The United Nations is set to adopt a crucial declaration on chronic diseases, which, in its initial form, outlined ambitious strategies to tackle the rising global burden of hypertension, cancer, diabetes, and other conditions claiming 43 million lives annually.
This landmark document encourages its 193 member states to implement universal health coverage and expand mental health services. It also pushed for robust health warnings on tobacco and nicotine products to curb premature deaths.
However, public health experts are voicing concerns that the World Health Organization’s recently released final version significantly dilutes earlier proposals. The initial draft had called for far more assertive actions against the primary contributors to noncommunicable diseases (NCDs), which are responsible for a staggering 75 percent of global fatalities.
Notably absent from the revised text are strong recommendations for graphic health warnings on cigarette packaging. Also removed were proposals for “health taxes” on tobacco, alcohol, and sugary drinks. In fact, the final declaration entirely omits any mention of sugar-sweetened beverages, a major factor in the escalating childhood obesity crisis, which currently impacts 35 million children under the age of five.
“We honestly anticipated more,” commented Verónica Schoj, Vice President of Food and Nutrition Policy at the Global Health Advocacy Incubator in Washington, D.C. “The diluted language is both disappointing and worrisome.”
Some changes in the document seem designed to shift the focus on the root causes of chronic illnesses. For instance, the original statement identifying obesity as “largely driven by unhealthy food environments” was broadened to include “the unaffordability and unavailability of healthy diets,” alongside factors like sleep deprivation and stress.
A significant portion of these revisions in the final document clearly align with the interests of major corporations—specifically, multinational tobacco, alcohol, and soda companies that would face substantial revenue losses if consumption of their products declined.
Unsurprisingly, industry groups largely expressed satisfaction with both the negotiation process and its outcome.
Kate Loatman, Executive Director of the International Council of Beverages Associations, stated that her organization “strongly supports multilateral efforts to achieve global NCD goals and has a proven track record of doing our part to accelerate progress.”
Typically, these powerful industries exert influence by channeling their concerns through various member-state delegations, advocating for changes to initial drafts during closed-door sessions.
“The health-harming industry’s influence is evident throughout this draft, yet the lack of transparency is incredibly frustrating,” stated Alison Cox, Policy Director at the NCD Alliance, an advocacy group. “While we see the industry benefiting from these changes, we’re not privy to the actual negotiations where these decisions are made.”
Last week, the W.H.O. made the rare move of openly criticizing the significant impact corporate lobbyists had on the draft’s revision. Tedros Adhanom Ghebreyesus, the W.H.O.’s Director-General, noted in a news conference that “governments often encounter fierce opposition from industries that profit from unhealthy products.”
Heart disease and cancer, along with other chronic conditions, are now the leading global causes of death, accounting for an estimated 17 million premature fatalities annually.
A strong link exists between many chronic illnesses and the widespread consumption of affordable, highly processed foods and sugary beverages, particularly prevalent in developing nations. The W.H.O. reports that over 82 percent of premature noncommunicable disease deaths now occur in low and middle-income countries.
A recent study, published in The Lancet, observed a general decline in deaths from these health conditions across most nations. However, it also highlighted a concerning slowdown in the rate of this decline, even in affluent countries such as the United States.
Evidence indicates that imposing taxes on soda and mandating clear, visible warning labels on packaging—alerting consumers to high levels of salt, sugar, or fat—can effectively reduce demand. In response, some manufacturers have chosen to reformulate their products to meet healthier standards and avoid these regulations.
Lindsey Smith Taillie, a nutrition epidemiologist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, found the omission of sugar-sweetened beverages from the final W.H.O. document particularly alarming, given the escalating global obesity crisis. She noted that over 80 countries have already implemented soda taxes, often allocating the revenue to healthcare initiatives.
“When 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 an unequivocal win,” she argued.
While the long-term health impacts of these new measures are still being studied, early results 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 seen a substantial reduction in the purchase of unhealthy items. Similarly, Mexico’s 2014 sugar-drink tax resulted in lower soda consumption and increased bottled water sales. As an additional benefit, Mexican authorities anticipate a $2.2 billion revenue boost next year from these taxes, earmarked for diabetes and cardiovascular disease treatment.
South Africa has also adopted soda taxes and stricter controls on cigarette advertising. However, Catherine Egbe, a senior scientist at the South African Medical Research Council, explained that other health initiatives, such as a proposal for plain packaging on cigarettes, have faced significant delays, partly due to strong industry resistance.
Dr. Egbe highlighted that many nations rely on the W.H.O.’s recommendations on chronic diseases to sway hesitant policymakers. She argued that removing the suggestion for graphic cigarette warnings would disarm health policy advocates. “Strong, precise language empowers countries to achieve more,” she stated. “But weak language implies a free hand for industry, leaving vulnerable populations unprotected.”
Experts also expressed disappointment over the removal of concrete proposals to reduce alcohol consumption, a factor in 2.6 million deaths each year. The initial recommendations featured advertising bans, stricter retail sales limits, and enhanced drunk-driving enforcement. These were replaced in the final document by a less specific call for governments to “reduce harmful use of alcohol.”
Leanne Riley, responsible for surveillance, monitoring, and reporting of noncommunicable diseases at the W.H.O., noted that several significant recommendations from the initial draft remained intact. These include clear targets for reducing NCD deaths by 2030 and a pledge to extend mental health care to an additional 150 million people globally.
“Political declarations begin with the loftiest ambitions, but then the documents undergo negotiation,” she explained. “That’s simply how multilateral processes operate.”
The final outcome, particularly the elimination of taxes as a global health strategy, is poised to create considerable confusion. Dr. Tedros, the W.H.O. Director-General, has actively advocated for “health taxes,” especially as American support for humanitarian aid diminishes. In July, the agency launched a distinct program encouraging member states to increase taxes on tobacco, alcohol, and sugar-sweetened beverages by 50 percent within 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 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 proposed health taxes as a dual solution: generating revenue and deterring unhealthy habits.
“We must adapt to this evolving reality,” he declared. “Yet, within this crisis lies an opportunity to shed the burden of aid dependency and usher in a new era of sovereignty, self-reliance, and solidarity.”