While WHO’s recent Executive Board meeting saw a considerable amount of sound and fury over the proposed pandemic treaty, an obscurely titled but vital appendix of updated “best buys” to combat noncommunicable diseases (NCDs) was also briefly on stage. 

This new set of cost-effective recipes to combat what are now the world’s biggest killers provides crucial guidance on how to address NCDs  Were governments to adopt the recommendations as official policies, they could significantly impact the growing trajectory of NCDs. 

Yet, this potentially powerful guidance is wrapped in a wonkily titled document called Appendix 3 of the Global Action Plan for The Prevention and Control of NCDs 2013‒2030. It’s just the kind of packaging that the food, alcohol or tobacco industry would never even dream of using to launch a new product or strategy.  

Powerful but poorly displayed, this new guidance must be packaged and communicated better to protect it from untoward corporate influences. 

For all of those reasons, and more, it deserves far more attention from health policy leaders and civil society as it winds its way to approval at the World Health Assembly in May. 

Unpacking the latest formulas to fight NCDs

The updated policies and interventions address risk factors that perpetuate NCDs such as  tobacco, alcohol and ultra-processed foods. Much in the current draft is good, such as a broader definition of “unhealthy diets”  that includes not only sodium, but also transfats, saturated fats, and free sugars; strengthening countries’ capacities for strategic, multisectoral NCD prevention; and not only enacting minimum prices for harmful products but monitoring how those prices need adjustment based on inflation and other economic factors.

It also does better at reflecting the evidence from low- and middle-income countries (LMICs). The last version in 2017 had data only from 20 LMICs, while the current draft reflects the experiences of 62 countries. 

Nevertheless, the document still does not go far enough on critical aspects of prevention – such as environmental health risk factors like traffic injuries, air pollution, climate change and biodiversity loss, and related to those, unhealthy and unsustainable food systems. It must include conflict of interest policies as recommended policy interventions.

The producers of unhealthy commodities that contribute to NCDs, including the tobacco, alcohol, and ultra-processed foods industries, have a direct stake in maintaining their markets and will attempt to dilute WHO’s recommended policies.(Coca-Cola has lobbied aggressively to remove taxes on sodas and sugary drinks – a best-buy to combat unhealthy diets – in previous versions of this document.)

That is why it is imperative that trusted parties – from civil society groups to individual researchers – carefully scrutinize the proposed revisions on their merits, offer feedback ahead of the WHA, and prevent efforts by self-interested commercial entities to undercut the proposed solutions. 

And there is still room for improvement, which is why we recommend WHO includes the following updates and commitments to its current draft of Appendix 3. These should include  a more explicit articulation of recommendations against conflict of interest, corporate influence, and a more proactive stance on integrated policies related to climate and environmental health that prevent NCDs, as follows:

Preventing corporate influence 

Corporate influence has been identified as a reason for the poor implementation of NCD policies. A global study of 194 countries identified corporate influence as one of the main reasons for the poor implementation of WHO’s recommended cost-effective solutions in Appendix 3. 

The most recent Gallup poll released by WHO and Bloomberg Philanthropies on public perception of NCDs bears this out further. Many people support policies like taxes on unhealthy commodities, particularly if the money will support public programs. 

They want labels on unhealthy foods and restrictions on advertisements that entice their kids. Therefore, removing conflicts of interest from mega-corporation must be included as a specific policy intervention, at least for tobacco control, alcohol use, and unhealthy diets. 

Tobacco control may offer a good template for initial steps towards more aggressive action given that conflicts of interest had already been listed as clear and unequivocal policy interventions in WHO’s global treaty, the Framework Convention on Tobacco Control, which went into effect way back in 2005. Indices like the Global Tobacco Industry Index provide a template for monitoring the global implementation of conflict-of-interest policies.

An integrated approach to prevention and control 

The different NCD risk factors often share a common underlying relationship. Improvements in one area can foster improvements in others. For instance, best-buy solutions that improve diets, particularly by reducing the consumption of ultra-processed products, can not only address obesity but also improve malnutrition in all its forms. 

Moreover, since food production is associated with 80% of land-use conversion and biodiversity loss, as well as 20-30% of greenhouse gas emissions, reductions in consumption of ultra-processed foods – the worst of the unhealthy dietary options – can reap environmental gains. 

These “double-duty” actions and co-benefits, concepts promoted by WHO, could be better signalled in Appendix 3. We recommend that WHO commits to a better-integrated guide of best-buy solutions for policymakers.

Appendix 3 acknowledges that a broader set of NCD risk factors must be acted upon. It stresses that cost-effective solutions for air pollution, road safety and traffic injuries, and mental and oral health, are part of complementary processes. Cost-effective solutions for these are to be published but separately from Appendix 3.

There is no mention of integrating these complementary processes within a single document. Multiple parallel processes are needlessly confusing to time-strapped policymakers. We recommend that WHO commits to creating a simple and all-encompassing guide of best-buy solutions for policymakers.

WHO’s updated guidance for NCDs is a great start. With under-resourced health systems struggling to keep up with cascading crises, countries need efficient solutions that will yield a big bang for their buck. Previously known as the “best buys,” “Appendix 3” offers just that. 

By helping governments determine where to place their efforts, Appendix 3 is a valuable document worthy of time and revision. But like any living document, it is open to interference. Global advocates must hold the process accountable. WHO leadership must welcome this committed activism and collaboration by producing a document with real potential for impact. 

Nandita Murukutla is Vice President of Global Policy, Research, Policy Advocacy and Communication for Vital Strategies

Image Credits: Wei Ding/ Unspash, Global Health Policy Incubator , Vital Strategies.