What We DoIssuesGlobal HealthGlobal Health Resource CenterCan UNGA80 help countries win the long game on Non-Communicable Diseases?
Written by Celynne Balatbat & Camden Malone, United Nations Foundation
On September 25, world leaders, diplomats, and experts will assemble for a fourth high-level meeting (HLM4) on the Prevention and Control of Non-communicable Diseases (NCDs) and the Promotion of Mental Health during the 80th UN General Assembly (UNGA80). The stakes are enormous: NCDs—such as cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases—are responsible for three out of every four deaths globally, yet only receive 1 to 2% of official development assistance (ODA).
The gathering is a pivotal milestone for reigniting momentum and political commitment on this complex set of issues. But the battle to restore urgency to efforts to control NCDs is happening while the global health community grapples with a rapid and steep reduction in funding.
NCDs are not just a health issue—they cut across development priorities. They undermine productivity, trap households in poverty, and amplify inequities shaped by gender, employment, education, and urban design. Risk factors—such as tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol, and air pollution—are rooted in broader socioeconomic, political, environmental, and cultural factors. That makes UNGA a particularly important venue. With a mandate spanning many areas of development, the Assembly is one of the few places where governments can move the needle on multisectoral approaches to NCD prevention and control.
The scale of the challenge is stark. Only 19 countries are on track to meet the global target of reducing premature deaths from NCDs by one-third by 2030.
The slower onset and chronic nature of these diseases mask the urgency of action and investment. Yet their costs are far greater, both in terms of lives lost and economic strain. Economies cough up more than $2 trillion each year, treating just the five leading NCDs (cardiovascular diseases, chronic respiratory diseases, cancers, diabetes, and mental health and neurological conditions).
The spending that does exist remains insufficient and misaligned: even in higher-income countries, budgets skew toward recurring costs associated with treatment, rather than prevention. Yet, cost-saving, preventive approaches—known as ‘best buys’—offer economic returns of upwards of 700%.
The misguided notion that NCDs are primarily a concern of high-income countries has also hindered progress. In reality, low- and middle-income countries (LMICs) bear the greatest share of the burden. Mental health disparities are a stark example: an estimated 80% of people living with a mental health disorder reside in LMICs, yet more than 75% receive no treatment. The epidemiological shift has outpaced political and financial responses.
The centerpiece of HLM4 is its political declaration, the product of months of negotiation. These declarations vary in ambition. The first-ever political declaration on NCDs in 2011 laid important groundwork for the global response to NCDs, including the establishment of a UN Interagency Task Force (UNIATF), a coordinating body, a monitoring framework, and an action plan to support country implementation. The most recent political declaration in 2018 firmly embedded NCDs in the broader Sustainable Development Goals (SDGs) framework, but many viewed it as a missed opportunity to address critical gaps left by previous declarations.
Negotiations on the 2025 political declaration concluded earlier this month. The finishing touches were felt by the co-facilitators to be the best approach to secure broad consensus among Member States and avoid gridlock on divisive issues.
A core strength of the declaration is an ambitious and wide-ranging set of targets for countries to pursue over the next five years:
The declaration also establishes a unifying target to achieve by 2030: 150 million less people using tobacco, 150 million more people with hypertension under control, and 150 million more people with access to mental health care. These benchmarks could help mobilize action and accountability.
However, negotiations have also narrowed the scope of the declaration. Action on commercial determinants, such as regulations on advertising and packaging, was notably softened. Environmental risk factors—particularly air pollution, the second greatest risk factor for NCDs—receive little attention.
The breadth of the NCD agenda tested negotiators at every turn. Their determination to lock in shared targets and agree on a unifying goal brings an important win for multilateralism, even as tougher issues remain unresolved. Looking ahead to the High-Level Meeting and the text’s adoption, Member States will have more opportunities to reflect on the strengths and weaknesses of the final outcome.
Negotiations Spent on Health Taxes
The most contentious negotiations have centered on health taxes. In preparation for the HLM4 process, WHO launched an initiative to raise $1 trillion over the next 10 years through excise taxes on tobacco, alcohol, and sugar-sweetened beverages (SSBs). When effectively designed and implemented, these taxes deliver a “triple-win” of increased revenue, reduced health system costs, and improved health outcomes due to reduced consumption.
Globally, emerging evidence suggests that a one-time 50% price hike on these products could save 50 million lives and generate an estimated $3.7 trillion over just five years. Crucially, over half of this revenue would accrue to LMICs, offering a rare opportunity to reinvest in universal health coverage (UHC) and other public health priorities.
Remarkable case studies underscore their impact. In the Philippines, successive increases in tobacco taxes led to a threefold increase in revenue in just 10 years. Across the United Kingdom, manufacturers responded to SSB taxes with major product reformulation that reduced sugar levels dramatically. In Botswana, traffic crash rates fell by 12% seven months after an alcohol tax was introduced and by an additional 12% five months after it was increased.
Despite this track record, health taxes remain underutilized or ineffectual, primarily due to industry pushback. For example, between 2016 and 2022, cigarettes actually became more affordable in 41 countries. Commitments to implement and increase taxes on health-harming substances were later eliminated through negotiations, fueling criticism that governments caved to commercial interests.
Still, momentum continues to build. Beyond this declaration, taxation is being reaffirmed in other fora: the Sevilla Commitment, adopted at the Fourth International Conference on Financing for Development (FfD4) earlier this year, asserts countries will “consider introducing or increasing taxes on tobacco and alcohol… with a clear potential to increase domestic revenue and reduce the risk factors of non-communicable diseases.”
The backdrop for these negotiations is more complicated than ever. UNGA80 itself is overshadowed by institutional reforms and a severe budget crisis. The UN faces downsizing of up to 20% because of unpaid dues from major contributors. Governments are under pressure to do more with less, balancing domestic demands with global responsibilities. In this environment, every new commitment is weighed against trade-offs elsewhere.
For NCDs, the timing is both challenging and opportune. Budgets are shrinking, but the costs of inaction are rising. The case for integrated, cost-effective solutions—prevention programs, strong primary care, health taxes—is stronger than ever. And as governments debate the role of the UN in a reimagined multilateral system, HLM4 offers a test case: can leaders muster the political will to tackle a slow-burning crisis with decisive, preventive action?
Ultimately, the success of HLM4 will not be judged solely by its declaration, but by whether governments treat NCDs with the seriousness they demand. The meeting is a reminder that multilateralism is not just about responding to emergencies—it is also about sustaining focus on long-term, structural challenges.
Last updated: September 8, 2025
Celynne Balatbat is a Global Health Strategy Officer at the UN Foundation. She supports strategy development, policy analysis, and stakeholder engagement across key issues including pandemic preparedness and response, malaria, and climate and health. Prior to joining the Foundation, Celynne spent nearly a decade at the National Academy of Medicine, where she led initiatives on emerging technologies and helped launch a global research agenda on climate change and health. She holds a B.A. in Neuroscience and Behavior from Vassar College.
Camden Malone advances the global health agenda through engagement with UN Member States on a wide range of health policy issues, including universal health coverage, antimicrobial resistance, and pandemic preparedness, prevention, and response. Prior to the United Nations Foundation, Camden worked at the Permanent Mission of Costa Rica to the UN, covering intergovernmental negotiations related to health and human rights. Camden holds a master’s degree in International Affairs from the Colin Powell School for Civic and Global Leadership at the City College of New York; and a bachelor’s degree in History and Political Science from the College of Saint Rose.
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