Last week, on Sept. 25, a fourth high-level meeting, or HLM4, of the United Nations General Assembly was held on the topic of noncommunicable diseases, or NCDs, and mental health. While initial ambitions showed potential, a flawed process led to a derailing of the negotiation process, a watered-down declaration, and ultimately, negative consequences for global health.
These types of meetings present a unique opportunity to raise the political priority of a global health issue. They are attended by heads of state and government, as well as other senior stakeholders, and typically result in a nonbinding political declaration of commitment.
Following a series of preparatory meetings and regional consultations, a “zero draft” political declaration was released in May 2025. The zero draft is intended to serve as the starting point for negotiations, with revisions made in response to member state demands. While it was considered that the zero draft “shows potential,” many civil society organizations called for the declaration to be more ambitious in its targets and bolder in its actions.
About the authors
Karen Milton
Karen Milton is an associate professor in public health at the University of East Anglia in the U.K. and the immediate past president of the International Society for Physical Activity and Health, or ISPAH.
Dr. Abdul Malik
Dr. Abdul Malik is the co-founder/president of the Maldives NCD Alliance; a member of the NCD Alliance’s “Our Views Our Voices” Global Advisory Committee for People Living with NCDs; a former minister of state for gender, family, and social services in the Maldives; and a former undersecretary for health and social policy at the president’s office.
Kent Buse
Kent Buse is a professor at Monash University Malaysia, in Kuala Lumpur. He is a political economist who has published widely on global health governance and health policy analysis. He is co-founder and co-CEO of Global 50/50. He was head of strategy at UNAIDS for over a decade and taught at Yale University and the London School of Hygiene and Tropical Medicine.
