Introduction by Croakey: Global efforts to improve prevention and control of non-communicable diseases are focusing on stronger health taxes, particularly on tobacco, alcohol and sugar-sweetened beverages, and for increased investment in prevention.
However, the draft of a new international declaration on non-communicable diseases and the promotion of mental health and wellbeing does not sufficiently address the increased risk faced by women and girls, or the impacts of climate change on health, according to an analysis by experts below.
The declaration, on which Australia and other Member States began negotiations last month alongside the 78th World Health Assembly, also needs to pay greater attention to treatment and care for NCDs, recognising the current and projected burden, they say.
Importantly, the declaration must also do more to ensure inclusion and participation of people and communities most affected by NCDs, including stronger recognition of the unique needs of specific community members, and ensuring participation of Indigenous and people with lived experience at all levels.
The draft declaration also has a clear message for the Australian Government.
“We encourage the Australian Government to think seriously about its domestic funding for NCDs as well, with prevention funding comprising less than two percent of federal public expenditure on health, which is far too low,” write the authors below: Lucy Westerman, Veronica Le Nevez and Hayley Jones.
Lucy Westerman, Veronica Le Nevez and Hayley Jones write:
The 78th World Health Assembly, held in Geneva last month, generated global headlines for its historic endorsement of a new pandemic agreement.
What has received less attention is that non-communicable diseases (NCDs) and mental health were also high on the WHA agenda.
A few days before the Assembly began on 19 May, countries were invited to comment on an important statement, the ‘Zero draft: Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being’.
Over coming weeks and months, Australia and other Member States will negotiate the substance of the draft Political Declaration, which is expected to close for input in August before it enters ‘silence procedure’ ahead of formal adoption during the UN General Assembly (UNGA) in September.
The onus is on Member States to highlight the gaps and put forward targets for accelerated action, and now is the time to take steps for real change to happen.
The final ‘Political Declaration’ will underpin another key meeting for NCDs this year – the 4th High-level Meeting of the United Nations General Assembly on the Prevention and Control of on NCDs (UNHLM), which is to be held in New York on 25 September during the high level week of the 80th UNGA.
This declaration will establish what governments commit to on NCDs, outlining for stakeholders – including UN agencies like the World Health Organization and the UN Development Programme, civil society and governments – what is planned for NCDs and mental health for the next several years.
NCDs – also referred to as chronic diseases – include heart and lung diseases, cancer, diabetes and mental health conditions, and are the world’s biggest killers, collectively responsible for 74 percent of deaths annually worldwide.
Yet progress on NCDs remains slow.
Key reasons include woefully insufficient financing, and that the causes of NCDs – and the best methods of prevention – need collaboration across different sectors. Progress on NCDs means cross-sector solutions to improving diet and physical activity, having healthy environments, and tackling unhealthy industries (among other things).
With the need for strong government leadership to make this happen, Australia’s statement during the World Health Assembly that it considers the UNHLM to be an “important opportunity to drive stronger global action on NCDs” was a welcome indication that Australia will be active in progressing action on NCDs.
We reviewed the draft Political Declaration through an Australian and regional lens. We considered priorities raised by stakeholders last year at a cross-sector NCD leadership workshop in Canberra, and drew on perspectives from the NCD Alliance, HelpAge International, World Cancer Research Fund International, and the Union for International Cancer Control, among others.
What’s good
- Prevention and management of NCDs and mental health are prioritised
- A call for stronger health taxes is included, particularly on tobacco, alcohol and sugar-sweetened beverages
- Risk factors AND determinants of health (wider contributing factors) are prioritised
- Air pollution (the largest environmental risk factor and cause of eight million deaths a year globally) and mental health have been integrated and elevated
- Some targets have been set for key conditions, and some timeframes set
- It includes a call for increased resourcing with ideas on how to achieve this
- A year has been proposed for the 5th High Level Meeting on NCDs (though it should be sooner – 2031 is too far away to create momentum and track progress – 2029 would be preferable to ensure NCDs are high on the post-2030 agenda.)
What needs more work
Improve ambition and innovation for financing: NCDs continue to be woefully under-financed. At a turbulent time in the global economy, we commend Australia for being reliable in its long-term commitment to financing of WHO and other UN agencies delivering health assistance, and for its regional partnerships which include NCDs and mental health.
Yet we note that these commitments are not sufficient to address the immense scale of the NCD and mental health burden borne in the Indo Pacific. Stronger, sustained and scaled up commitments to development assistance for health and specifically for NCDs and mental health are needed, which could be in the form of specific financing of recipient led initiatives, new partnerships contributing technical assistance and capacity sharing, and through the UN’s multi-donor Health for Life Fund. The political declaration risks becoming empty commitments without new resourcing pledges.
On the domestic financing front, the zero draft includes a strong call for health taxes and increased funding for public health, universal healthcare and prevention – a welcome call but one which needs to be supported by comprehensive regulation, compliance and enforcement to be effective.
We encourage the Australian Government to think seriously about its domestic funding for NCDs as well, with prevention funding comprising less than two percent of federal public expenditure on health, which is far too low to hold back the anticipated rise in chronic disease prevalence.
Expand references to climate change and its effect on NCDs, including mental health: The draft falls short of recognising the impacts of climate change on health and taking action to address them. The impacts of climate change can compromise availability and access to clean air and water, nourishing food, and essential health services, to name a few.
We see dramatic effects locally within rural Australia, and bear witness to effects on our Pacific Island neighbours. In this sense the zero draft neglects to reflect the many factors which intersect and have huge and devastating effects on overall health, chronic diseases and mental health. At a minimum, there is a need for more specific commitments on air pollution – and with it, tackling the main driver, fossil fuels.
Gender and women’s health was notably absent from the draft declaration, which is worrying given that women and girls around the world are at greater risk of NCDs and experience lower access to healthcare, particularly in low-resource contexts. Adopting measures to incorporate a gendered approach to health will improve health equity.
Greater attention to treatment and care for NCDs is needed, recognising the current and projected burden. While NCDs continue to be the world’s leading cause of mortality, improvements in their detection, treatment and care mean that more people are living longer, including with chronic and mental health conditions.
The Zero draft and existing NCD targets fail to appropriately reflect the importance of not only living longer but also of living well across the life course. Focussing primarily on extending life risks marginalising measures that promote health and wellbeing. This could be remedied by incorporation of new targets for health adjusted life expectancy (HALE) and/or Disability Adjusted Life Years (DALY’s). NCD interventions should be grounded in overall health system strengthening and achievement of Universal Health Coverage, which is not mentioned.
Improve inclusion and participation of people and communities most affected: Commitment to closing health equity gaps requires active inclusion and participation of communities most affected to lead, design and implement socially, culturally and contextually appropriate responses. Indigenous leadership during the COVID pandemic is a leading example of the power of community-led responses to public health challenges. We would also like to see stronger recognition of the unique needs of children and young people, and the importance of ensuring their meaningful participation at all levels.
Commitments on the adoption of existing technical packages and action plans on major risk factors: Some commitments to tackle key areas of action for some NCDs and risk factors are included – notably on tobacco, hypertension and mental health. This is not representative of the total global burden of disease for NCDs, with cancer being absent. Greater emphasis should be placed on all 5 main NCDs and risk factors (the 5×5 framework) (including food, alcohol, and physical activity), with a commitment to the adoption of existing WHO technical packages and action plans.
Safeguards against conflicts of interest from health-harming industries: While some private sector products and services improve health, there many examples of private sector actors whose products and practices detrimentally impact health and so they have an extremely limited role to play in preventing and managing NCDs.
With an estimated 10-20 percent of delegates at the recent NCD Multistakeholder hearing in New York representing the alcohol industry alone, according to the NCD Alliance, it is clear that health-harming industries will be seeking to water down government commitments on NCDs at every turn. Engagement with the private sector must be carefully done, with clear mechanisms to prevent and manage conflicts of interest.
Next steps
The UN High Level Meeting is going to be another test for multilateralism, but there are signs in the Zero draft that give us hope and confidence that significant progress on NCDs can – and will – be made, both in Australia and overseas.
With the deadline for feedback on the draft Political Declaration looming, we are counting on Australia’s Government to continue to be a key voice of ambition and leadership in global efforts to reduce the impact of NCDs and mental health and improve the lives of people everywhere.
Keen for a deeper dive?
The George Institute’s Response to the Zero Draft on NCDs and Mental Health https://www.georgeinstitute.org/our-impact/policy-statements-and-recommendations/the-george-institutes-response-to-the-zero-draft-on-ncds-and-mental-health
Global Mental Health Action Network: https://gmhan.org/response-zero-draft
Curious what else was discussed at the WHA relating to NCDs and Mental Health? Check out NCD Alliance’s resources: https://ncdalliance.org/resources/ncd-alliance-advocacy-briefing-78th-session-of-the-world-health-assembly-wha78-19-may-to-27-may-2025
Interested in other analysis? https://healthpolicy-watch.news/un-zero-draft-on-ncds-focuses-on-tobacco-control-hypertension-and-mental-health-care/
About the authors
Lucy Westerman is a Lecturer, Public Health at the University of Melbourne School of Population and Global Health, and is deeply committed to helping people enjoy better health for longer, having also worked at Australian Chronic Disease Prevention Alliance (ACDPA), the Victorian Health Promotion Foundation (VicHealth) and at the global Non-Communicable Disease (NCD) Alliance.
Veronica Le Nevez is Head of Impact and Engagement at The George Institute for Global Health, where she leads the Institute’s advocacy and policy engagement activities in Australia and the Pacific region to help increase the impact of the institute’s health and medical research. The George Institute for Global Health is the recipient of funding under the Australian Government’s Partnerships for a Healthy Region program.
Hayley Jones is the Director of the McCabe Centre for Law and Cancer, the WHO Collaborating Centre on Law and Noncommunicable Disease, and drives forward its mission to promote the effective use of law to prevent cancer and NCDs and ensure equitable treatment and supportive care for people affected.
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