On Sept. 25, 2025, world leaders gathered in New York for the fourth high-level meeting of the United Nations General Assembly on the prevention and control of NCDs and the promotion of mental health and well-being, or HLM4. The global health community is at a crossroads: We are five years from the 2030 Sustainable Development Goals deadline, facing rising financial pressures, shrinking external assistance, and a growing burden of noncommunicable diseases, or NCDs, and mental health conditions in every country.
NCDs such as heart disease, stroke, cancer, diabetes, chronic kidney disease, and chronic respiratory diseases accounted for about 75% of all non-pandemic-related deaths in 2021. Their impact is compounded by mental health conditions and neurological disorders, which drive disability, morbidity, and long-term economic costs worldwide. While NCDs affect every region, low- and middle-income countries, or LMICs, carry most of the mortality burden, representing 73% of all NCD deaths.
The economic consequences are profound, costing the global economy more than $2 trillion annually — a figure exceeding the gross domestic product of many major economies. And yet, NCDs receive only a fraction of global funds, despite being largely preventable: Just 1% to 2% of total development assistance for health has been dedicated to NCDs over the past 20 to 30 years. Evidence shows that investing less than $1 per person per year in proven, cost-effective interventions could save 7 million lives and deliver more than $230 billion in economic and social benefits in LMICs alone by 2030.
Since the first high-level meeting on NCDs in 2011, political declarations have helped shape global priorities. But without financing and practical implementation mechanisms, commitments risk remaining aspirations. The 2025 political declaration — which, although pending formal approval by the U.N. General Assembly, is being treated as the working framework for NCD and mental health efforts — provides a chance to change that trajectory, recognizing that sustainable financing is essential to turn political momentum into real progress.
The discussions at HLM4, together with the draft text of the 2025 political declaration, highlight critical areas where immediate focus and collaboration could transform commitments into results.
Accountability is strengthened by the inclusion of fast-track targets. For the first time, specific, measurable “fast-track” and tracer targets have been included to monitor progress and ensure shared accountability. These targets will accelerate implementation toward universal health coverage and strengthen health systems and health-promoting environments. Specifically, the target of 60% of member states establishing policies for financial protection and essential diagnostics and medicines access is a meaningful opportunity to spur investment in NCD care.
Countries need support to act. Strong global partnerships are essential. Political commitments risk remaining aspirational without sufficient government prioritization of NCDs to generate urgent, sustained domestic financing. Bridging the gap between commitments and delivery requires targeted external support to incentivize action and build financing mechanisms that can withstand shocks and deliver impact over time.
Countries can maximize impact by using data to guide decisions. Mobilizing and allocating resources for the greatest impact — more health for every dollar spent — requires evidence-informed budgeting and planning. However, evidence is often poor, especially in low-income countries, where health-related data sources are notoriously weak. Robust data is essential for accurately monitoring the NCD burden and performing the economic evaluations necessary to inform and secure effective impact investment.
Universal health coverage is the fundamental vehicle for NCD action — and should be delivered through integrated care. The declaration text highlights the need for integrated, sustainable, resilient, and well-financed health systems, with particular attention to primary healthcare. This requires linking NCD, mental health, and infectious disease services — including essential immunization programs — into a comprehensive, people-centered approach that leverages cost-effective interventions and leaves no one behind.
Strong leadership and collaboration across sectors are essential for progress, particularly in reaching vulnerable populations. Ministries of health, finance, and other key players, together with multistakeholder partnerships — including civil society and people living with NCDs — can drive accountability and results, especially in vulnerable and hard-to-access populations. The private sector also has a critical role to play, contributing expertise, innovation, and resources to complement public efforts. This includes not only life sciences and health industries, but also companies across all sectors that face impacts on their workforces and communities when NCDs are not prioritized.
These extraordinarily challenging times, marked by rising health and economic pressures, demand radical collaboration and systematic change. Translating the ambition of the 2025 political declaration into measurable results for people living with NCDs and mental health conditions will require deliberate, multisector collaboration focused on the following:
• Strengthening national systems and sustainable financing: Countries must view health as an investment, not a cost, leveraging the evidence of health economics to secure financing. They must build locally led, context-specific solutions that develop skills, systems, and accountability by expanding domestic financing and leveraging funding to ensure sustainable and equitable health financing. And they must update national medical guidelines to global standards.
• Prioritizing data, research, and surveillance: Investment in high-quality, disaggregated data collection and research is required to accurately track the burden and trends of NCDs and mental health conditions, providing the evidence base necessary for effective policy and resource allocation.
• Ensuring equitable access to essential tools at the point of care: Investment must be channeled into securing and distributing essential diagnostics and medicines to primary health care facilities, enabling frontline workers to efficiently detect and treat NCDs and mental health conditions.
• Investing in an integrated primary care workforce: Efforts should be focused on training and equipping the primary health care workforce to deliver integrated NCD and mental health services, ensuring accessible early detection and ongoing care, and closing the gap on necessary tools and technology in community settings.
• Prioritizing early prevention for children and young people: A significant part of the NCD burden can be avoided through early prevention efforts targeted at children and youth. This requires an “all of society” approach, fostering cross-sector collaboration to build resilient, inclusive, and sustainable health systems.
The commitments made in the political declaration are a foundation and a recommitment by member states: They keep NCDs and mental health on the global agenda and open new conversations. They should be seen as the “floor,” rather than the “ceiling,” for action. Their success will be determined by financed, measurable, and sustained action on the ground.
This is a shared responsibility. Governments must lead. Development partners must align and support. The private sector must contribute resources, innovation, and solutions that advance public health goals. And civil society must hold actors accountable. Critically, all efforts must be anchored in the understanding that health is a universal right, requiring deliberate action to reach vulnerable populations who often bear the heaviest burden of NCDs.
The potential rewards are enormous: Investing in NCD and mental health prevention and care improves health outcomes and strengthens economies by increasing productivity, resilience, and equity. Every dollar invested generates benefits far beyond the health sector.
This moment is an opportunity to mobilize collective solidarity and action. The time to move from declaration to delivery is now. If we succeed, the 2025 high-level meeting will be remembered not only for the commitments made but for the impact achieved in the years that followed.
This opinion piece is signed by:
Access Accelerated
HemoCue
The International Society of Nephrology
NCD Alliance
UNICEF USA
World Child Cancer
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