Guidance intended to curb diseases caused by tobacco, alcohol and unhealthy foods has been watered down in advance of a key United Nations convening, alarming some civil society and public health groups. 

Commitments to impose taxes on sugary drinks, require graphic warnings on cigarette packs and restrict alcohol advertising, all evidence-based public health interventions, were cut from the latest draft of a UN declaration on how member states will prevent diseases like cancer, diabetes and obesity, according to The Examination’s review of the document.

The political declaration, due for approval at the UN General Assembly’s meeting on Sept. 25, is a collective statement by member states about how they will tackle noncommunicable diseases, the leading cause of preventable death and disability worldwide. 

Civil society and public health groups that have followed negotiations over the agreement say that some countries, under pressure from the food, beverage, alcohol and tobacco industries,  argued for the removal of language committing to ban advertising, require warnings and impose taxes.

Though not legally binding, the agreement will set the agenda for legislation globally. And with critical elements stripped out or softened, public health advocates argue that the declaration could be meaningless.

“As negotiations continue, we are deeply concerned that the draft is significantly less ambitious and that renegotiations will lead to further weakening of the text,” said Alison Cox, director of policy and advocacy at the NCD Alliance, one of the groups that have spoken out on the changes.

Noncommunicable diseases, which also include heart disease and chronic respiratory diseases, are responsible for more than 43 million deaths each year, including 18 million people under 70 years old, according to the UN. 

The Global South bears a disproportionate share of the burden. In 2022, the World Health Organization estimated that 86% of people who died prematurely from noncommunicable diseases lived in low- and middle-income countries.

Safura Abdool Karim, a public health lawyer in South Africa and an adjunct professor at Columbia University, said she is deeply concerned about the weakening of the document. 

“It’s supposed to be the bold agenda we aspire to until the next political declaration comes around — not a humble, conservative set of asks,” she said. “We need to push our states to exercise political will to address this problem.” 

Declarations like this are important, she said, because they set expectations for what countries should do to tackle these diseases.

“We know that these measures are deeply contentious. We know that they are vehemently opposed by industry actors,” Karim said. “By having something that is an international document that says, this is what you should do to prevent this illness, you are providing countries with ammunition” to defend measures to combat these diseases.

The groups that spoke with The Examination didn’t provide evidence of industry influence. The Examination has reported on British American Tobacco’s efforts to weaken health warnings on nicotine pouches in Kenya, where officials later introduced precedent-setting graphic warnings, and aggressive industry lobbying to derail or defang sugar taxes in South Africa and other countries. 

The Examination sought comment from tobacco companies British American Tobacco, Japan Tobacco International, Imperial Brands and Philip Morris International; the International Tobacco Growers Association, which is a membership organization for tobacco growers; the International Food and Beverage Alliance, which represents the food and beverage industry; and the alcohol industry group the International Alliance for Responsible Drinking. None answered our questions.

The agreement is still being negotiated and the final version will reflect consensus among member states, a spokesperson from the Office of the President of the General Assembly told The Examination. 

Sugar taxes dropped

The original draft of the declaration, published in May, said countries will “increase taxation on tobacco, alcohol and sugar-sweetened beverages,” in line with World Health Organization recommendations. 

The latest draft, dated Aug. 4, drops sugary drinks from that statement and softens the language, saying countries should “consider introducing or increasing taxes on tobacco and alcohol to support health objectives.” 

Karim criticized the removal of the call for taxes on sugary drinks given there is so much evidence that they are harmful. Many low- and middle-income countries already have sugar taxes. 

The omission contradicts the WHO’s recent call for countries to increase prices of tobacco, alcohol and sugary drinks by at least 50%, which is meant to reduce consumption, curb chronic diseases and generate revenue for health care, education and other needs. 

Tobacco advertising, packaging restrictions dialed back

The current draft weakens language on implementing plain packaging for tobacco — free of any brand imagery or colors — and graphic warnings. It suggests “restricting” tobacco and nicotine advertising, promotion and sponsorship rather than “eliminating” it, as the initial draft recommended.

Dr. Prabir Chatterjee, a community medicine doctor at a rural clinic in West Bengal, India, criticized the rollback on advertising bans. 

“If you say restriction is your goal, then you'll fall short of even that goal,” he said. “Your goal has to be a little higher.”

Though India requires warnings on tobacco packaging, it doesn’t require plain packaging. Chatterjee said states’ enforcement of advertising restrictions is weak and that tobacco companies market to young people. 

Most of his patients suffer from chronic illnesses, he said, with many linked to smoking or indoor pollution. Every day after work, he said, he collects packets of chewing tobacco discarded at the clinic entrance. 

For electronic cigarettes and heated tobacco products, the most recent draft of the UN declaration changes the wording from “restrict and regulate” to “regulate, as appropriate.” 

Catherine Egbe, senior specialist scientist at the South African Medical Research Council, said this change is significant because these products are not now covered under her country’s tobacco control law.

“The UN must be clear and avoid provisions that leave nations in doubt, because that creates a loophole for the industry to exploit,” she said. 

Causes of obesity revised, food warning labels cut

The May draft said that “obesity is largely driven by unhealthy food environments and lack of physical activity.” The revised version attributes obesity to “multiple factors, including the unaffordability and unavailability of healthy diets, lack of physical activity, sleep deprivation, and stress.” 

Karim said it’s ridiculous to suggest that stress and sleep deprivation contribute to obesity in the same way as unhealthy food. “People are not developing obesity because they are stressed and don’t sleep enough,” she said.

She said it’s critical to tie obesity to food environments in which healthy foods have been replaced with “unhealthy, affordable, highly palatable, borderline-addictive, processed foods.”

Front-of-pack food labels have also been reframed. The latest UN draft specifies that these labels should “provide nutritional information to consumers” rather than warning them about high levels of salt, sugar or fat. 

Lawyers and researchers said there’s a big difference between nutritional labels and warnings. Nutritional labels simply list data, such as "44g of sugar," without putting it in context; warnings say whether that’s a lot of sugar.

Warning labels are more effective at helping consumers make healthier choices than nutritional labels alone, said Lindsey Smith Taillie, a nutrition epidemiologist at the University of North Carolina’s Gillings School of Global Public Health.

“By diluting this language and making it less specific, they're providing a ton of wiggle room for the food industry to essentially prevent meaningful regulation,” she said.  

Steps to curb alcohol consumption, drunk driving gone

Specific policies to tackle harmful alcohol use were scrapped as well. 

The original draft from May urged countries to ban or restrict alcohol advertising, restrict alcohol availability and enact and enforce drunk-driving laws. Those measures have vanished, despite WHO findings that excess drinking kills 2.6 million people each year and its announcement in 2023 that no level of alcohol consumption is safe.

Maik Duenbbier, director of strategy and advocacy at Movendi International, a global nonprofit organization focused on alcohol policy, expressed shock that the draft UN declaration is weaker than the WHO’s 2022 global alcohol action plan. That plan, unanimously backed by member states, says reducing the harmful use of alcohol is a public health priority.