The United Nations’ upcoming declaration on chronic diseases, set to be adopted by world leaders this Thursday, initially presented robust strategies. These included ambitious recommendations aimed at combating the rising global rates of conditions like hypertension, cancer, and diabetes, which collectively claim an staggering 43 million lives annually.
The draft document advocated for universal health coverage and expanded mental health services across its 193 member nations. It also pushed for prominent health warnings on all cigarette and nicotine products, a crucial step to curb premature deaths from tobacco-related illnesses.
However, public health advocates are deeply concerned that the World Health Organization’s (WHO) finalized version, released this week, significantly dilutes these strong proposals. They argue it pales in comparison to an earlier draft that called for far more assertive actions against the primary causes of noncommunicable diseases (NCDs), which tragically account for 75% of all global fatalities.
Strikingly absent from the final text are explicit recommendations for graphic health warnings on cigarette packaging, along with proposed ‘health taxes’ on tobacco, alcohol, and sugary drinks. The complete omission of sugary beverages is particularly troubling, given their significant role in the global childhood obesity crisis, which impacts 35 million children under the age of five.
Verónica Schoj, Vice President for Food and Nutrition Policy at the Global Health Advocacy Incubator in Washington, D.C., expressed her disappointment: ‘To be honest, we expected more. The watered-down language is both disappointing and concerning.’
Many of these revisions seem designed to shift the narrative surrounding chronic illnesses. For instance, the original text, which attributed obesity ‘largely to unhealthy food environments,’ was broadened to include factors such as ‘the unaffordability and unavailability of healthy diets,’ alongside sleep deprivation and stress.
A significant number of these alterations directly align with the commercial interests of powerful multinational corporations in the tobacco, alcohol, and soda industries, which would face substantial revenue losses if consumption of their products were to decline.
Predictably, industry organizations such as the International Alliance for Responsible Drinking and the International Council of Beverages Associations have lauded both the process and the final outcome of the declaration.
Kate Loatman, Executive Director of the International Council of Beverages Associations, stated: ‘We strongly support multilateral efforts to achieve global NCD goals and have a proven track record of doing our part to accelerate progress.’
These powerful industries frequently exert their influence through national delegations, who then push for changes to initial drafts during confidential, closed-door negotiations.
Alison Cox, Policy Director at the NCD Alliance, an advocacy group, voiced strong criticism: ‘The health-harming industry’s fingerprints are undeniably all over this draft, but the lack of transparency is truly frustrating. We can see the industry benefiting from the outcome, yet we were barred from witnessing the actual negotiations.’
In a rare public move, the WHO last week openly criticized the excessive influence of corporate lobbyists in shaping the draft. WHO Director-General Tedros Adhanom Ghebreyesus remarked at a press conference that ‘governments often face fierce opposition from industries that profit from unhealthy products.’
Globally, chronic conditions such as heart disease and cancer are now the leading causes of death, resulting in approximately 17 million premature fatalities annually.
A significant link exists between many chronic illnesses and the rising consumption of highly processed foods and sugary beverages, which have become increasingly accessible and affordable, particularly in developing nations. The WHO reports that over 82% of premature deaths from NCDs now occur in low- and middle-income countries.
Recent research published in The Lancet indicates that while NCD-related deaths have been decreasing in most nations, the rate of this decline has notably decelerated in recent years, even in high-income countries like the United States.
Studies show that implementing taxes on sugary drinks and requiring clear, prominent warning labels on packaging for items high in 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 regulatory measures.
Lindsey Smith Taillie, a nutrition epidemiologist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, criticized the removal of sugar-sweetened beverage references from the WHO document, calling it ‘especially egregious’ amidst a global obesity crisis. She highlighted that over 80 countries have already implemented soda taxes, often allocating the revenue to healthcare initiatives.
‘Considering the savings in healthcare costs, reduced disability, and improved productivity, the cost-benefit analysis clearly shows that sugary drink taxes, similar to tobacco taxes, represent a net positive outcome,’ Taillie asserted.
While these policies are relatively new and research on their long-term health outcomes is still emerging, initial findings are promising. Seattle’s 2018 soda tax, for instance, has been linked to a modest decrease in children’s body mass index. Chile, a pioneer in requiring front-of-package warning labels on food, has observed a notable reduction in unhealthy product purchases. Mexico’s 2014 sugary drink tax resulted in lower soda consumption and increased bottled water sales. Mexican officials anticipate a $2.2 billion revenue boost from these taxes next year, earmarked for treating diabetes and cardiovascular disease.
South Africa has also adopted soda taxes and limited cigarette advertising. However, Catherine Egbe, a senior scientist at the South African Medical Research Council, noted that other public health initiatives, such as plain packaging for cigarettes, have faced significant delays, largely due to industry resistance.
Dr. Egbe emphasized the importance of strong WHO guidance, stating that health officials rely on these recommendations to influence hesitant policymakers. The removal of graphic cigarette warnings, she explained, disarms public health advocates. ‘When the language is strong and watertight, it helps countries do better,’ she said. ‘But when the language is weak, it sends the message that ‘you can do what you want’ and leaves vulnerable populations at the mercy of industry.’
Experts also expressed alarm over the deletion of concrete proposals to curb alcohol consumption, linked to 2.6 million deaths each year. Initial suggestions included alcohol advertising bans, stricter retail sales regulations, and enhanced drunk-driving law enforcement. These were replaced in the final document by the ambiguous recommendation that governments ‘reduce harmful use of alcohol.’
Leanne Riley, WHO’s lead for NCD surveillance and reporting, pointed out that several crucial recommendations from the original draft remain. These include specific targets to lower NCD-related deaths by 2030 and a pledge to extend mental healthcare access to an additional 150 million people globally.
‘When crafting political declarations, the initial draft always represents the highest aspirations,’ Riley explained. ‘However, these documents then undergo negotiations—that’s just how multilateral processes function.’
The final version’s omission of taxes as a global health strategy is particularly perplexing, given Dr. Tedros’s strong advocacy for ‘health taxes.’ This stance is especially pertinent amidst declining US support for humanitarian and development aid. In July, the WHO launched a separate initiative urging member states to boost taxes on tobacco, alcohol, and sugary drinks by 50% over the next decade. Dr. Tedros projects these taxes could generate an estimated $1 trillion for public healthcare over ten years and prevent 50 million premature deaths over fifty years.
During his address at last month’s Africa Health Sovereignty Summit in Ghana, Dr. Tedros highlighted a 40% reduction in aid this year as a critical warning for African leaders. He argued that health taxes could simultaneously generate revenue and deter unhealthy habits.
‘We must all adapt to this new reality,’ he declared. ‘Yet, within this crisis lies an opportunity — a chance to shed the burden of aid dependency and usher in a new era of sovereignty, self-reliance, and solidarity.’