In this blog, Liz Arnanz and Marijke Kremin, NCD Alliance Policy and Advocacy Managers, reflect on the outcomes and opportunities of this year's World Health Assembly.

The packed agenda of the 76^th World Health Assembly (WHA76) demonstrated the commitment of global public health professionals to strengthen not just health systems, but the multi-lateral collaboration needed to get us there. NCD Alliance was pleased to see NCD prevention and care frequently named as a critical component of UHC and pandemic prevention and recovery efforts.

NCDs and UHC – an opportunity to reinforce synergies

Discussions on items 13.1 – Universal Health Coverage and 13.2 Prevention and control of NCDs and mental health were combined in a last-minute adjustment. This underscored the inextricable connection between NCDs and UHC. The integration of NCDs into UHC health benefits packages is one of NCDA’s key asks for the upcoming UN High-Level Meeting on UHC taking place in New York this September, and several Member States highlighted this opportunity.

Bhutan stated that UHC can be achieved if NCDs and mental health policies outlined in the Appendix 3 of WHO’s Global NCD Action Plan (aka NCD ‘best buys’ and other recommended interventions) are implemented. Meanwhile, Singapore highlighted lessons to promote UHC and control NCDs including primary care capacity, health systems resilience, and digital health to accelerate action. The double burden of communicable and noncommunicable diseases impacts countries like Tanzania, who noted that they advocate for prevention efforts nationwide, encouraging messages on healthy eating, exercise, and early detection through a community-based care model.

Hearing these interventions was heartening, but they cannot remain in Geneva and should be reflected in the final UHC Political Declaration in September. While the Zero Draft of UHC Political Declaration recognizes NCDs and the critical role of prevention, it stops short of including legal and regulatory measures to promote the intersectoral policies needed to integrate NCDs into UHC health benefits packages.

Among the policy deliberations progressing at WHA, the Intergovernmental Negotiating Body (INB) released an updated draft of the Pandemic Draft Treaty, which notably, and regrettably, has removed language outlining people living with health conditions among vulnerable groups. 60-90% of COVID deaths were people living with NCDs, making them truly susceptible. There is a need for recognition of people living with NCDs and chronic conditions within the Pandemic Treaty, and across the multiple High-Level Meetings taking place this year including on UHC and Pandemic Prevention, Preparedness, and Recovery.

The updated NCD ‘best buys’ – an investment case for the NCD response

As discussed at the WHA76 side event Unpacking the expansion of NCD ‘best buys’ and their investment case, hosted by Vital Strategies and NCD Alliance, the major item under this year’s NCD agenda was the update of the Appendix 3 of WHO’s Global NCD Action Plan 2013–2030. Appendix 3 provides a menu of cost-effective policy options to accelerate NCD prevention and care nationally. The updated Appendix 3 was unanimously adopted and offers “more ways, to save more lives, for less money”, presenting 28 NCD ‘best buys’.

Another major update is that decision EB152(11) asks WHO to regularly update the Appendix 3 interventions based on the latest evidence and data. This is key to keep reinforcing the investment case of these policy recommendations on both NCD prevention and care. As mentioned by Norway at WHA76, this is part of WHO’s normative role and scientific integrity, and therefore the regular update process will need to be from free from commercial and undue influences.

Overcoming the commercial determinants of health to accelerate implementation

Statements from Sweden and Eswatini (on behalf of the European and African regions respectively) were very supportive of the Appendix 3 update, stressing the need to address commercial determinants of health. There was much resonance in this regard. Dr Nandita Murukutla of Vital Strategies said in a Health Policy Watch interview that corporate influence is a major reason for the delay in implementing NCD ‘best buys’. Prof Anna Gilmore, lead author in the Lancet’s recent series on commercial determinants, highlighted how commercial actors manipulate science to influence policies.

At the WHO strategic roundtable for the 20th anniversary of the Framework Convention on Tobacco Control (FCTC), Paula Johns of ACT Promoção da Saúde noted that there is a lot we can learn from the tobacco control movement to address other NCD risk factors, including alcohol, unhealthy diets and air pollution.

A flagship initiative by WHO – the Acceleration Plan to Stop Obesity – was also discussed, with statements from many countries, including Barbados. This Small Island Developing State (SIDS) has recently increased its sugar-sweetened beverages (SSB) tax to WHO’s recommended level, implemented a new school health policy and is committed to strengthening front-of-package labelling to improve national food systems.

Moreover, Barbados – an NCD champion – is hosting the upcoming SIDS Ministerial Conference on NCDs and Mental Health (14-16 June 2023), a process through which the commercial determinants of health and climate change have been identified as major drivers of the NCD and obesity epidemic that SIDS currently face.

A packaged agenda for Pillar 3 with a focus on equity and planetary health

The discussions around WHO’s Pillar 3 (One billion more people enjoying better health and well-being) were also extremely relevant for accelerating action on NCDs and achieve policy coherence as highlighted by Thailand on behalf of the South-East Asia region. Under Pillar 3, the WHA adopted WHO’s first-ever global framework for achieving well-being, and noted a new operational framework for monitoring social determinants of health equity.

Both frameworks are groundbreaking – while the former provides examples of interventions that can lead to a well-being economy valuing planetary and human health, the latter aims to monitor data to measure social determinants (including aspects such as water and air quality) and actions taken to address these, like social protection and education policies.

The linkages between planetary and human health were very present during WHA76. One WHO strategic roundtable was on health and climate, announcing the inclusion of a 'Health Day' in the agenda of UNFCCC COP28, which will include a meeting of Health and Climate Ministers. This is crucial, especially for populations most at risk, and will highlight the health co-benefits that climate change mitigation can bring. The Netherlands urged Member States at WHA76 to consider a climate and health resolution.

Other major developments included the adoption of a resolution on the health of Indigenous Peoples, led by Brazil with support from many Member States including Panama, who highlighted the need to involve and protect these populations from the growing NCD burden that disproportionally impacts them. The resolution on the impact of chemicals, waste and pollution on human health, led by Peru, was also very welcomed; however, the NCD community voiced concerns regarding the absence of recognition of fossil fuels as major pollutants. Air pollution constitutes one of the world's greatest environmental risks to health and is the second largest cause of death in Africa – however, action to address it within the global health agenda remains insufficient.

Leadership will remain key to ensure synergies in public health

Leadership at the highest political level remains crucial to see real change ahead of the September meetings. We would like flag Ghana’s call at WHA76 for other governments to join the Global Group of Heads of State and Government for the Prevention and Control of NCDs.

The NCD Alliance will remain at the disposal of the NCD community to help ensure the moment for caring has arrived with action on NCD prevention and care being prioritized within efforts to accelerate universal health coverage and promoting the health and well-being of the billions of people living with or at risk of developing NCDs, including mental health conditions.

Whether you are a civil society representative, government delegate or UN official, we welcome your feedback via this survey on how helpful NCD Alliance’s work in the lead up to WHA76 has been for you, to ensure we improve our support in upcoming WHO and UN processes.

About the authors:

Liz Arnanz (@lizarnanz) is NCDA’s Policy and Advocacy Manager on NCD Prevention, she is responsible for coordinating our policy and advocacy work on the main NCD risk factors, upstream determinants, and health promotion more broadly. Prior to this, Liz worked at FDI World Dental Federation, advocating for the integration of oral health promotion and care within health systems, and she also worked for NCDA's partnerships and membership team.

Marijke Kremin (@MarijkeKremin) is NCDA's Policy and Advocacy Manager based in New York City, she is responsible for covering financing policy and United Nations advocacy. Prior to this, Marijke worked in international peace and security and human rights focusing on gender and the WPS (women, peace and security) agenda, mass atrocity prevention, and the protection of civilians in conflict. She has also worked in legal aid and advocacy for refugees and asylum seekers in Cape Town, South Africa.