U.N. Health Goals Weakened by Industry Pressure, Experts Say

In many respects, the United Nations declaration on chronic diseases that world leaders are expected to adopt on Thursday offers bold recommendations to combat soaring rates of hypertension, cancer, diabetes and other health conditions that kill a combined 43 million people a year.

The document calls on its 193 member states to adopt universal health coverage and to increase access to mental health services. It also urges countries to add health warnings to cigarette and nicotine products, in an effort to reduce the number of premature deaths from tobacco.

But public health advocates say the final document released this week by the World Health Organization falls far short of an earlier draft that endorsed much more aggressive measures to tackle some of the biggest drivers of noncommunicable diseases, or NCDs, which account for 75 percent of all deaths worldwide.

Gone was the language calling for graphic health warnings on cigarette packs. Gone, too, were the recommendations for so-called health taxes to discourage smoking and the consumption of alcohol and sugar-sweetened drinks. The final document contains no mention of sugary beverages, a key culprit in the rising rates of childhood obesity that affects 35 million children under 5 years old.

“To be honest, we expected more,” said Verónica Schoj, the vice president for food and nutrition policy at the Global Health Advocacy Incubator in Washington, D.C. “The watered-down language is disappointing and concerning.”

Some revisions appear aimed at changing the conversation about the underlying causes of various chronic illnesses. For example, a reference to obesity as “largely driven by unhealthy food environments” was replaced by a longer list of risk factors that included “the unaffordability and unavailability of healthy diets,” sleep deprivation and stress.

Many of the most substantial changes to the final document reflect the interests of corporations — the multinational tobacco, alcohol and soda giants that would stand to lose revenue from declining consumption of their products.

Asked to comment, industry groups like the Distilled Spirits Council of the United States and the International Council of Beverages Associations issued statements largely praising the process and the outcome. But they declined to discuss their roles in shaping the final document.

“We strongly support multilateral efforts to achieve global NCD goals and have a proven track record of doing our part to accelerate progress,” Kate Loatman, executive director of the International Council of Beverages Associations, said in a statement.

Affected industries often make their interests known through member-state delegations that press for changes to initial drafts in closed-door meetings.

“The health-harming industry’s fingerprints are all over this draft, but the lack of transparency is really frustrating,” said Alison Cox, director of policy at the NCD Alliance, an advocacy organization. “We’ve seen industry at the scene of the crime, and they certainly benefit from the outcome, but we’re not actually in the room to see the deed being done.”

The W.H.O. last week took the unusual step of publicly criticizing the outsize role played by corporate lobbyists in revising the draft. “Often, governments face fierce opposition from industries that profit from unhealthy products,” Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., said at a news conference.

Chronic conditions like heart disease and cancer have become the leading cause of death worldwide, with an estimated 17 million premature deaths each year.

And many chronic illnesses are associated with the consumption of highly processed foods and sugary drinks that are increasingly affordable and available, especially in developing countries. More than 82 percent of premature deaths from noncommunicable diseases now occur in low and middle-income countries, according to the W.H.O.

A study published this month in The Lancet found that deaths from such health conditions have been declining in most countries but that the pace of the decline, including in high-income countries like the United States, has slowed in recent years.

Research suggests that taxes on soda and highly visible labels on packaging that warn consumers when an item is high in salt, sugar or fat can be effective at dampening demand. To avoid those measures, some companies have opted to reformulate their products to be healthier.

Lindsey Smith Taillie, a nutrition epidemiologist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said the removal of references to sugar-sweetened beverages in the final W.H.O. document was especially egregious given the global obesity crisis. More than 80 countries have adopted soda taxes, directing much of the revenue toward medical care.

“When you factor in savings in health care costs, reductions in disability and improvements in productivity, the cost-benefit analysis suggests that sugary drink taxes, much like tobacco taxes, are a clear overall win,” she said.

Because such measures are relatively new, research into their impacts on health outcomes is limited. In Seattle, a soda tax introduced in 2018 has been associated with a small decline in the body mass index of children. Chile, one of the first countries to require front-of-package warning labels on food, has reported a significant drop in purchases of unhealthy products. And the sugar-drink tax that Mexico imposed in 2014 led to a drop in soda consumption and a rise in sales of bottled water. An added bonus: Mexican officials expect a $2.2 billion windfall from the taxes next year, which will go toward treating diabetes and cardiovascular disease.

South Africa, too, has embraced soda taxes and restrictions on cigarette advertising. But Catherine Egbe, a senior scientist at the South African Medical Research Council, said other efforts, including a proposal for cigarettes to be sold in plain packaging, had stalled partly because of industry opposition.

Dr. Egbe said that many countries value the W.H.O.’s guidance on chronic diseases, and health officials often use their recommendations to pressure recalcitrant policymakers and political leaders. Dropping the recommendation for graphic warnings on cigarette packages, she said, would remove an important arrow from the quiver of health policy advocates. “When the language is strong and watertight, it helps countries do better,” she said. “But when the language is weak, it sends the message that ‘you can do what you want’ and leaves vulnerable populations at the mercy of industry.”

Health experts were also dismayed by the removal of specific proposals for reducing alcohol consumption, which is associated with 2.6 million deaths annually. The initial recommendations included advertising bans on alcohol products, expanded restrictions on retail sales and increased enforcement of drunk-driving laws. The final document replaced those with a vague recommendation that governments “reduce harmful use of alcohol.”

Leanne Riley, who oversees surveillance, monitoring and reporting for noncommunicable diseases at the W.H.O., said many significant recommendations from the earlier draft had survived. They include concrete targets for reducing deaths from noncommunicable diseases by 2030 and a commitment to provide mental health care to 150 million more people around the world.

“When we start with these political declarations, the first draft reflects the highest level of ambition that’s being expressed, but then the documents go through this negotiation,” she said. “That’s simply how multilateral processes work.”

The end result, especially the removal of taxes as a tool for improving global health, is likely to cause some confusion. Dr. Tedros, the W.H.O. leader, has been promoting so-called health taxes, especially in the face of plummeting American support for humanitarian aid and development assistance. In July, the health agency announced a separate initiative that calls on member states to increase taxes on tobacco, alcohol and sugar-sweetened beverages by 50 percent over the next decade. The taxes, Dr. Tedros has said, could raise an estimated $1 trillion for government health care efforts over 10 years and prevent 50 million premature deaths over 50 years.

In his opening remarks at the Africa Health Sovereignty Summit last month in Ghana, Dr. Tedros warned that a 40 percent drop this year in aid should be a wake-up call for African leaders. Health taxes, he said, would help raise funds while discouraging unhealthy behavior.

“We must all adjust to this new reality,” he said. “But in this crisis lies an opportunity — an opportunity to shake off the yoke of aid dependency, and embrace a new era of sovereignty, self-reliance, and solidarity.”