at taxpayer expense.” He also attacked recipient countries and regions – notably Sub-Saharan Africa – for not repaying the US with UN votes despite billions in aid.

The move marks the final chapter in the rapid dismantling of the agency since January, upon which millions of the world’s most vulnerable people relied upon for vital health, nutrition and other development assistance. That saga began in January, when Elon Musk, the world’s richest man, famously tweeted he had skipped “some great parties” to put USAID “into the wood chipper,” telling the agency: “Time to die.”

The Trump administration had previously cancelled 83% of its aid operations earlier this year, throwing the international aid world into chaos. What remains of old US AID programmes will be “targeted and limited,” and be folded into the State Department, the memo said.

“USAID viewed its constituency as the United Nations, multinational NGOs, and the broader global community—not the U.S. taxpayers who funded its budget or the President they elected to represent their interests on the world stage,” Rubio wrote, adding that the agency “has little to show since the end of the Cold War.”

‘No one has died’

US Secretary of State Marco Rubio told Congress no one is dying from tens of billions in cuts to foreign aid.

Rubio’s State Department letter makes no mention of humanitarian concerns, instead reflecting the transactional view that has underpinned the Trump administration’s trade policy and America First foreign policy approach.

As for the estimates mortality projections tabled by scientists,  the architects of USAID’s dismantling tell a different story: no one is, has or will die.

“No one has died because of USAID [cuts,]” Rubio told Congress in late May, months after the majority of its operations were already terminated. “No children are dying on my watch.”

Musk echoed the same sentiment in March: “No one has died as a result of a brief pause to do a sanity check on foreign aid funding. No one.”

Fact Check

The stories at country level say something very different.

In Sudan, a mother described watching her toddler die from a treatable chest infection after the termination of antibiotic supplies to local clinics following the USAID cuts.  Others watched their babies starve while older children died begging for food, after soup kitchens were closed, according to one field report  by the Washington Post. And the absence of US-funded disease response teams has made it harder to contain deadly cholera outbreaks, doctors reported.

In East Africa countries like Zimbabwe, where USAID has long provided HIV medication, the sudden cuts left thousands without access to life-saving antiretroviral drugs, according to another report, by Health Policy Watch.  See related story.

Bribes and Rationing of AIDS Medicine in Zimbabwe as Trump’s Aid Cuts Bite

Thousands of organizations running health clinics, vaccination centres, food distribution sites, water purification drives, and other life-saving activities will be forced to curtail activities or shut down altogether, cutting off basic services.

In 2023 alone, USAID provided essential healthcare to 92 million women and children, as well as services to 20 million people infected with HIV. Many of those services now gone or in suspension until Congress decides if it will extend the lifespan of the President’s Emergency Program on AIDS Relief (PEPFAR), whose latest one-year authorization expired in March.

International aid organizations, including UN agencies and major charities, are struggling to cope with the loss of more than $60 billion in US funding. Facing steep staff cuts and slashed budgets, none are positioned to quickly replace USAID’s operations or maintain the same reach to vulnerable populations.

USAID’s Health Legacy

Elon Musk, who was named a “special government employee” by the Trump administration, secured the president’s backing to eliminate USAID, the country’s foreign aid agency, sending shockwaves through global humanitarian efforts.

That “sanity check” on foreign aid has since morphed into a total halt. This is particularly dramatic in the health sector, where the US has been the backbone of aid – totalling nearly a third of all health aid globally – for decades as the Lancet illuminates what will be lost.

The Lancet analysis found that higher levels of USAID funding—primarily directed toward low and middle-income countries, particularly in Africa—were associated with a 15% reduction in all-cause mortality and a 32% reduction in deaths of children under five.

The agency’s programs achieved remarkable reductions across multiple disease categories: a 65% reduction in HIV/AIDS deaths (saving 25.5 million lives), 51% reduction in malaria deaths (8 million lives), and 50% reduction in deaths from neglected tropical diseases (8.9 million lives).

Among the programs affected by the cuts is the President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved an estimated 26 million lives through HIV treatment and prevention. Its collapse would have immediate, devastating consequences: in just three months, nearly 136,000 babies – about 1,500 each day – would be born with HIV as pregnant women lose access to transmission-prevention medication.

Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrheal diseases, lower respiratory infections, and maternal and perinatal conditions.

“Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID,” James Macinko, a health policy researcher at UCLA and study co-author told NPR. “For that small amount, we’ve been able to translate that into saving up to 90 million deaths around the world.”

Charity is bad

Low-income countries on average depend on foreign aid for one-third of their national health spending. Eight of the world’s poorest countries—South Sudan, Somalia, Democratic Republic of Congo, Liberia, Afghanistan, Sudan, Uganda and Ethiopia—rely on USAID for over 20% of their total foreign assistance.

Facing their highest debt burdens in decades, many of the world’s poorest nations are unlikely to be able to compensate for the budget hole blown open by USAID’s withdrawal.

Former President Barack Obama called the decision to dismantle USAID a “colossal mistake,” saying the agency’s efforts to prevent disease, fight drought and build schools made it synonymous with America itself. “To many people around the world, USAID is the United States,” Obama said.

Citing two anecdotes – a Zambian man who told American diplomats teaching his countrymen to “learn to fish” instead of receiving US aid, and an Ethiopian woman praising two-way investment schemes – Rubio said the new model will provide “targeted and limited” aid, while favoring nations who demonstrate an “ability and willingness to help themselves” and welcome US investment.

“The charity-based model failed because the leadership of these developing nations developed an addiction,” Rubio said. “That ends today, and where there was once a rainbow of unidentifiable logos on life-saving aid, there will now be one recognizable symbol: the American flag.”

The United States flag has for decades been on the center of all aid packages distributed by the agency.

Image Credits: White House .