With just two weeks remaining before the UN’s fourth High-Level Meeting (HLM4) on Noncommunicable Diseases (NCDs) and mental health, civil society groups are warning that chronic underinvestment in essential NCD medicines and services is threatening global health.
The Geneva-based NCD Alliance, a coalition of over 500 organizations, has urged governments—including Bangladesh’s—to step up spending and strengthen health systems.
On Wednesday evening, the Alliance launched its latest benchmark report, “Delivering on Health and Financial Protection for All: Government Spending on Essential NCD Medicines and Services”, authored by researchers at the University of Washington. The study reveals that most countries spend only 0.26% to 0.46% of their gross national income (GNI) on NCDs—far below the recommended 1.1% to 1.7% needed to achieve universal health coverage.
“Ministries of Health and Finance must act decisively,” said Dr David Watkins, lead author of the report. “This analysis provides governments with data to support smarter investment in NCDs, mental health, and neurological conditions. It’s not just about increasing investment but about making health budgets go further.”
The report highlights the fact that access to medicines remains the single largest barrier to expanding NCD services, particularly in low- and middle-income countries (LMICs). Many patients are forced to rely on out-of-pocket spending, creating what the Alliance calls a “double-edged sword”: low access to essential drugs alongside high personal costs.
Bangladesh, like other LMICs, faces a heavy NCD burden. Heart disease, diabetes, cancer, and chronic respiratory illnesses account for the majority of deaths, while mental health and neurological conditions remain underfunded despite affecting millions. Public health experts warn that the country risks falling further behind on health-related Sustainable Development Goals if investments are not scaled up.
“Governments must commit to targets for financial protection and access to affordable medicines,” said Katie Dain, the NCD Alliance CEO. “Every year, millions are driven into poverty by out-of-pocket costs. Yet negotiations for HLM4 have diluted commitments, favouring industry interests over public health.”
The report also shows that medicine prices vary widely across countries, with potential savings of 20% to 50% if governments secure the best available rates globally. Such cost efficiencies could free up resources to strengthen health systems.
Every year, NCDs kill 43 million people worldwide—over 75% of all deaths. In LMICs, they claim more lives under 40 than HIV, TB, and maternal deaths combined. Meanwhile, 970 million people live with mental health conditions globally.
Bangladesh’s civil society groups, already engaged in campaigns against tobacco use, unhealthy diets, and physical inactivity, are expected to join the global “Time to Lead” campaign during the Global Week for Action on NCDs (September 18–25).
“This is a critical moment,” said Nupur Lalvani, a member of the Our Views, Our Voices Global Advisory Committee. “People living with NCDs know what works—and so do governments. What we need is leadership, funding, and accountability. The world is watching.”
The HLM4 will convene on September 25 in New York, where governments are expected to finalise a political declaration on NCDs and mental health. Advocates fear that draft commitments on health taxes and prevention policies have been weakened, resulting in a weaker global framework.
During a media telebriefing, Alison Cox, Policy and Advocacy director at the NCD Alliance, said tackling NCDs requires a multisectoral approach. “It’s not just about health—it involves prevention measures and investing in healthcare systems. Bangladesh needs a strong government commitment and an investment of about 1–1.5% of GDP in NCDs,” she added.
Dr David Watkins noted Bangladesh has made significant progress in accessing health services in recent years. “Historically, it has been a leader in the region. Innovating in primary care to deliver better, high-quality chronic care will remain a priority,” he said.
Nupur Lalvani, Founder and CEO of Blue Circle Diabetes Foundation, emphasised that focusing on health promotion and prevention is key for Bangladesh.
