LAUSR

This September’s UN General Assembly high-level meeting (HLM) on noncommunicable diseases (NCDs) provides a strategic opportunity to propel the response—from “where do we want to be” to “how do we get there”. The WHO Independent High-Level Commission on NCDs made a number of solid proposals to inform HLM negotiations. These include a call for governments to enhance regulatory frameworks to protect health, for example, through a code on the marketing of some health–harming products and a full–cost accounting of these products. The draft of the HLM’s political declaration prioritises universal health coverage, including affordable treatment, and promotion of mental health but falls short on the primary prevention of NCDs and promot ing healthy societies as per Agenda 2030. The transition from health-harming to health-enhancing products and processes requires action across multiple sectors and strengthened public institutions. We propose an agenda for member state HLM negotiators (panel). First, accountability must be assigned at the highest political levels. The WHO NCD Commission called on heads of government to lead the NCD response, as was the case with effective AIDS responses. This will ultimately empower ministers of health by ensuring all government departments are accountable to national leadership and are enabled to manage political opportunities, barriers, and trade-offs for NCD prevention. Rather than create new vertical structures, the NCD agenda should be integrated into national Sustainable Development Goal (SDG) plans. The declaration must commit to distributed ownership, impact assessments, policy coherence, and accountability across ministries. Second, improving fiscal policies should be prioritised. Countries should implement a synergistic approach to taxing sugar (not just sugarsweetened beverages but also sugary snacks), tobacco and alcohol, as well as unhealthy nutrients. The international community should provide technical advice on taxation and removing subsidies for processed foods, alcohol, and fossil fuels, and for divesting from tobacco, alcohol, and fossil fuels; governments should also support healthy local food systems. Third, additional financial resources must be mobilised. The declaration should call for dramatic financial increases for NCDs over the US$1 billion currently spent annually. Domestic resource mobilisation, in line with the Addis Ababa Action Agenda, along with development assistance and catalytic external funding, is necessary to address issues of equity, provide public goods, and ensure value for money through evidence–informed resource allocation. Fourth, the commercial determinants of health should be more rigorously regulated. Evidence suggests that self–regulation cannot be relied on to deliver healthy outcomes. Building on experience from tobacco control, governments must regulate the alcohol, processed, and ultra–processed foods industries. Access to healthy foods demands effective regulation to improve production and formulation, restrict harmful marketing (particularly to children), mandate better labelling, and set price incentives for healthier consumption. This requires building country capacity, creating strong health provisions in international trade agreements, as well as strengthening international institutions to counteract interference in establishing and implementing evidence-informed standards. Fifth, the growing impact of pollution and urbanisation on NCDs, injuries, and mental health must be addressed. The declaration should call on governments and partners to (re)design and build healthy communities that enable people to exercise freely and safely, access healthy foods easily, and reduce their exposure to household, traffic, and industrial pollution. Sixth, support shoud be provided for meaningful civil society engagement. Agenda 2030 is premised on effective partnerships, including with civil society. The declaration must ensure meaningful engagement with and by affected communities, citizens, and public interest groups, explicitly highlighting their role in national multi sector planning and coordination platforms and independent accountability mechanisms. Countries should increase investment in the advocacy and service delivery functions of civil society and its networks. Seventh, principles of equity, human rights, and gender equality must be upheld. Recognising that burden of NCDs and mental health is inequitably distributed across populations, responses must address differential circumstances—for example, socioeconomic position, gender, ethnicity, and geography. Explicit commitment to a rights-based approach to prevention and treatment can help empower and protect populations living in vulnerable circumstances. As with previous UN General Assembly political declarations on AIDS, this would entail nondiscrimination in access to information, services, affordable care, medicines, and technology; meaningful participation of people affected by NCDs or mental