What’s the mood among delegates on the eve of the UN summit on non-communicable diseases as they gather in hotel bars and the confusion of side events in New York City?

Well, earlier in the day I went on a hike through Central Park with about 50 others in an event organised by the NCD Alliance to publicise that 300 million people are now caught up in the global diabetes epidemic. We waved helium balloons and cars honked in support from 5th Avenue. My walking partner was Allison Schauwecker, a graduate of international relations now working for a company which makes a weekly television show on US cable television for diabetic patients. It pulls in millions of viewers every week. Allison, diagnosed with Type 1 Diabetes when she was 25, carried a small bag of sweets “in case I go low.” 

We all wore blue t-shirts emblazened with the slogan “Outrage.” Is there a mood of outrage among the policy advocates here? Not really. There is quiet relief that lobbying by NGOs has had some effect on the final draft of the political declaration to be signed by 192 member states tomorrow. Witness the pledge to eliminate industrially produced trans fats in food, an acknowledgment that taxing tobacco actually works and reduces consumption (thank you, Norway for really pushing on that one) and, for tobacco at least, the recognition of the conflict of interest between industry and public health.

But there’s disappointment too: at the lack of concrete goals – crucial if health ministers want to leverage cash for NCDs from their national treasuries; there is little to nothing on curbing the harm of alcohol; the business interests of food, pharmaceutical, and alcohol companies are only checked with a light hand – the whole document is littered with acknowledgements that industry has an important role “where appropriate.” And there’s very little about improving access to drugs, no GAVI-like deals in the offing to prevent “stock outs” of oncology and diabetes drugs in countries like Kenya, which happens when the money runs out and the supply chain fails. Unlike the last UN health summit a decade ago, for HIV/AIDS, this declaration won’t be ratified by the security council, just by the general assembly. In short, it lacks clout.

The private sector is here in force, from side events organised by PepsiCo, Novo Nordisk, and Pfizer, to name just three. I keep hearing that the private sector has come in much earlier and quicker into the NCD field, compared to HIV/AIDS. They won’t be late at the table again.

At a World Bank cocktail reception last night I spoke to an executive from Medtronics, the world’s largest medical technology company. He told me the company had spent more than £7m this year alone in the run up to the summit, raising “awareness” of the need to treat NCDs to authorities in poorer countries, and training nurses in places such as Madras, India, and Rwanda. The home page on the company’s website this week exclaims that “Medtronics is taking on the global NCD challenge.”

It’s not difficult to get the NGOs to sound off about conflicts of interests. Much rarer is to hear any straight talking from government officials or WHO officials. One lone voice yesterday was the Hungarian health minister at a New York Academy of Medicine event. Miklós Szócska ignited the event with his remarks: “You have to understand how exposed poorer countries like Hungary are to the influence of multinational companies. People in my country still see smoking Marlboro and drinking Coca-Cola as an expression of freedom. We need clarity in the handling of the private sector.” Turning to the WHO he said: “You should not be encouraging member states to go into inappropriate partnerships. We have very little money so it’s hard to resist companies who offer to commercially sponsor health programmes. We are very exposed to their influencing techniques. We desperately need new investment models.”

Is there anything left to play for? Double the number of countries expected have applied to speak over the next few days, now at least 60, although few are likely to be newsworthy. I’ve been told to watch out for Australia and the EU statements. “It’s all theatre now” said one Washington-based lobbyist, suggesting the political declaration is a done deal.

And are member states expected to commit any funding in these financially straightened times? The latest draft has been watered down so countries just need to “explore the provision of predictable and sustained resources,” to fight NCDs. However, the latest economic analysis, released last night by the WHO, is compelling. It shows that scaling up an intervention package to prevent and treat NCDs in low to middle income countries costs less than $12 billion a year. Staggeringly cheap when you consider that the World Economic Forum estimates economic losses due to NCDs of nearly $500 billion a year. If governments claim there is no money to fund this $12 billion, why do they leave billions of dollars on the table by keeping tobacco taxes so low? The NCD Alliance were yesterday handing out fake $1 billion dollar notes. The stunt was to show that a 1% increase in tobacco taxes worldwide would raise $1 billion or more.

For those in need of good news, a plan to develop goals and develop metrics is emerging. There is a lot of talk, for example, about making the reduction of NCDs worldwide a new Millennium Development Goal, once some of the current ones expire. And if nothing else, this declaration does represent a strongly worded description of the scourge of chronic disease worldwide. “I really believe it’s the beginning of the end for NCDs,” said an NCD Alliance spokesperson.

Rebecca Coombes is features editor, BMJ