The United Nations’ new declaration on chronic diseases, set to be adopted by world leaders this Thursday, contains ambitious proposals to combat the alarming global increase in conditions like hypertension, cancer, and diabetes, which collectively claim 43 million lives annually.
This vital document urges its 193 member states to implement universal health coverage and expand access to mental health services. It also presses nations to introduce health warnings on all cigarette and nicotine products, a move intended to drastically cut premature deaths caused by tobacco.
However, public health advocates express deep disappointment, noting that the World Health Organization’s final version, released this week, falls significantly short of an earlier draft. That initial draft had championed far more assertive strategies to combat the primary causes of noncommunicable diseases (NCDs), which are responsible for a staggering 75 percent of global fatalities.
Strikingly absent from the final text are explicit calls for graphic health warnings on cigarette packaging. Also removed are crucial recommendations for ‘health taxes’ designed to curb smoking and reduce the consumption of alcohol and sugary drinks. In fact, the document makes no mention whatsoever of sugary beverages, despite their well-documented role in the escalating childhood obesity crisis, which now impacts 35 million children under five.
“Frankly, we anticipated a stronger stance,” commented Verónica Schoj, vice president for food and nutrition policy at the Global Health Advocacy Incubator in Washington, D.C. “This diluted language is both disheartening and worrying.”
Certain revisions seem designed to shift the narrative surrounding the root causes of chronic illnesses. For instance, the original statement identifying obesity as “largely driven by unhealthy food environments” was broadened to include a wider array of risk factors, such as “the unaffordability and unavailability of healthy diets,” alongside sleep deprivation and stress.
Many of the most significant alterations to the final document clearly cater to corporate interests. Multinational tobacco, alcohol, and soda companies stand to lose substantial revenue if consumption of their products declines, and these changes reflect their influence.
When approached for comment, industry bodies such as the Distilled Spirits Council of the United States and the International Council of Beverages Associations generally lauded the process and its outcome. However, they were unwilling to elaborate on their specific contributions to shaping the document.
Kate Loatman, executive director of the International Council of Beverages Associations, stated, “We actively support multilateral initiatives aimed at achieving global NCD goals and have consistently demonstrated our commitment to accelerating progress.”
These influential industries frequently advance their agendas by working through member-state delegations, pushing for changes to early drafts during private, closed-door negotiations.
Alison Cox, policy director at the NCD Alliance, an advocacy group, lamented, “The influence of industries that profit from unhealthy products is undeniable in this draft, and the sheer lack of transparency is incredibly frustrating. We know these industries were involved and stand to gain, but we weren’t privy to the actual negotiations.”
In an unusual public move last week, the World Health Organization openly criticized the significant role corporate lobbyists played in modifying the draft. WHO Director-General Tedros Adhanom Ghebreyesus noted at a press conference, “Governments frequently encounter intense resistance from industries whose profits depend on unhealthy products.”
Globally, chronic conditions such as heart disease and cancer are now the leading causes of death, resulting in an estimated 17 million premature fatalities annually.
A significant number of these chronic illnesses are linked to the growing consumption of highly processed foods and sugary beverages, which are becoming more affordable and accessible, particularly in developing nations. The WHO reports that over 82 percent of premature deaths from noncommunicable diseases now occur in low- and middle-income countries.
A recent study in The Lancet indicated that while deaths from these health conditions are generally decreasing worldwide, the rate of decline has notably slowed in recent years, even in high-income countries like the United States.
Evidence suggests that implementing taxes on soda and clear, prominent warning labels on packaging that highlight high levels of salt, sugar, or fat can effectively reduce consumer demand. In response, some companies have chosen to reformulate their products to be healthier, rather than face these measures.
Lindsey Smith Taillie, a nutrition epidemiologist at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, stated that omitting mentions of sugar-sweetened beverages from the final WHO document is particularly troubling, especially amidst a global obesity epidemic. She noted that over 80 countries have already implemented soda taxes, often allocating the generated revenue directly to healthcare.
She emphasized, “Considering the savings in healthcare costs, reductions in disability and boosts in productivity, the cost-benefit analysis unequivocally shows that taxes on sugary drinks, much like tobacco taxes, represent a clear win-win scenario.”
While these measures are relatively recent, studies on their health impacts are growing. For instance, Seattle’s 2018 soda tax has been linked to a modest reduction in children’s body mass index. Chile, a pioneer in requiring front-of-package warning labels on food, has seen a notable decrease in the purchase of unhealthy items. Similarly, Mexico’s 2014 sugar-drink tax resulted in reduced soda consumption and increased bottled water sales. As a further benefit, Mexican authorities anticipate a $2.2 billion revenue surge from these taxes next year, earmarked for diabetes and cardiovascular disease treatment.
South Africa has also adopted soda taxes and restricted cigarette advertising. However, Catherine Egbe, a senior scientist at the South African Medical Research Council, pointed out that other initiatives, such as plain packaging for cigarettes, have been stymied, partly due to industry resistance.
Dr. Egbe emphasized that many nations rely heavily on WHO’s guidance regarding chronic diseases, with health officials frequently leveraging these recommendations to influence hesitant policymakers and political figures. She argued that removing the recommendation for graphic cigarette warnings would disarm health policy advocates. “Strong, unambiguous language empowers countries to achieve better health outcomes,” she explained. “Weak language, however, effectively tells them, ‘do as you please,’ leaving vulnerable populations exposed to industry pressures.”
The omission of concrete proposals to curb alcohol consumption, which contributes to 2.6 million deaths each year, also caused dismay among health experts. The original recommendations featured alcohol advertising bans, broader retail sale restrictions, and enhanced enforcement of drunk-driving laws. These were replaced in the final document by a less specific call for governments to “reduce harmful use of alcohol.”
Leanne Riley, WHO’s lead for surveillance, monitoring, and reporting on noncommunicable diseases, noted that several significant recommendations from the initial draft remained intact. These include clear targets for reducing NCD-related deaths by 2030 and a pledge to extend mental healthcare access to an additional 150 million people globally.
She explained, “Political declarations begin with the loftiest ambitions in their first drafts, but then these documents enter a negotiation phase. That’s just the nature of multilateral processes.”
The final outcome, particularly the elimination of taxes as a global health strategy, is expected to create ambiguity. WHO Director-General Dr. Tedros has been a vocal proponent of ‘health taxes,’ especially as American support for humanitarian aid and development assistance sharply declines. In July, the WHO launched a distinct initiative urging member states to boost taxes on tobacco, alcohol, and sugary drinks by 50 percent over the next decade. Dr. Tedros projects these taxes could generate an estimated $1 trillion for government healthcare over ten years and avert 50 million premature deaths over half a century.
During his address at last month’s Africa Health Sovereignty Summit in Ghana, Dr. Tedros cautioned African leaders that a 40 percent reduction in aid this year should serve as a stark warning. He reiterated that health taxes could simultaneously generate revenue and deter unhealthy habits.
He concluded, “We must all adapt to this evolving landscape. Yet, within this crisis lies a unique opportunity: to shed the burden of aid dependency and usher in a new era of sovereignty, self-reliance, and collective strength.”