Offline: NCDs, WHO, and the neoliberal utopia

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The WHO Independent High-Level Commission on Non-Communicable Diseases presented an important opportunity. Yet, by common consensus, it failed to deliver. The Guardian newspaper reported that, “An independent panel advising the World Health Organisation has stopped short of recommending taxing sugary drinks to reduce obesity after failing to reach a consensus.” WHO scrambled to reassure critics that the agency “still supported taxing” sugar-sweetened beverages. The Commission was left unhappily advocating a set of recommendations substantially weaker than those already existing. Dr Tedros, WHO's Director-General, rejected the Commission's conclusions. “WHO's position cannot change because of this report”, he commented. Critics called the Commission's findings “scandalous”, “startling”, “vague”, “absurd”, “limp”, “lacklustre”, “disappointing”, “unfortunate”, and “sugar-shy”. Overall, the Commission left global health advocates underwhelmed. As one Commissioner wrote to me, “You win some…”. His implication? We lost this one. Although the Commission was certainly disappointing in several ways—and the Commission co-chairs pointed these deficiencies out themselves—such negative interpretations are unfair and mistaken. The Commission was direct in the scale of the challenge it sees ahead. Despite myriad well-intentioned declarations, conventions, commitments, roadmaps, goals, and targets, commissioners underlined a “lack of adequate global progress”, concluding without equivocation that SDG 3.4 (to reduce premature mortality from NCDs by one third) “will not be met”. As a result, their recommendations were not only directed at the usual suspects—ministers of health and the broad global health community. Instead, they appealed to Heads of State. It was they who needed “to accept primary responsibility for taking action”. The Commission went beyond the traditional 4x4 NCD agenda (four main diseases, four main risk factors). It widened its circumference of concern to include mental health, dementia, and air pollution, emphasising the importance of taking a life-course and gendered approach. The Commission pulled no punches about the obstacles to progress: lack of political action, damaging commercial and market forces, no money, and zero accountability for promises easily made and later broken. Now turn to the recommendations. Heads of State need to take responsibility and set priorities. Achieving universal health coverage will be critical. Effective regulation is essential. Although no sugar-sweetened beverage tax was proposed specifically, the Commission did recommend that “fiscal [ie, tax] incentives and disincentives should be considered to encourage healthy lifestyles by promoting the consumption of healthy products and by decreasing the marketing, availability, and consumption of unhealthy products”. Commissioners called for “evidence-based fiscal measures” to reduce the use of unhealthy foods and beverages. The Commission demanded a huge scale-up in financing, proposing new NCD-specific financial instruments, such as a multidonor trust fund. And finally, the Commission called for the creation of an independent accountability mechanism—a Countdown 2030 for NCDs—to monitor and review progress, and to call out those who failed to act on their prior commitments. When you look at the totality of the Commission's proposals, it is far too harsh to call it a failure. On the contrary, it has set a high bar to judge progress in countries and has provided an ambitious manifesto for the UN High-Level Meeting on NCDs, to be held later this year. There are two further important reasons why the Commission should be judged a success. First, it flushed out the chief opponent of political progress—the US Government. As Jamey Keaten and Maria Cheng reported for the Associated Press, it was the US representative on the Commission, Eric Hargan, who “torpedoed” efforts to add a recommendation on taxing sugar-sweetened beverages. Now we have a target: the US administration, which has adopted an anti-science position on fiscal interventions and whose raison d'être is to defend health-harming industries. Second, the controversy over the Commission's report highlights the context of the debate about NCDs—namely, the pervasive and escalating dangers of neoliberalism. We should thank the Commission for so expertly clarifying the terms on which the struggle against NCDs must now be fought.