By President and CEO Mary-Ann Etiebet, M.D.
We cannot afford to ignore accelerated efforts to create saturated markets for unhealthy commodities in low and middle-income countries. Instead, let’s come together to build sustainable markets for health.
On the sidelines of the Global NCD Alliance Forum 2025 in Kigali, Rwanda, I had the opportunity to address a roundtable of journalists on the pressing challenges, opportunities, and way forward for and preventable addressing the world’s leading causes of premature deaths – noncommunicable diseases (NCDs) like heart disease, cancer, diabetes, and respiratory illnesses.
Here are five of my key points:
- NCDs are preventable—but only if we stop treating them as personal failures. Far too often and for too long, we’ve placed the burden of chronic disease prevention on individuals. To prevent diabetes, you need to lose weight; to reduce your risk of cancer, stop smoking; to prevent obesity, eat healthy foods; to have less trouble breathing, exercise more. But these conditions don’t exist in a vacuum. They are symptoms of broader economic, social, and commercial systems – ones that flood markets with ultra-processed foods, expose populations to toxic air, and aggressively market harmful products.
- Public health systems are crumbling under the weight of chronic diseases – but what got us here won’t get us where we need to go. Our public health systems were built over a century ago, primarily to protect the public from infectious diseases, and they have done so with extraordinary success. Public infrastructure and services that ensure clean water, vaccines, and antiretrovirals reach communities in need have doubled global life expectancy since 1900. But today, NCDs account for over 75% of global deaths. Our legacy public health infrastructure is not designed, equipped or resourced to reduce risk factors for noncommunicable diseases and injuries. As a result of failing to protect communities from these newer threats to life and well-being, they are losing the public’s trust.
- Health taxes are an untapped opportunity to save millions of lives – as well as generate revenue to support health care budgets and invest in public health systems. Unhealthy commodities like tobacco, alcohol, and sugary drinks are linked to over 10 million deaths annually. If all countries increased excise taxes to raise their prices by 50%, we could prevent 50 million premature deaths over the next 50 years. And it’s not just a health win—it’s an economic one. These taxes could raise $3.7 trillion in just five years, with over half of that revenue benefiting LMICs. They have the potential of increasing government spending on health care by 40% and creating a stable and sustainable source for domestic resource mobilization.
- Death, disease and disability from NCDs are not experienced equally – closing the gap on NCD prevention, control and care is a health equity issue. 85% of premature and preventable NCD deaths occur in low- and middle-income countries and this disparity is expected to worsen. These countries – the new “food deserts” – are facing aggressive and false marketing of harmful commodities like tobacco, alcohol, ultra-processed food and sugary beverages products that directly contribute to over 10 million deaths a year. With global financing for NCDs plateauing at less than 3% of development assistance, there is limited funding available for public awareness and prevention campaigns that effectively communicate accurate and culturally relevant information.
- The solution to save lives at scale exists – what’s missing is the [political] will to implement them. Since 2019, global progress on health tax policies has stalled. In contrast to the global status quo, earlier this month, Rwanda announced plans to increase taxes on tobacco and alcohol that are helping to pay for expanded health insurance coverage for NCD prevention, care and treatment. Can we build on this pocket of leadership and build the momentum that will hold political leaders at global, regional, national and local levels accountable for action? Will we also hold global financing institutions and global health funders accountable for incentivizing these solutions and supporting coordinated and complementary actions, instead of competing efforts?
For every dollar invested in a WHO Best Buy for NCD prevention and care – there is a $7 return on investment as a result of healthier lives, increased productivity and economic development. As we look ahead to the United Nations High level Meeting on NCDs this September, Vital Strategies is calling on governments, policy makers, the private sector and other institutions at global, national and municipal levels to help build the public health systems of the future that can effectively and sustainably tackle the growing burden of NCDs. To do so we must:
- Let the data guide priority-setting
- Invest in evidence-based win-win solutions like health taxes
- Build cross-sector partnerships to drive policy change that create environments where the default way of life is a healthy way of life.
The window for action is now. The current crisis in global health financing has highlighted the need for reliable sources of domestic revenue. It is creating an opportunity for coalescing around bold and decisive action that will drive substantial savings in lives while building more sustainable markets for health. Together, we can build more responsive and resilient public health systems that help to create a world where people can live their healthiest and most vital lives.
We asked our staff to guess what percentage of global health funding goes towards Noncommunicable diseases.