From Kigali to New York, Civil Society asks for the UN HLM on NCDs and why it matters for G7 countries

Author: Sarbani Chakraborty, Senior Researcher, Department of Neurology, TUM University Hospital, and Center for Global Health, School of Medicine and Health, Technical University of Munich, Germany

The UN High-Level Meeting on Non-communicable diseases (NCDs) will be held in September amidst concerns over reduced development assistance for health (DAH) and a debt crisis in Sub-Saharan Africa, where the disease burden is exceptionally high. According to WHO, in 2021, 18 million people died from an NCD before age 70 years and 82% of these premature deaths occurred in low- and middle-income countries. Nevertheless, NCDs have traditionally received only 2-3% of DAH. Many may argue, that it therefore does not matter that DAH is decreasing since the impact on NCDs is marginal – but the opposite is the case: as countries seek to replace lost funding, there is a significant risk that NCDs will be overlooked (again!) in favour of communicable diseases and maternal and child health programs traditionally financed through DAH. As the global health community stands at a crossroads, it is a good time to remind ourselves of what civil society, especially those living with NCDS, are asking of the global community.

The 4th Global NCD Alliance Forum, held in Kigali, Rwanda, from February 13–15, 2025, marked an important milestone in amplifying civil society's voice in their demands for the UN HLM on NCDS. The forum brought together over 700 delegates from more than 66 countries, including civil society leaders, policymakers, health experts, and youth advocates, to tackle the escalating burden of noncommunicable diseases (NCDs) and mental health challenges worldwide.​ It was organised around “A Time to Lead on NCDs.” Three broad themes emerged throughout the Forum: accelerating the implementation of evidence-based approaches, health financing, and meaningful engagement of persons living with the condition, whether communicable or non-communicable. It is increasingly recognised globally that these are artificial boundaries; in fact, most people live with co-morbidities that require an integrated, people-centred approach to delivering health services.

The voices of NCD advocates are increasingly asking for:

Integration of NCDs into Health Systems

 A key discussion point at the Kigali Forum was health systems integration – moving from silos to synergies in global health and ensuring that NCDs are not left behind in health systems investments. The role of integrated primary health care (PHC) as the key entry point for people and communities was highlighted. Forum sessions addressed the cost-effectiveness of integrating HIV, NCDs, and mental health services, emphasising the benefits of a unified approach in PHC settings. Rwanda, co-host of the Forum, showcased its commitment to integrating NCD services into PHC through initiatives like the PEN-Plus program. This program decentralises NCD care by training nurses and equipping health posts, especially in remote areas, to enhance screening and patient follow-up. The country's community-based health insurance scheme further facilitates access to these services. In a context of declining DAH, doing more with less will require integrated service delivery that includes NCDs.

A Strong Focus on Prevention and Control

Advocates are increasingly calling for greater investment in NCD prevention and control, supported by equity and inclusivity. The delegates emphasised the necessity for innovative financing mechanisms as a win-win for prevention and health system financing. Rwanda's Health State Minister, Dr Yvan Butera, underscored the country's proactive measures, including raising taxes on harmful products like tobacco and alcohol. These policies have resulted in a decrease in tobacco use from 14% to 7%. Furthermore, banning public smoking and implementing car-free days have enhanced public health outcomes.

Despite the potential of health taxes, this policy instrument remains underused in numerous countries. A recent article from the IMF notes: “Even though health taxes are a win-win for health and revenue, they are underused and set at too low rates. The average tobacco tax rate is 42 percent of the retail price, well below the WHO’s target of 75 percent. Alcohol and sugary drink tax rates are lower still. Moreover, health taxes are failing to keep pace with inflation, eroding their impact over time. Indeed, cigarettes became more affordable in 41 countries between 2016 and 2022.” This situation arises at a time when youth smoking rates remain high in many countries, including Germany.

Robust Data Collection and Greater Accountability

There was a strong call for robust data collection and research to inform evidence-based policies and track progress toward NCD targets. Investing in digital health tools and health information systems enhances data accuracy and accessibility. A thematic session titled “Advocacy for Accountability: What Gets Measured Gets Done” highlighted the importance of systematic data collection in driving policy and programmatic decisions. Speakers underscored that holding stakeholders accountable or measuring progress effectively is challenging without reliable data.

The forum facilitated the introduction of the East Africa Community Regional Framework, which aims to harmonise NCD policies, strategies, and interventions across member states while fostering a unified approach to NCD prevention and control.​The East African Community (EAC) Regional Health Data Governance Framework is a strategic initiative to enhance digital transformation and innovation within the health sector across EAC member states. This framework aims to establish standardised protocols for health data management, ensuring secure and efficient cross-border data sharing.

These outcomes are set to influence the agenda of the upcoming 2025 UN High-Level Meeting on NCDS, reinforcing global commitments to prioritise NCDS within health and sustainable development frameworks. As the G7 health ministers prepare to convene during the G7 Leaders’ Summit in Kananaskis, Alberta, from June 15 to 17, 2025, it is crucial to consider the requests of civil society organisations in the lead-up to the UN HLM. At a time of achieving more with less DAH, G7 health ministers should focus on integrating NCDs into health systems as a unifying theme.