The upcoming United Nations declaration on chronic diseases, set for adoption by world leaders this Thursday, contains ambitious proposals to curb the alarming rise of conditions like hypertension, cancer, and diabetes, which collectively claim 43 million lives annually.
This vital document champions universal health coverage and expanded mental health services across its 193 member nations. Furthermore, it pushes for stronger health warnings on cigarette and nicotine products, aiming to dramatically cut premature deaths linked to tobacco.
However, public health advocates are deeply concerned, stating that the World Health Organization’s final version released this week falls significantly short of an earlier, more assertive draft. That initial proposal had championed tougher strategies against the primary causes of noncommunicable diseases (NCDs), which tragically account for three-quarters of all global deaths.
Crucially, the strong calls for graphic health warnings on cigarette packaging have vanished. Similarly, recommendations for ‘health taxes’ on tobacco, alcohol, and sugary drinks—designed to curb consumption—are entirely absent. In a glaring omission, sugary beverages, a major contributor to the global childhood obesity crisis affecting 35 million children under five, receive no mention at all.
“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.”
Some of these changes seem designed to shift the narrative surrounding the root causes of chronic illnesses. For instance, the original emphasis on obesity being ‘largely driven by unhealthy food environments’ was broadened to include a wider range of risk factors such as the lack of affordable healthy diets, insufficient sleep, and chronic stress.
Indeed, many of the most significant alterations in the final document clearly align with the interests of powerful corporations—specifically, the global tobacco, alcohol, and soda industries that would face considerable financial losses if consumption of their products were to decline.
Predictably, industry associations such as the International Alliance for Responsible Drinking and the International Council of Beverages Associations released statements commending both the negotiation process and its ultimate conclusions.
“We are staunch supporters of multilateral initiatives to meet global NCD targets and have consistently demonstrated our commitment to advancing this progress,” stated Kate Loatman, executive director of the International Council of Beverages Associations.
These powerful industries frequently exert their influence through national delegations, advocating for changes to initial policy drafts during confidential, closed-door negotiations.
“The handiwork of industries that harm public health is evident throughout this draft, yet the lack of transparency is truly exasperating,” remarked Alison Cox, policy director at the NCD Alliance. “We know these industries were involved and clearly benefit from the results, but the actual process of dilution happened behind closed doors, out of public view.”
Last week, the WHO itself took the unusual step of publicly condemning the disproportionate influence of corporate lobbyists in shaping the draft. Dr. Tedros Adhanom Ghebreyesus, the WHO’s director-general, pointed out in a news conference that governments frequently encounter intense resistance from industries whose profits rely on unhealthy products.
Heart disease and cancer, among other chronic conditions, are now the leading global causes of death, contributing to an estimated 17 million premature fatalities annually.
A significant number of these chronic illnesses are linked to the growing consumption of inexpensive, readily available processed foods and sugary drinks, particularly prevalent in developing nations. The WHO reports that over 82% of premature NCD deaths now occur in low- and middle-income countries.
Recent research in The Lancet revealed a general decline in deaths from these health conditions across most nations. However, the study also highlighted a concerning slowdown in this progress in recent years, even in wealthy countries such as the United States.
Evidence indicates that imposing taxes on soda and mandating clear, front-of-package warning labels about high salt, sugar, or fat content can effectively reduce consumer demand. Faced with these potential regulations, some companies have proactively chosen to reformulate their products for better health.
Lindsey Smith Taillie, a nutrition epidemiologist at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, found the omission of sugary beverages from the WHO’s final document particularly alarming, especially given the ongoing global obesity crisis. She noted that over 80 countries have already implemented soda taxes, often earmarking the revenue for healthcare initiatives.
She emphasized, “Considering the substantial savings in healthcare costs, reduced disability, and boosted productivity, the cost-benefit analysis strongly suggests that taxes on sugary drinks, much like tobacco taxes, represent a clear win for public health.”
While these measures are relatively new, early research into their health impacts is promising. Seattle’s 2018 soda tax, for instance, 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. Mexico’s 2014 sugar-drink tax resulted in 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, funds designated for treating diabetes and cardiovascular diseases.
South Africa has also adopted soda taxes and restricted cigarette advertising. However, Dr. Catherine Egbe, a senior scientist at the South African Medical Research Council, reported that other initiatives, such as plain packaging for cigarettes, have faced considerable delays, primarily due to resistance from the industry.
Dr. Egbe stressed that many nations rely on the WHO’s guidance on chronic diseases, with health officials frequently leveraging these recommendations to influence hesitant policymakers. She warned that removing the explicit call for graphic warnings on cigarette packs deprives health advocates of a crucial tool. “When the language is robust and unambiguous, it empowers countries to achieve more,” she explained. “But vague wording signals permissiveness, leaving vulnerable populations exposed to corporate interests.”
Experts were equally troubled by the removal of concrete proposals to reduce alcohol consumption, which contributes to 2.6 million deaths each year. The original draft suggested alcohol advertising bans, stricter retail sales limits, and enhanced drunk-driving enforcement. These specific measures were replaced in the final document by a much broader, less actionable recommendation for governments to simply ‘reduce harmful use of alcohol.’
Leanne Riley, who manages NCD surveillance and reporting at the WHO, acknowledged that while some compromises were made, many significant recommendations from the initial draft remain. These include ambitious targets to lower noncommunicable disease deaths by 2030 and a pledge to extend mental healthcare access to an additional 150 million people globally.
She explained the reality of international negotiations: “When we embark on these political declarations, the initial draft always represents the highest aspirations. However, these documents then proceed through a negotiation phase, which is simply inherent to multilateral processes.”
The final outcome, particularly the exclusion of health taxes as a public health tool, is bound to create bewilderment. This is especially true given that Dr. Tedros, the WHO’s director-general, has actively championed such taxes, particularly in light of dwindling American support for humanitarian and development aid. Just this July, the WHO launched a separate program urging member states to boost taxes on tobacco, alcohol, and sugary drinks by 50% over the next decade. Dr. Tedros projects that these taxes could generate an astounding $1 trillion for government healthcare over ten years and avert 50 million premature deaths over half a century.
Speaking 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 critical wake-up call for African leaders. He argued that health taxes could simultaneously generate revenue and deter unhealthy habits.
“We must all adapt to this evolving landscape,” he declared. “Yet, within this challenge lies a profound opportunity—a chance to shed the burdens of aid dependency and usher in a new era of national sovereignty, collective self-reliance, and global solidarity.”