US blocks new UN political declaration

Meeting on September 25, 2025, at the fourth high-level meeting of the United Nations General Assembly on noncommunicable diseases (NCDs) and mental health, Member States sought to adopt an ambitious political declaration aimed at accelerating prevention and treatment efforts. The text reaffirms the goal of reducing premature mortality from NCDs by one-third by 2030 and sets measurable targets for the next five years, including on tobacco, hypertension, and mental health. But despite broad consensus, its adoption was blocked by the United States, forcing a vote in the General Assembly.[1].

A global response to a growing burden

The political declaration adopted by the Member States highlights that non-communicable diseases are now the leading cause of death worldwide, with more than 43 million deaths each year, 18 million of which are considered premature, i.e., occurring before the age of 70. Cardiovascular diseases account for the largest share of this mortality, followed by cancers, diabetes, and chronic respiratory diseases. The global burden also includes other conditions such as chronic kidney disease, oral and dental disorders, and rare diseases, which increase pressure on health systems.

The declaration emphasizes that these diseases are largely linked to modifiable risk factors, such as tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity, and air pollution. The heads of state and government reaffirmed the need for coordinated global responses, mobilizing all sectors beyond the health sector. This includes targeted prevention policies, strengthening primary care systems, establishing sustainable financing, and integrating the fight against NCDs into development strategies.

States also recognized that NCDs disproportionately affect the most vulnerable populations – people living in poverty, rural populations, communities exposed to the effects of climate change, and residents of small island developing states. These inequalities call for a collective effort to ensure universal access to prevention, screening, and treatment, in order to reduce the health, social, and economic burden of NCDs in all regions of the world.

A central section dedicated to the fight against tobacco

The new political declaration places a strong emphasis on combating tobacco use, which has been identified as the leading preventable risk factor for non-communicable diseases. With 1.3 billion users and more than seven million deaths each year, including 1.6 million linked to passive smoking, tobacco remains a major global public health issue.

For the first time, Member States have set a quantified target: to reduce the number of tobacco users by 150 million by 2030. To achieve this goal, the text encourages the implementation of proven measures, consistent with the WHO Framework Convention on Tobacco Control (FCTC). These include increasing taxation on tobacco products, strengthening health warnings, banning advertising, promotion, and sponsorship, and ensuring comprehensive protection against exposure to smoke in places of collective use: public and professional places. The declaration also broadens its scope to include new nicotine products placed on the market by tobacco manufacturers, calling on States to regulate, or even ban, e-cigarettes, heated tobacco, and other nicotine delivery devices.

The declaration also calls on Parties to accelerate the implementation of the FCTC and its Protocol to Eliminate Illicit Trade in Tobacco Products, emphasizing the need to ensure the absence of any industry interference. Finally, it emphasizes the importance of promoting safe and evidence-based cessation programs to support smokers who wish to quit. This comprehensive approach reflects the desire to strengthen prevention, reduce addiction, and prevent new generations from initiating tobacco and nicotine use.

But despite widespread support, the declaration failed to be adopted by consensus. The United States vetoed it at the last minute, stating that certain provisions—including the taxation of "unhealthy" products—exceeded the role of the United Nations and infringed on national sovereignty. Because of this American objection, the text will now have to go to the General Assembly for a vote to be formally adopted.[2].

This obstruction reflects geopolitical tensions surrounding expectations for international health regulation, and serves as a warning that global political will remains fragile, even in the face of apparent consensus.

Mental health and equity at the heart of priorities

Mental health occupies a stronger place in the political declaration, which recognizes the scale of the challenge: nearly one billion people worldwide are currently living with a mental health disorder, and suicide is the third leading cause of death among young people aged 15 to 29. States have committed to improving prevention, reducing stigmatization of those affected, and expanding access to care. A quantified target has been set: to provide mental health services to an additional 150 million people by 2030, with a focus on integrating these services into primary care systems. The very issue of addictions (tobacco, alcohol, other nicotine products, gambling, screen use, etc.) is also central to the mental health of hundreds of millions of people worldwide.

The declaration also highlights the close links between mental health, noncommunicable diseases, and social determinants of health. People with mental health conditions are at increased risk of chronic diseases, with higher rates of morbidity and mortality. States recognize the need for multisectoral policies that address these interactions and integrate mental health into national strategies to combat NCDs.

Finally, the focus is on reducing inequalities. Disadvantaged populations, older people, women, and people with disabilities bear a disproportionate burden of NCDs and mental health conditions. States committed to ensuring equitable access to prevention and care services, taking into account situations of heightened vulnerability, particularly in low- and middle-income countries and small island developing States. The declaration thus underlines the importance of an approach based on equity and respect for human rights, in order to leave no one behind in the global response to NCDs and mental health.

©Generation Without Tobacco

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[1] Press release, Fourth High-level Meeting of the UN General Assembly on the prevention and control of NCDs and the promotion of mental health and wellbeing (HLM4), WHO, published September 25, 2025, consulted the same day

[2] UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus, Health Policy Watch, published September 25, 2025, accessed the same day