BREAKING: UN Declaration on Noncommunicable Diseases Appears Headed for Vote After US Objections Foil Consensus Agreement Non-Communicable Diseases 25/09/2025 • Elaine Ruth Fletcher Share this: Click to share on X (Opens in new window) X Click to share on LinkedIn (Opens in new window) LinkedIn Click to share on Facebook (Opens in new window) Facebook Click to print (Opens in new window) Print WHO Director General Dr Tedros Adhanom Ghebreyesus with UN Under Secretary General Amina Mohammed at Thursday’s opening of the UN High Level Meeting on Noncommunicable Diseases. NEW YORK CITY – A painstakingly negotiated High Level Political Declaration on Noncommunicable Diseases received overwhelming support from UN member states at a special session in the General Assembly on Thursday. But in a last minute communiqué, the United States sought to torpedo the declaration’s formal adoption, saying consensus had not been formally reached in line with the agreed-upon UN protocols for the political declaration’s approval. A long list of statements by the largest blocks of developed and developing countries Thursday at the Fourth UN High Level Meeting on NCDs and Mental Health declared that the draft finalized in early September, should be seen as a consensus document. Technically, however, the US objections cast uncertainty over whether a simple decalaration of consensus could hold procedurally, or if member states might have to seek other means to formalize the declaration, e.g. through a UN General Assembly process and vote. Draft text is first political declaration to set clear NCD targets The draft sets, for the first time ever, some defined, if modest, targets for combatting NCDs, stating that by 2030, there should be 150 million fewer people using tobacco; 150 million more people with hypertension under control and 150 million more people with access to mental health care. Testing a patient for hypertension. Two-thirds of Africans with high blood pressure are unaware of their condition. Those targets are still far from the UN SDG 3.4 goal calling for a reduction of premature NCD deaths by one-third by 2030 – a goal that the world lags far behind in meeting as NCDs continue to represent 74% of premature deaths. In the final draft, the language supporting national taxes on unhealthy products, one of the most potent tools for prevention, was watered down under industry pressures. The final text now recommends that member states: “consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances.” RFK Jr – declaration ‘exceeds the UN’s proper role’ Robert F Kennedy Jr says the United States would ‘walk away’ from the political declaration. Addressing the plenary, United States Health and Human Services Secretary Robert F Kennedy Jr charged that the final draft text, “exceeds the UN’s proper role while ignoring the most pressing health issues, and that’s why the United States will reject it. “More specifically. We cannot accept language that pushes destructive gender ideology,” Kennedy said. “Neither can we accept claims of a constitutional or international right to abortion, the WHO cannot claim credibility or leadership until it undergoes radical reform. The United States objects to the political declaration of non communicable diseases. “The draft declaration should not have been included in today’s agenda,” Kennedy insisted, adding it was “filled with controversy with provisions about everything from taxes to … management by international bodies of communicable diseases. “The United States will walk away from the declaration,” Kennedy stated, “but we will never walk away from the world or our commitment to end chronic disease. We stand ready to lead to partner to innovate with every nation committed to a healthier future.” The final draft text makes no reference to abortion, stating only that NCDs need to be mainstreamed into “sexual and reproductive health programmes.” A single reference to gender calls for mainstreaming “a gender perspective” into NCD prevention and control as critical to understanding and addressing the health risks of women and men “of all ages.” Overwhelming support by other member states Suriname’s new President, Dr. Jennifer Simons, a physician, stresses importance of mental health. At the HLM meeting, the US role seemed to be anything but one of leadership. A wall of statements in the Thursday plenary expressed support for the draft resolution as it was agreed to in early September. Those included statements by: the Group of 77 including China, the UN’s largest bloc representing 130 emerging economies; the Gulf Cooperation Council, representing a powerful group of Middle East oil-producing states; the Caricom alliance of Caribbean nations; the European Union; Pacific Island nations; and the Philippines, speaking on behalf of the Association of Southeast Asian Nations (ASEAN). The Philippines noted how the country has deployed over 20,000 primary care providers to address NCDs and mental health at primary care level more systemically, at a cost of about $518 million. “The investment case is clear. NCDs cost the Philippines $13.5 billion annually through the health care cost and productivity losses,” said Secretary of Health, Teodoro Herbosa. Suriname’s new President, Jennifer Simons, herself a physician, stressed the importance of addressing mental health issues – a theme echoed by many ministers and heads of state. “Our people are more and more confronted with the impact of mental health challenges. They feel lonely, depressed and often isolated. We will have to pay attention to the risk of social media and screen time in general, on the mental health of our children,” Simons said, adding that countries like hers also face “an escalating race of unhealthy lifestyles, which cuases, of course, obesity among children, and adults.” WHO’s role in combating NCDs affirmed The new UN high-level resolution is the strongest appeal, to date, for access to mental health services. “The political declaration before you is the strongest yet with ambitious, measurable and achievable targets,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, speaking before the UN Assembly on Thursday morning. The political declaration, the fourth such document since 2011, also marks the first time that mental health risks are extensively addressed as part of the NCD paradigm, Tedros said. “For the first time, mental health is fully integrated into a political declaration,” said Tedros. “It’s about time, in this declaration, you’re committing to expanding access to services for mental health care, but brick by brick, we must also tear down the walls of stigma that keeps so many people trapped.” The WHO Director General called upon countries to implement three measures in connection with combatting NCDs – more preventive measures; full integration of NCD diagnosis and care into primary healthcare systems; and more equitable access to medicines and treatments. “Health does not start in clinics and hospitals. It starts in homes, schools, streets and workplaces, in the food people eat, the products they consume, the water they drink, the air they breathe, and the conditions in which they live and work,” Tedros declared. “So the number 1 [ask] should be addressing the root causes and helping people to lead a healthy life. Examples of the 16 WHO Best Buys to reduce NCDs. “Second, I ask all countries to integrate services for NCDs and mental health into primary health care at the foundation of universal health coverage. “Third, I ask all countries to deliver equity through access and accountability. That means making essential medicines and technologies available and affordable to all with financing that reduces out of pocket payments or costs. Over US objections, the final declaration still refers to WHO in half a dozen places, recognizing: “the key role of the World Health Organization as the directing and coordinating authority on international health in accordance with its Constitution to continue to support Member States through its normative and standard-setting work, provision of technical cooperation, assistance and policy advice, and the promotion of multisectoral and multistakeholder partnerships and dialogues.” WHO “Best Buys” for prevention and control of NCDs is also cited. The Best Buys are a package of 16 key interventions to prevent and address smoking, excessive alcohol use, physical inactivity and obesity, as well as cancer risks. Air pollution mentioned – but not its fossil fuel sources Smoke billows from power plant in Poland – generating both air pollution and CO2 emissions. The new declaration also mentions air pollution as a ‘fifth’ risk factor for NCDs – a position for which environmental health advocates have long argued. The text states that member states: “recognize also that the main modifiable risk factors of noncommunicable diseases are tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution and are largely preventable and require cross-sectoral actions;” It also notes that an estimated 7 million people die prematurely every year from air pollution-related diseases – most of them NCDs. These include air pollution-related hypertension, heart and lung diseases, and cancers that develop as tiny air pollution particles travel through the bloodstream and into key organs of the body, including the brain. And the draft text recommends measures that can reduce air pollution and its related disease burden, including: “clean, efficient, safe, accessible and expanded urban public transport options, and active mobility, such as walking and cycling;” as well as reduced open waste burning; more affordable clean cooking, heating and electricity generation; vehicle and industrial controls on pollutants, as well as reduced exposures, particularly for children, to lead and other hazardous chemicals. (Center) Jane Burston, CEO Clean Air Fund: omitting fossil fuels is ‘like pledging to tackle smoking without mentioning tobacco.’ However, the declaration doesn’t go far enough on the sidesteps any reference to fossil fuels as a major source of health-harmful air pollutants, noted Jane Burston, CEO of the Clean Air Fund, and it makes no mention of the co-benefits that can be gained from reducing air pollutants – particularly for climate. “It’s like pledging to tackle smoking without mentioning tobacco,” Burston said of the omission, in an appearance at a side event Wednesday evening, organized by the civil society group, the NCD Alliance. “We need to acknowledge where it’s coming from.” Added Norway’s Minister of International Development Åsmund Grøver Aukrust, “the declaration reflects also a challenging geopolitical climates. This has clearly influenced the outcome of these documents… We regret the removal of targets for taxes on tobacco, alcohol and sugar sweetened beverages. We must work harder to prevent the devastating consequences of climate change, air pollution and their impact on health. We must be clear on our commitment on air pollution. Let’s remind ourselves that 95 percentage of all premature death due to air pollution occur in low- and middle-income countries.” US objections – not entirely a surprise Ralph Gonsalves, Prime Minister of St. Vincent and the Grenadines tells the Assembly that the draft was the result of a painstaking negotiation. The US objections were not a complete surprise. A 3 September memo to the president of the UN GA by the political declaration’s co-facilitators, Luxembourg and St. Vincent and the Grenadines, declared that the draft represents “the broadest possible consensus” – but not full agreement amongst all member states: “On 2 September, we were informed by one delegation that it is not able to join consensus despite all our collective efforts,” stated the letter, obtained by Health Policy Watch. “While there is no unanimity of views, it is our firm belief that the finalized version of the political declaration we are submitting to you adheres to the principle of consensus because it reflects a general agreement among the membership and garners the broadest possible political acceptance by Member States. It represents the broadest possible consensus.” In the 18 September letter, the US Mission to the United Nations pushed the issue further, saying, “the most recent draft of the political declaration has not been agreed by consensus in advance, and thus the conditions stipulated by the modalities resolution have not been met. Therefore, the draft political declaration should not be brought before the high-level meeting for approval.” Speaking at the High Level Meeting St. Vincent and Grenadines Prime Minister Ralph Gonsalves, said: “We recognize that it is not perfect, but perfection is not the standard in multilateralism, nor is it the measure of progress. What we have is a declaration that is robust, comprehensive enough to provide the necessary catalyst for action, and reflects the broadest possible consensus.” ‘Birthday checkups’ and other country commitments Indonesia’s Deputy Director General, NCDs, Bonanza Perwira Taihitu. In public and informal fora around the High Level Meeting, member states at all levels of development talked about what they were doing to combat the global NCD epidemic – from higher taxes on items like sugary drinks and tobacco, to training health care workers to screen ‘at risk’ populations. “We didn’t want to call them mandatory checks, so we are calling them ‘birthday checks’,” quipped Indonesia’s Deputy Director General in the Ministry of Health’s NCD Department, Bonanza Perwira Taihitu, at a civil society event Wednesday. The country’s drive to conduct health screenings for hypertension, high blood pressure and other NCDs, which began in February, has already reached 32 million people out of Indonesia’s population of some 280 million people, he said. Indonesia is also investing heavily in new digital health systems, Taihitu added, echoing calls by industry forces to national health systems to expand their reach “via health innovation systems” along with expanding Universal Health Coverage to combat the high cost of NCD diagnosis and treatment. (Right) Jeremy Farrar, WHO Assistant Director-General (ADG) of Health Promotion, Disease Prevention and Control, at a NCD Alliance panel event Wednesday evening. Meanwhile, Jeremy Farrar, WHO Assistant Director General said that while the weakening of some of the declaration’s language was regrettable, what really matters is the momentum being seen at the national level. “If you’d said to me six months, 12 months ago, that in 2025 with the current geopolitical tensions that we are living through, you would have had the [WHO] pandemic accord approved in May, and now, we hope tomorrow, a declaration on NCDs?” he said, looking at the glass half full. “Although we need to say we nobody’s happy with it, everybody is moving forward,” he said. “And ultimately, does anybody in Ho Chi Minh City or Jakarta or London really care what’s in that declaration? What matters is what the governments now go back to do in their own jurisdiction, and that’s what really matters.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO, PAHO, Janusz Walczak/ Unsplash, E. Fletcher/Health Policy Watch. 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