UN Declaration on Noncommunicable Diseases Will Shape Global Health Action Without US Backing.
UN Declaration on Noncommunicable Diseases Will Shape Global Health Action Without US Backing
In December, the UN General Assembly formally adopted the declaration, despite opposition from the United States and Argentina. This moment underscores the need for public health to engage more directly with the commercial forces developing the products that contribute to many noncommunicable diseases, writes Dean Adnan Hyder.
Dear Colleagues,
In October, I reflected on the disappointment many of us felt when the UN High-Level Meeting on Noncommunicable Diseases (NCDs) and Mental Health concluded without adopting a political declaration. At that time, it was unclear whether the deadlock was procedural or a sign of a deeper split. Given that NCDs remain the leading causes of death and disability worldwide and that the Sustainable Development Goal to reduce premature mortality from NCDs is significantly off track, many of us hoped the moment would still spark action.
That question was answered on December 15, 2025, when the UN General Assembly overwhelmingly adopted the political declaration, with 175 countries voting in favor and only two, the United States and Argentina, voting against. The declaration is now formally in place, setting global targets to reduce tobacco use, improve hypertension control, and expand access to mental health care by 2030. This outcome is significant for the world, including the United States—not just because the US is now out of step with the global health community on NCD prevention, but also because it reveals the long-standing tension between public health and Commercial Determinants of Health (CDoH).
It is well documented that NCDs are not just caused by individual behaviors, they are also shaped by powerful commercial forces that influence the environments in which choices are made. The tobacco, alcohol, ultra-processed food, and sugar-sweetened beverage industries play a key role in raising NCD risk through marketing, product design, pricing, and political influence. These industries are deeply embedded in the US economy and exert significant influence on public policy and evidence-based prevention efforts through multiple channels (e.g., lobbying, campaign finance) at the local, state, and federal levels.
The UN declaration addresses this issue by urging countries to implement fiscal, regulatory, and policy measures, such as taxes on tobacco and alcohol, improved food labeling, and limits on harmful exposures, to reduce NCD risk. These strategies are among the most well-studied and cost-effective “Best Buys” for NCD prevention. However, these policies remain politically controversial in many countries, including the United States, because they directly challenge deeply rooted commercial interests that rely on continued consumption of these health-harming products. These corporate entities maintain significant public policy influence; even as NCDs remain the leading causes of death, disability, and healthcare expenditures in the US, the current policy landscape often perceives evidence-based interventions as overreach.
Additionally, the declaration is non-binding—its adoption does not force domestic policy changes; it merely suggests introducing or enhancing existing interventions (e.g., taxes on tobacco and alcohol) in line with local/domestic circumstances. Nonetheless, this declaration does shape the future architecture of global health action and will influence global norms, funding priorities, and accountability structures for years to come. By rejecting the declaration, the United States risks losing leadership in setting standards for how governments address CDoH at a time when its own NCD burden is increasing, and health inequities are widening.
Yet the US has shown efforts to engage on this topic, including recently. Aspects of the new national dietary guidance issued by the US Department of Health and Human Services, that emphasize whole and minimally processed foods, limit ultra-processed products, and reduce added sugars, are factors that partly align with longstanding WHO recommendations on NCD prevention. However, the new dietary guidelines could also increase consumption of foods that contribute to heart disease. The public health impact of this guidance will depend on whether it is supported by regulatory and fiscal measures that address commercial practices and food environments, rather than relying primarily on individual behavior change. For now, its lack of clear focus on structural, commercial, and equity factors limits its potential effectiveness.
For public health academia, this moment underscores the urgent need to engage more directly with CDoH. We must examine how corporate practices, lobbying, and regulatory capture undermine prevention efforts, and collaborate with communities and policymakers to counter these influences. This also involves advancing research on taxation and regulation, documenting industry interference, and training future leaders to navigate the complex interplay among health, markets, and governance; making it a truly multi-sectoral collaborative endeavor. At Boston University, we are committed to addressing the CDoH of NCDs. In 2023, BUSPH researchers David Jernigan, professor of health law, policy & management, and Xixi Zhou, a graduate student, presented evidence at a legislative briefing at the Massachusetts State House. They demonstrated the significant health burden related to alcohol use in the state. They also promoted evidence-based policy options to reduce harm, such as limiting alcohol availability, restricting alcohol advertising, and raising excise taxes. These findings informed legislative discussions on proposed bills to increase alcohol taxes. While this work makes an important contribution to efforts to curb CDoH, it also underscores the need to continue advocacy and to further CDoH research.
The nearly unanimous approval of the UN Declaration clearly shows that the global community recognizes NCDs and mental health as systemic issues influenced by policy decisions and corporate influence. The overwhelming public health evidence, global momentum, and moral obligation to act remain strong. The task before US universities and research institutions now is to ensure that public health, rather than commercial interests, guides the response to one of the defining health challenges of our time.
Warm regards,
Adnan Hyder, MD, MPH, PhD
Dean and Robert A. Knox Professor
Boston University School of Public Health
