Common threats to global development and security call for a concerted global thrust to counter them. This is widely recognised in case of public health emergencies such as Covid-19. An escalating disruption like climate change is seen as an imminent threat since its malign manifestations are already ravaging Earth.
However, there are also ‘slow motion’ public health emergencies, which have surged over time but now call for urgent action to stem their advancing tide. Without a determined global response, such threats can prematurely end millions of human lives and derail economies. Non-communicable diseases (NCDs) are one example of such an alarming threat. Continued neglect of NCDs will become the blight of the 21st century.
Even at the end of the 20th century, it was clear that NCDs were the leading cause of death and disease globally, not only in high income countries but also in most of the low-, and middle-income countries. Among them, cardiovascular disease was dominant (heart attacks and strokes), followed by cancer, respiratory disease and diabetes. Tobacco claimed over 6 million lives a year, mostly in LMICs.
Yet, the United Nations’ Millennium Development Goals framed in 2000 made no mention of NCDs or tobacco control. This was because those goals were scripted by rich countries that held that they had the resources to deal with NCDs, while poorer nations should worry more about health challenges like communicable diseases, and maternal and child health disorders.
Wisdom dawned by 2011, when the UN convened a high-level meeting of heads of government on the prevention and control of NCDs. By then, it had become abundantly clear that NCDs and mental health posed a global threat, affecting even the poor among countries and the poor within countries. A target was set to reduce premature mortality due to NCDs (deaths between 30 and 70 years) by 25 percent by 2025. This was later modified in the Sustainable Development Goals to target a onethird reduction in premature deaths by 2030. Mental health disorders, another growing but hitherto neglected global threat, were coupled with NCDs.
The need for effective action on this cluster had grown more urgent by the time the 4th UN high-level meeting on NCDs was convened in September 2025. It was noted that in 2021, NCDs caused over 43 million deaths, with most premature deaths occurring in the poorer nations.
It was also noted that mental health conditions are a major contributor to severe disability. Over a billion people worldwide live with mental health disorders, but a majority of them do not receive the needed care. So, September’s UN meeting proposed to set targets and redefine strategies to curb deaths and distress due to NCDs and mental health disorders.These included proposals to address major risk factors like tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity. The draft declaration called for:
1. Encouraging at least 80 percent of member states to implement excise taxes on tobacco, alcohol, and sugar-sweetened beverages at World Health Organization-recommended levels.
2. Improving the integration of NCD and mental health care into primary health care for equitable access to diagnosis, treatment, and care.
3. Access to medicines and technologies needed for care of NCDs and mental health disorders. Financial protection (through universal health coverage programmes) for those seeking needed care.
4. Multi- sectoral collaboration to address the determinants of health which drive NCDs.
5. Placing people living with NCDs and mental health conditions at the centre of prevention and control efforts.
6. Tracking progress in implementation on targets set by them.
At forums like the UN, political declarations are adopted by consensus and not by voting. A painstakingly negotiated political declaration, with overwhelming support from the vast majority of UN members, failed to win formal endorsement because the US torpedoed it. Now the resolution will be placed before the UN General Assembly, where it will face a vote. While scores of presidents, prime ministers and health ministers hailed the draft, US Health Secretary Robert Kennedy Jr charged that the UN draft went too far in recommending measures like increased taxes on unhealthy products.
Disengagement of the US from global health agreements is not new, in recent years it has disrupted attempts to catalyse convergent actions by all countries to collectively tackle major health challenges. The US this year withdrew from the WHO for the second time under a Trump administration. It withdrew from the pandemic treaty that is being negotiated under auspices of the WHO.
With the principal American agency for international funding (USAID) shuttered and the two lead science agencies (National Institutes of Health and Centers for Disease Control and Prevention) forbidden from conducting collaborative studies or exchanging technical information with scientists from other countries, the present US administration has effectively severed links with global health.
In the past too, the US refused to abide by the norms adopted by global consensus reached via multilateral negotiations. It did not sign the WHO Framework Convention on Tobacco Control after it was adopted by the World Health Assembly in 2003. Though it did sign it in 2004, it did not ratify it through a congressional process. Thus, the US is not legally bound by the treaty’s provisions. Ditto for the UN Convention on the Rights of the Child.
Signing merely conveys intent to examine the treaty domestically and ‘consider ratification’, but it doesn’t create a legally binding obligation. This is strange since it has been a tradition for all chief executives of UNICEF to be from the US since its establishment as the lead global child health agency in 1947, with its headquarters in New York.
If a country heading the world’s premier child health organisation does not respect global consensus on child rights, it signals a cynical disdain for multilateral agreements in international relations. The recent shattering of consensus on NCDs fits a pattern.
K Srinath Reddy | Chancellor of the PHFI University of Public Health Sciences and Chair of the Centre for Universal Health Coverage at the Indian School of Public Policy
(Views are personal)
(ksrinath.reddy@phfi.org)
