In many respects, the United Nations declaration on chronic diseases, expected to be adopted by world leaders, presents strong recommendations to combat the alarming rise of hypertension, cancer, diabetes, and other conditions that claim 43 million lives annually.
The document champions universal health coverage for its 193 member states and advocates for increased access to mental health services. It also presses countries to implement health warnings on cigarette and nicotine products, aiming to curb premature deaths linked to tobacco.
However, public health experts assert that the final document, released this week by the World Health Organization, falls considerably short of an earlier draft. That initial version had proposed much more aggressive strategies to tackle the primary drivers of noncommunicable diseases (NCDs), which are responsible for a staggering 75 percent of all deaths globally.
Conspicuously absent from the final version is the strong language advocating for graphic health warnings on cigarette packaging. Also removed were recommendations for ‘health taxes’ designed to deter the consumption of tobacco, alcohol, and sugar-sweetened beverages. Notably, the document now makes no mention of sugary drinks, despite their critical role in the global childhood obesity crisis, affecting 35 million children under five.
“To be honest, we expected more,” remarked Verónica Schoj, vice president for food and nutrition policy at the Global Health Advocacy Incubator in Washington, D.C., expressing her disappointment. “The watered-down language is both disheartening and worrying.”
Some alterations in the revised document seem designed to shift the narrative around the root causes of chronic illnesses. For instance, a direct reference to obesity being “largely driven by unhealthy food environments” was broadened into a list of multiple risk factors, including “the unaffordability and unavailability of healthy diets,” sleep deprivation, and stress.
Crucially, many of the most significant changes in the final document appear to align with the interests of major corporations—the multinational tobacco, alcohol, and soda giants—who would face substantial revenue losses if consumption of their products declined.
Industry bodies, such as the International Alliance for Responsible Drinking and the International Council of Beverages Associations, have largely praised the negotiation process and its outcome.
“We strongly support multilateral efforts to achieve global NCD goals and have a proven track record of doing our part to accelerate progress,” stated Kate Loatman, executive director of the International Council of Beverages Associations.
These affected industries often relay their concerns through member-state delegations, pushing for specific changes in initial drafts during private, closed-door meetings.
“The health-harming industry’s fingerprints are all over this draft, but the lack of transparency is really frustrating,” commented Alison Cox, policy director at the NCD Alliance, an advocacy group. “We’ve seen industry at the scene of the crime, and they certainly benefit from the outcome, but we’re not actually in the room to see the deed being done.”
Last week, the World Health Organization took the unusual step of publicly criticizing the disproportionate role played by corporate lobbyists in shaping the revised draft. “Often, governments face fierce opposition from industries that profit from unhealthy products,” said Tedros Adhanom Ghebreyesus, the WHO Director-General, during a news conference.
Chronic conditions like heart disease and cancer are now the leading causes of death worldwide, accounting for an estimated 17 million premature deaths each year.
These illnesses are often linked to the increased consumption of highly processed foods and sugary drinks, which have become increasingly affordable and accessible, particularly in developing nations. According to the WHO, over 82 percent of premature deaths from noncommunicable diseases now occur in low- and middle-income countries.
A study published recently in The Lancet revealed that while deaths from such health conditions are declining in most countries, the rate of this decline has slowed in recent years, even in high-income countries like the United States.
Research suggests that taxes on soda and clear, front-of-package warning labels indicating high levels of salt, sugar, or fat can effectively reduce consumer demand. To circumvent these measures, some companies have chosen to reformulate their products to be healthier.
Lindsey Smith Taillie, a nutrition epidemiologist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, emphasized that the removal of references to sugar-sweetened beverages from the final WHO document is particularly alarming, given the escalating global obesity crisis. Over 80 countries have already implemented soda taxes, with much of the revenue directed towards healthcare initiatives.
“When you factor in savings in health care costs, reductions in disability, and improvements in productivity, the cost-benefit analysis suggests that sugary drink taxes, much like tobacco taxes, are a clear overall win,” she stated.
As these measures are relatively new, comprehensive research into their long-term health impacts is still developing. However, in Seattle, a soda tax introduced in 2018 has shown a small decrease in the body mass index of children. Chile, an early adopter of mandatory front-of-package warning labels, has reported a significant reduction in purchases of unhealthy products. Furthermore, Mexico’s sugar-drink tax, implemented in 2014, led to a decrease in soda consumption and an increase in bottled water sales. As an added benefit, Mexican officials anticipate a $2.2 billion windfall from these taxes next year, earmarked for treating diabetes and cardiovascular disease.
South Africa has also embraced soda taxes and restrictions on cigarette advertising. However, Catherine Egbe, a senior scientist at the South African Medical Research Council, noted that other initiatives, such as a proposal for plain packaging on cigarettes, have faced considerable delays, partly due to industry opposition.
Dr. Egbe underscored that many countries rely on WHO guidance for chronic diseases, using these recommendations to influence hesitant policymakers. She believes that removing the recommendation for graphic warnings on cigarette packages takes a crucial tool away from 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.”
Health experts also expressed dismay over the removal of specific proposals aimed at reducing alcohol consumption, which is linked to 2.6 million deaths annually. Earlier recommendations included alcohol advertising bans, broader restrictions on retail sales, and stricter enforcement of drunk-driving laws. The final document replaced these with a vague recommendation for governments to “reduce harmful use of alcohol.”
Leanne Riley, who oversees surveillance, monitoring, and reporting for noncommunicable diseases at the WHO, highlighted that many significant recommendations from the earlier draft did survive. These include concrete targets to reduce NCD-related deaths by 2030 and a commitment to expand mental health care to an additional 150 million people worldwide.
“When we start with these political declarations, the first draft reflects the highest level of ambition that’s being expressed, but then the documents go through this negotiation,” she explained. “That’s simply how multilateral processes work.”
The final outcome, particularly the removal of taxes as a primary tool for improving global health, is likely to create confusion. Dr. Tedros, the WHO leader, has been a strong proponent of ‘health taxes,’ especially given the plummeting American support for humanitarian aid and development assistance. In July, the health agency launched a separate initiative urging member states to increase taxes on tobacco, alcohol, and sugar-sweetened beverages by 50 percent over the next decade. Dr. Tedros estimates these taxes could generate $1 trillion for government health care efforts over ten years and prevent 50 million premature deaths over five decades.
In his opening remarks at the Africa Health Sovereignty Summit in Ghana last month, Dr. Tedros warned African leaders that a 40 percent drop in aid this year should serve as a stark wake-up call. Health taxes, he argued, would both generate funds and discourage unhealthy behaviors.
“We must all adjust to this new reality,” he said. “But in this crisis lies an opportunity — an opportunity to shake off the yoke of aid dependency, and embrace a new era of sovereignty, self-reliance, and solidarity.”