On September 25, 2025, the United Nations convened its 4th high‑level meeting on non‑communicable diseases (NCDs) and mental health in New York City. Delegates from around the world expected to endorse a political declaration that would accelerate action on chronic illnesses and associated risk factors. Instead, the session ended without consensus after the United States voiced unexpected objections, delaying a formal endorsement and forcing the draft to return to the General Assembly for a vote.
Background and Draft Targets
NCDs account for about 74 % of premature deaths globally. The draft declaration recommended cost‑effective “best buys” such as taxing tobacco, alcohol and sugary drinks, reducing air pollution, and expanding access to essential medicines and services. Though the targets fell short of Sustainable Development Goal 3.4, which calls for a 1/3rd reduction in premature NCD deaths by 2030, health advocates saw the draft as a realistic step toward reversing rising chronic disease trends.
Major Targets included 150 million fewer tobacco users, 150 million more people with hypertension under control and 150 million more people accessing mental‑health services by 2030.
Objections Raised by HHS
US Health and Human Services Secretary Robert F. Kennedy Jr. delivered a fiery speech rejecting the draft. He argued the document exceeded the UN’s mandate, attacked U.S. constitutional principles and failed to address pressing health issues. Kennedy criticised language recommending taxes on unhealthy products, characterizing it as governmental overreach. He claimed the draft promoted what he called “gender ideology” and hinted at concerns over reproductive rights, though the text did not explicitly mention abortion. Kennedy stated the US would “walk away” from the declaration and insisted the draft should not have been on the agenda at all.
Reactions from Member States and Experts
The US stance drew criticism and bewilderment. Delegates from the European Union, the Group of 77 and China, the Gulf Cooperation Council, the Caribbean Community, the Pacific Islands and the Association of South-east Asian Nations (ASEAN) voiced strong support for the declaration. Leaders highlighted the enormous economic and social costs of NCDs, noting that in the Philippines alone, chronic illnesses cost the economy $13.5 billion annually. The prime minister of St. Vincent and the Grenadines said perfection was not the standard and urged countries to embrace the “broadest possible consensus.” Advocates from the NCD Alliance accused the U.S. of “sabotaging” the process; they noted that while a few countries objected, the overwhelming majority backed the declaration and momentum for action continued.
Implications and Further Steps
Because the document was meant to be adopted by consensus, the US intervention means it must now go before the full General Assembly for a formal vote. Observers expect the measure to pass despite American objections, but the incident underlines tensions between public health priorities and national interests. Health experts worry that delaying the declaration will hinder efforts to strengthen primary care for chronic diseases, integrate mental health into NCD programmes and implement proven preventive strategies.
Although the US cited unspecified concerns over parental rights and federal oversight, the draft text merely recommended that countries “consider introducing or increasing taxes” on tobacco and alcohol, expand mental‑health services and integrate NCD care into universal health coverage. As WHO Director General Dr Tedros noted, the document was the strongest to date, integrating mental health and setting measurable targets. He urged countries to focus on the root causes of disease like diet, physical inactivity, tobacco and air pollution – and to ensure access to essential medicines and care at the primary level.
