The United Nations is set to adopt a crucial declaration on chronic diseases this Thursday. This document puts forth strong recommendations to fight the global surge in conditions like high blood pressure, cancer, and diabetes, which collectively claim an staggering 43 million lives annually.
The declaration urges all 193 member countries to implement universal health care and expand access to mental health support. It also mandates clear health warnings on tobacco and nicotine products to help reduce early deaths caused by smoking.
However, public health experts are concerned that the World Health Organization’s final version, released this week, is significantly weaker than an earlier draft. That initial version proposed far more robust actions against the primary causes of noncommunicable diseases (NCDs), which are responsible for 75% of all global fatalities.
Strikingly, the final text omits calls for prominent graphic warnings on cigarette packaging. Recommendations for ‘health taxes’ on tobacco, alcohol, and sugary drinks have also been removed. Even more concerning, the document entirely fails to mention sugary beverages, a major contributor to the global childhood obesity epidemic, affecting 35 million children under five.
“Frankly, we anticipated something more substantial,” stated Verónica Schoj, Vice President of Food and Nutrition Policy at the Global Health Advocacy Incubator. She added that the diluted wording is both disheartening and worrying.
It seems some changes were made to shift the focus on the root causes of chronic illnesses. For instance, the original text citing ‘unhealthy food environments’ as a primary driver of obesity was broadened to include a range of risk factors like inaccessible healthy diets, lack of sleep, and stress.
Many of these significant alterations directly serve the interests of powerful multinational corporations in the tobacco, alcohol, and soda industries, whose profits would suffer if consumption of their products decreased.
When approached for comment, industry organizations such as the Distilled Spirits Council of the United States and the International Council of Beverages Associations largely commended the declaration’s development and outcome. However, they remained silent on their specific involvement in shaping the final text.
Kate Loatman, executive director of the International Council of Beverages Associations, issued a statement asserting, “We firmly back multilateral initiatives aimed at achieving global NCD targets and have consistently demonstrated our commitment to accelerating this progress.”
These industries often advance their agendas by influencing member-state delegations, who then advocate for changes to initial drafts during private meetings.
Alison Cox, policy director at the NCD Alliance, an advocacy group, voiced frustration: “The health-harming industry’s influence is undeniable throughout this draft, yet the lack of transparency is truly exasperating. We can see the industry’s involvement and the benefits they reap, but we’re not privy to the actual negotiations.”
Last week, the WHO unusually called out the significant influence of corporate lobbyists in revising the draft. WHO Director-General Tedros Adhanom Ghebreyesus noted in a press conference that “governments frequently encounter strong resistance from industries that profit from unhealthy goods.”
Conditions such as heart disease and cancer are now the leading global causes of death, resulting in an estimated 17 million premature fatalities annually.
A significant number of chronic illnesses are linked to the growing consumption of inexpensive, readily available processed foods and sugary beverages, particularly in developing nations. The WHO reports that over 82% of early deaths from noncommunicable diseases now happen in low and middle-income countries.
Despite a general decline in deaths from these health issues in most countries, a study published recently in The Lancet highlighted a troubling slowdown in this progress, even in affluent nations like the United States.
Evidence indicates that imposing taxes on soda and mandating clear, visible labels warning consumers about high levels of salt, sugar, or fat can successfully reduce demand. In response, some companies have chosen to reformulate their products to be healthier, avoiding such regulations.
Lindsey Smith Taillie, a nutrition epidemiologist at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, called the omission of sugary beverages from the final WHO document “especially egregious,” considering the worldwide obesity crisis. She noted that over 80 countries have already implemented soda taxes, with much of the revenue funding healthcare.
She emphasized that when considering the savings in healthcare costs, reduced disability, and increased productivity, the cost-benefit analysis clearly shows that taxes on sugary drinks, similar to tobacco taxes, are an undeniable win-win solution.
Since these measures are relatively recent, research on their long-term health impacts is still developing. However, early results are promising: Seattle’s 2018 soda tax correlated with a slight decrease in children’s body mass index. Chile, a pioneer in requiring front-of-package warning labels on food, observed a significant reduction in unhealthy product purchases. Mexico’s 2014 sugar-drink tax led to lower soda consumption and increased bottled water sales. As a bonus, Mexican authorities anticipate a $2.2 billion revenue boost from these taxes next year, earmarked for diabetes and cardiovascular disease treatment.
South Africa has also adopted soda taxes and restricted cigarette advertising. Yet, Catherine Egbe, a senior scientist at the South African Medical Research Council, explained that other initiatives, like mandating plain packaging for cigarettes, have been held up, partly due to industry resistance.
Dr. Egbe noted that many nations rely on the WHO’s guidance on chronic diseases, with health officials often leveraging these recommendations to influence hesitant policymakers. She argued that removing the suggestion for graphic cigarette warnings significantly weakens public health advocacy. “Robust, clear language empowers countries to improve health outcomes,” she stated. “Weak language, however, implies permissiveness, leaving vulnerable populations exposed to industry pressures.”
Experts were equally concerned by the elimination of concrete proposals to curb alcohol consumption, which contributes to 2.6 million deaths each year. Initial suggestions included banning alcohol advertising, tightening retail sales restrictions, and strengthening drunk-driving laws. These were replaced in the final document by a general recommendation for governments to “reduce harmful use of alcohol.”
Leanne Riley, who manages NCD surveillance and reporting at the WHO, highlighted that several key recommendations from the original draft remained intact. These include ambitious targets to decrease noncommunicable disease deaths by 2030 and a pledge to extend mental health services to an additional 150 million people globally.
She explained, “When drafting these political declarations, the initial version reflects peak ambition. However, the documents then undergo negotiation—that’s just the nature of multilateral processes.”
The final outcome, particularly the removal of health taxes as a global health strategy, is expected to create confusion. WHO Director-General Dr. Tedros has actively championed health taxes, especially given the sharp decline in U.S. support for humanitarian and development aid. In July, the WHO launched a separate initiative urging member states to hike taxes on tobacco, alcohol, and sugary drinks by 50% over the next decade. Dr. Tedros estimates these taxes could generate $1 trillion for government healthcare over ten years and prevent 50 million premature deaths over five decades.
During his opening address at the Africa Health Sovereignty Summit in Ghana last month, Dr. Tedros issued a stark warning: a 40% reduction in aid this year should serve as a wake-up call for African leaders. He reiterated that health taxes could both generate revenue and deter harmful behaviors.
“We all need to adapt to this new reality,” he declared. “Yet, within this crisis lies a unique opportunity to break free from aid dependency and usher in an era of sovereignty, self-reliance, and solidarity.”