The NCD Declaration: A Pragmatist’s Defence of an Imperfect Victory
By Dr Taskeen Khan, Director of Research and Policy Development, WISH
Another United Nations high-level meeting, another lengthy political declaration on non-communicable diseases (NCDs). To the global health community, the draft Political Declaration on the prevention and control of NCDs and the promotion of mental health can feel like a familiar ritual. And with ritual comes critique. Having read the various criticisms, I find myself in a curious position: I agree with many of them, yet I disagree with the overarching sentiment of disappointment. To judge this document fairly, one must first understand the labyrinthine process from which it emerged.
The secretariat tasked with drafting this text operates under constraints that are invisible to most readers. There is a strict limit on words, a desire from 194 member states to see their priorities reflected, and a political necessity to achieve consensus. This is not an academic paper where precision is paramount; it is a transactional document where every comma can be a battlefield. The result is inevitably a compromise—a tapestry woven from threads of ambition, pragmatism, and sometimes, unfortunate dilution.
Given these parameters, this declaration is not just good; it is a significant step forward.
What the Declaration Gets Right
Let’s start with the triumphs. The document makes welcome and concrete strides. The inclusion of a dedicated focus on gender, including the crucial point about differences in cardiovascular disease presentation between women and men, moves beyond tokenism. The commitment to three specific, quantifiable “fast-track” targets—150 million fewer tobacco users, 150 million more people with hypertension under control, and 150 million more with access to mental health care—provides a clearer line of sight for accountability than any previous declaration. The integrations of oral health, the effects of air pollution, and the nods to digital health and data surveillance are all positive and necessary expansions of the NCD agenda.
The Flaws We Can’t Ignore
And yet, the criticisms are valid. Mental health, despite its billing in the title, often feels like a secondary pillar rather than a fully integrated component. The language on taxing harmful products like alcohol and unhealthy foods is watered down to “consider introducing or increasing taxes,” a far cry from the forceful language applied to tobacco. Beyond the three headline targets, other goals lack the same measurability. And the commercial determinants of health, while addressed, are handled with gloves, avoiding direct confrontation with the industries that profit from ill-health.
But take a step back and look at the transactional world we live in. Are we really surprised? Are we surprised that commercial interests lobbied fiercely to protect their markets? Are we surprised that tax policies, a sovereign nightmare for many nations, were softened to secure consensus? Are we surprised that not every single one of hundreds of NCDs gets a specific mention? No. In the arena of global health diplomacy, where geopolitics and national economic interests constantly clash with public health ideals, this level of ambition is arguably the ceiling, not the floor.
This brings me to a more fundamental point. The issues we have as a global NCD community may stem less from this declaration and more from the historical framing of the challenge itself. We have grouped completely different diseases—with vastly different pathologies, treatments, and care pathways—under the simplistic banner of “Non-Communicable Diseases.” We did this for administrative and advocacy convenience, to create a bloc large enough to counter the dominance of infectious diseases on the global agenda.
While the common risk factors—tobacco, alcohol, unhealthy diets, air pollution—provide a useful hook, they are ultimately proxies for deeper social and commercial determinants that affect all health. This neocolonial approach of grouping diverse conditions into one monolithic “NCD” category is why mental health perpetually feels like an afterthought; its paradigms of care, stigma, and measurement simply don’t fit neatly into the classic NCD box. The problem is not that the declaration failed; it’s that the entire architecture they have to work within is inherently flawed.
As a hypertension expert, do I think the 150 million target is the best we can do? Hardly. It could be more ambitious. But it is a number. It is a hook, on which programmes can be hung and funding can be justified. In the real world of ministry budgets, that is a tangible win.
This declaration’s true weakness, therefore, is not in its semantics but in its relationship to current reality. It calls for ambitious action in a world on fire. It proposes integrated care in countries buckling under debt (and kudos to the text for finally acknowledging the need for international assistance). It envisions resilient health systems amid protracted humanitarian crises that shred those very systems daily. It name-checks the Global Fund and Gavi, multilateral institutions that are themselves fighting for relevance and funding for their traditional mandates, let alone expanding into the vast universe of NCDs.
Once again, the global NCD community’s ambition risks being isolated from the brutal realities of the world it seeks to change. We draft declarations for the world we want, not the world we have. And that is my biggest takeaway.
Why It Still Matters
But here is the crucial, often unspoken, truth: you have to be profoundly naive to believe that a political declaration, any political declaration, will single-handedly change reality. As someone who has worked on the ground, from implementing direct patient care to advising on national population health roll-outs, I know that these documents do not magically fix supply chains, fill staffing gaps, or balance ministry budgets. They do not calm a conflict zone or erase a country’s debt. The raw, gritty work of implementation happens in spite of, and often completely disconnected from, the lofty language negotiated in New York.
Therefore, we must stop judging these documents by the wrong metric. Their purpose is not to be a direct operational manual. Their value is not in its paragraphs magically transforming care at the bedside.
Their true purpose is threefold:
First, it is a permission slip for advocates. A Ministry of Health official fighting for a larger budget share for NCDs can now walk into a meeting with the Ministry of Finance and point to a unanimously adopted UN document that their Head of State signed. It is a powerful tool to counter internal opposition and justify policy change. It legitimizes their fight.
Second, it is a framework for accountability. However imperfect, those targets—especially the 150 million on hypertension, tobacco, and mental health—create a benchmark. They allow civil society organizations, academic institutions, and international agencies to ask governments, “What is your plan to meet our shared commitment?” It provides a common language to measure progress, or the lack thereof.
Third, and perhaps most importantly, it is a statement of consensus and a signal of intent. In a world fragmenting by the day, this document represents a rare moment of global agreement. It signals that, at least on paper, the world still believes in multilateralism, in the right to health, and in the need to tackle these burdens together. It is a beacon, however flickering, that reminds us what we are supposed to be working towards.
This declaration is a good document. It is progressive, more specific than its predecessors, and provides several new tools for advocates. But it is also a mirror reflecting the limitations of our global governance. It shows us what is possible through painstaking diplomacy while hinting at the much larger, more systemic battles we have yet to win.
The declaration is not the problem; it is a symptom. The problem is the transactional, fragmented, and underfunded global health ecosystem in which it must be implemented. To the policymakers, practitioners, and advocates of the WISH community: our focus should now shift from critiquing the text to using it. Wield it as a tool in your budget meetings, your policy reform agendas, and your patient advocacy. Use its targets to demand action, its consensus to open doors, and its vision to build alliances. Its power was never in its words, but in our hands—the hands of those on the ground who know how to use them to drive the collective action our communities deserve.
