The World Economic Forum’s (WEF) latest report on acting early on noncommunicable diseases (NCDs) signals more than urgency. It signals a shift in what counts.

Beneath familiar calls for earlier action sits a quieter move: a re-ordering of NCD priorities themselves. Some diseases now sit firmly at the centre of the agenda. Others, no less prevalent or consequential, are absent or muted.

The clearest indicator is the report’s treatment of chronic kidney disease (CKD). CKD is presented, not as a downstream complication, but as a core NCD, positioned comfortably alongside cardiovascular disease, diabetes, cancer, and chronic respiratory disease. No extended justification is offered. Its inclusion is just assumed.

CKD’s elevation is overdue, but its inclusion in the WEF report also reveals how NCD categories solidify. Diseases move to the centre not only because of burden, but because they align with existing biomedical pathways, specialist care models, insurance logic, and pharmaceutical governance. 

Seen this way, the report is not simply about acting earlier. It is about which disease problems global health institutions are structurally prepared to organise around.

The politics of NCDs

NCDs have never been a neutral list. They are the product of political and institutional settlement. Inclusion brings visibility, financing, and organisational ownership. Exclusion does not erase a condition, but it shapes how seriously it is taken in policy, planning, and budgets. What this report suggests is that the settlement is shifting again, quietly rather than through open debate.

The contrast between what fits and what does not is striking. Oral health is absent altogether, despite affecting more people globally than all other NCDs combined. Dementia barely registers, even as it reshapes ageing societies and long-term care systems. 

Air pollution appears only as a generic risk factor, detached from its regulatory implications. Obesity and physical inactivity are acknowledged but they never organise the analysis. Mental health is present, but thinly so. Eye health and several other NCDs are missing entirely.

This is not ignorance. The WEF itself has published economic analyses making the case for investing in oral health. It is well aware of dementia, air pollution, and obesity as global challenges. The issue is not whether these conditions matter, it is whether they fit prevailing system architectures.

Institutional compromises

Debates around expanding the NCD frame, including the so-called 6×6 perspective, were never simply about adding conditions to a list. They exposed how the NCD framework hardened into an institutional compromise, privileging problems that are easier to govern, finance, and narrate. 

Oral health and others were excluded not because the evidence was weak, but because their inclusion would have unsettled that compromise.

What the WEF report suggests is that the frame is being adjusted again, but cautiously. Rather than opening outward to accommodate conditions that strain existing arrangements, it tightens inward around those that reinforce them.

 CKD aligns neatly with this logic. It can be framed as an extension of diabetes and hypertension. It lends itself to biomedical markers, specialist pathways, and pharmaceutical management. It fits insurance systems and performance frameworks. 

Crucially, it does not force difficult conversations about food systems, sugar, taxation, or commercial power. It can be absorbed without rewriting the rules.

Other conditions are less accommodating. Oral diseases pull sugar into view as a specific commercial determinant, not a vague lifestyle choice. They expose the fragility of private financing and fee-based care, and make inequality impossible to ignore. Dementia collapses the boundary between health and social care.

 Air pollution pushes responsibility far beyond the health sector. Climate-related exposures, including extreme heat, increasingly shape NCD risk and outcomes, yet remain difficult to absorb into disease-specific prevention frameworks, as they demand action across labour policy, urban design, housing, and climate governance. Obesity, if taken seriously, leads quickly to trade policy and regulation.

These are not marginal complications. They are precisely the kinds of questions that strain consensus and unsettle partnerships.

Inclusive understanding

This quiet consolidation sits alongside longer-standing efforts by groups such as the NCD Alliance to defend a broad and inclusive understanding of NCDs. That advocacy has helped keep multiple conditions visible in political commitments, even as institutional practice increasingly favours a narrower, more governable set of priorities.

The institutional setting matters. The WEF operates through public–private convening. Pharmaceutical companies, diagnostics firms, and health-technology actors are not peripheral to its health work; they are part of the room. This does not mean reports are written to serve corporate interests, but it does shape which narratives travel easily and which stall.

One contemporary signal reinforces this pattern. This week at the WEF in Davos, a global partnership was announced between Colgate-Palmolive (the leading global manufacturer of oral hygiene products) and the WHO Foundation. 

At a moment of tightening budgets at WHO, including the loss of dedicated oral-health staff, such arrangements are widely hoped to help stabilise institutional capacity and preserve visibility for conditions otherwise at risk of further marginalisation.

Analytically, they reflect the same logic at work: when conditions fall outside the core NCD architecture, they advance through parallel channels rather than through the centre of system reform.

The risk is subtle but real. The NCD discourse begins to tilt away from the conditions that most shape lived experience towards those that best fit institutional comfort. Authority shifts not because of burden or equity, but because of governability.

CKD did not move to the centre by chance. It arrived because it belongs to the version of NCDs that the global health sector currently finds easiest to manage. Other conditions remain outside, not because they matter less, but because they ask harder questions about responsibility, power, and what health systems are ultimately for.

That is what this report reveals. It is not primarily a story about acting early. It is a story about how carefully and quietly the boundaries of action are being redrawn.

Habib Benzian is Professor at the University of the Western Cape (Cape Town, South Africa), Noel Martin Visiting Chair at the University of Sydney’s Dental School; and a member of the Lancet Commission on Oral Health. He advises governments and international organisations on health policy and equity.

Image Credits: WEF.