The United Nations (UN) periodically holds High-Level Meetings (HLMs) to address major health issues, and this year’s 4th such meeting focused on non-communicable diseases (NCDs), including heart disease, cancer, diabetes, and mental health.

Typically, in these meetings, Member States negotiate a Political Declaration (a non-binding statement of intent) that outlines commitments and priorities for tackling NCDs. Before the meeting takes place, a “Zero Draft” (initial version) of the declaration is prepared by the facilitators or secretariat based on initial consultations and provides a foundation for negotiations. Subsequently, Member States suggest amendments. Through negotiations, the text undergoes revisions. The final draft resulting from these negotiations is then submitted for adoption (by consensus or vote) at the HLM or the General Assembly.

 This year, the Zero Draft of the Political Declaration on NCDs set modest targets for NCDs for the first time: by 2030, 150 million fewer people are expected to use tobacco; 150 million more are expected to have their hypertension controlled; and 150 million more are expected to access mental health care. Issued in May, it also included commitments to utilise fiscal, regulatory, and health policy tools to reduce risk factors. The goal was to adopt the declaration by consensus. However, the US vetoed the process. 

Robert F. Kennedy Jr., the current United States Secretary of Health and Human Services, blocked the consensus approval of the Political Declaration. He objected to the Draft Declaration, stating that the text exceeded the UN’s mandate by prescribing national tax and regulatory policies. He framed it as an infringement on sovereignty, claiming such commitments encroach on the U.S. and other states’ rights to determine domestic fiscal and health policies. His objection forced the draft to be referred to the UN General Assembly for a vote instead of being automatically adopted, thus providing a much-needed reprieve for the tobacco, alcohol, and sugary drink industries. 

The lack of consensus was not unexpected and had been foreseen. The draft Political Declaration will now be presented for a formal vote in the UN General Assembly plenary and is likely to be decided during the current session, scheduled for October. Adoption by majority vote is almost inevitable, given that the text is non-binding and most member states support it. Countries may still suggest oral or written amendments before the vote and record “explanations of position” (formal reservations, clarifications) in the official record.

Civil society groups argue that the final text is a watered-down document that binds no one, while Kennedy frames his objection as a matter of sovereignty. Ultimately, the real winner is the industry.

Although supported by many countries, the weaker text allows nations to adapt based on their own circumstances, rather than being tied to a joint statement that might not entirely reflect their domestic priorities or policies. The absence of consensus weakens the declaration’s normative influence. Ultimately, the diluted version not only relieves WHO pressure and maintains national flexibility but also provides the tobacco and alcohol industries with space to innovate rather than face uniform global restrictions.