Noncommunicable disease political declaration needs ‘more teeth’

Noncommunicable diseases, or NCDs, have long been sidelined by the global health sector, which has largely focused on infectious diseases — but deprioritizing them has dire consequences. They’re now the leading cause of death and disability globally — with nearly three-quarters of these deaths occurring in low- and middle-income countries. Treatments are often expensive, with many people paying out-of-pocket or forgoing them when the price is too high. This year, the visibility around these diseases — such as chronic lung, cardiovascular, cancer, hypertension, diabetes, and mental health — has been elevated due to an upcoming high-level meeting at the United Nations General Assembly in September. And the first big moment in the lead-up to this meeting was the World Health Assembly, or WHA, in Geneva, where countries approved the first resolution on kidney health, established a global day focused on cervical cancer elimination, and approved resolutions on lung health, eye, and hearing care. The president of the U.N. General Assembly and facilitators of the intergovernmental negotiations also released the first draft of the political declaration that countries are expected to sign. Written comments from countries on the draft are due by May 27, with consultations starting on June 5. While the draft has been praised for some elements, including targets set — some have also criticized its lack of accountability mechanisms. There are also concerns that certain industries will work to ensure a watered-down draft makes its way to political leaders in September. “The world faces a tsunami of NCDs and mental health conditions amid an increasingly fragile global health infrastructure,” said Dr. Jérôme Salomon, assistant director-general for universal health coverage and communicable and noncommunicable diseases at the World Health Organization. “Evidence shows that these conditions undermine economic growth and threaten to overwhelm health systems and public budgets.” And while many public health issues are largely tackled by the health sector, these diseases are often driven by decisions outside of the health sector, in areas such as taxes and policies around agriculture, tobacco, alcohol, and sugar. This calls for an all-of-government approach, experts said. Competing priorities, dire outcomes Noncommunicable diseases are rising due to global lifestyle changes such as those that have resulted in populations moving to polluted cities, the proliferation of processed food in grocery stores, and a move to sedentary, computer-focused lifestyles. But it’s also a world with competing priorities and limited resources. And often that means funding is funneled to what’s most pressing. Dr. Hanan Balkhy, WHO’s regional director for the Eastern Mediterranean region, said this is felt acutely in some of the regions she covers. In Gaza, screening for breast cancer and checking blood pressure are a luxury for people who are under bombardment and must share one bathroom with hundreds of others. “You're talking about a situation where people are living in the midst of rubble,” she said. “They want to eat, drink and shower.” In rural Afghanistan, she added, she’s seen places without primary health care infrastructure — not a single obstetrician or gynecologist. In these settings, she said, NCDs and mental health should be embedded in national emergency plans, and countries should have stocks of NCD treatments in place. But it’s not just conflict and post-conflict zones that have struggled to muster resources. Over the past 30 years, less than 2% of annual official development assistance has gone toward NCDs. Experts said that with limited resources, prevention is key — such as early screening and promoting healthy lifestyles. But this alone won't solve the problems. A representative from Barbados emphasized at the World Health Assembly that people need access to affordable care, such as cancer treatments. “I do recall when we were there with HIV and the cost of medicines were astronomical,” she said. “The reality is that we have an overwhelming number of persons who already have [cancer], and the problem is even bigger than when we were faced with HIV, at the time.” A declaration with ‘teeth’ The first draft of the political declaration calls for a reduction by one-third of premature mortality from NCDs by 2030. It calls for at least 80% of countries to implement or increase excise taxes on tobacco, alcohol, and sugar-sweetened beverages to WHO-recommended levels by 2030, and at least 80% of public primary health care facilities in all countries to have uninterrupted availability of at least 80% of WHO-recommended essential medicines and basic technologies for NCDs and mental health conditions at affordable prices. Katie Dain, chief executive officer of the NCD Alliance, said that it will be crucial in the coming months to ensure that the targets remain intact. Alison Cox, director of policy and advocacy at the organization, said the NCD Alliance is concerned about the lack of concrete accountability mechanisms and that there isn’t specific reference to fossil fuels as driving air pollution — nor was there mention of corrective taxes on the sector. There’s also no mention of taxes on processed foods high in fat, salt, and sugar. “The lack of acknowledgement of commercial determinants of health is also worrying — we know there are industries that profit from health harming products like alcohol will be doing all they can to weaken the text," she wrote in a statement, adding that her organization is making recommendations on how to give the declaration “more teeth.” Dain said it's important that there's strong accountability at the country level in monitoring and reporting progress on NCDs, and there's a voice for civil society in the discussions. “It's pretty silent on the issue of community engagement,” she said. And creating legal environments to tackle these issues is also important, according to Sarah Kline, chief executive officer of United for Global Mental Health. In countries where suicide is illegal, for example, people aren’t going to come forward for services “We need to decriminalize suicide everywhere, and that should be included in the high-level meeting declaration,” she said. Doing more with less As official development assistance for health becomes less reliable, crafting new approaches for mobilizing health financing is critical, along with determining how these resources are pooled and spent, experts said. And while the Trump administration’s dismantling of the U.S. Agency for International Development, for example, won’t have as large of an immediate impact on NCDs that it does on infectious disease — that doesn’t mean it ultimately won’t, said Kimberly Green, who leads PATH's primary health care program. USAID didn’t largely finance NCDs, Green said, but there’s concern that the downstream effect will happen when there’s a need to reallocate resources to health areas that were once financed through USAID. The World Health Assembly also served as an opportunity to showcase successes. Barbados, for example, in 2022 doubled its taxes on sugary drinks to 20%. And more broadly, small Island nations signed a 2023 Bridgetown Declaration where they laid a path forward on tackling these diseases. Ghana’s National Health Insurance Scheme benefit package was expanded to include childhood cancer diagnosis and treatment, as well as free dialysis for kidney patients. Vietnam has a Tobacco Control Fund and Kenya has revolving fund pharmacies where donated drugs are sold at a small markup to ensure stocks are replenished. MedAccess is also working on innovative finance models to ensure affordability of treatments. This includes a pay-per-use model for radiation machines — which have high up-front costs, as well as costly maintenance, said Mayank Anand, head of NCDs and maternal, newborn, and child health at MedAccess. This includes providing a financial guarantee to a company if there’s a shortfall in the number of patients needed to pay off the placement of machines over time in East Africa.