Monika Arora, President of the NCD Alliance, delivered a powerful opening speech at the fourth Global NCD Alliance Forum in Kigali, Rwanda, on February 13, 2025. Addressing 700 delegates from 66 countries, Arora highlighted the urgent need for action against noncommunicable diseases (NCDs), emphasizing that progress towards 2025 targets is off track and 2030 SDGs are at risk. She acknowledged some advancements in legislation and prevention efforts while stressing the unacceptable human toll of NCDs and the persistent high prevalence of risk factors. Arora called for political leadership and increased financing to scale up implementation of solutions, setting the tone for the three-day Forum aimed at turning the tide on NCDs and preparing for the upcoming UN High-Level Meeting on NCDs. What follows is a transcript of her full speech:

Good afternoon and Namaste from India:

Honourable Minister of State, Dr. Yvan Butera:

Delegates, ladies and gentlemen:

It is my honour to warmly welcome you to the fourth Global NCD Alliance Forum in the beautiful city of Kigali. We are delighted to be hosting this Forum in Sub-Saharan Africa for the first time and in Rwanda, a country that has made remarkable progress in health and NCDs and is a champion regionally and globally.

So let me start by thanking the Honourable Minister of State Dr Yvan Butera, the Ministry of Health and Prof Claude Mambo Muvunyi, Director General, the Rwanda Biomedical Centre for your leadership and collaboration.

I would also like to sincerely thank the Rwanda NCD Alliance, our local host. The Leona M. and Harry B. Helmsley Charitable Trust, our strategic partner that shared our vision for this event from the outset. And our 38 other sponsors for your collaboration and partnership.

Ladies and gentlemen, it was five years ago almost to this day that we convened in Sharjah in the UAE for our last Forum, under the patronage of Her Highness Sheikha Jawaher Bint Mohammed Al Qasimi

In these five short years, the world has changed dramatically. We are living in polarised and uncertain times, with rising geopolitical tensions. The US government announcement to freeze foreign aid and withdraw from WHO has sent shockwaves around the global health community. Paralysing health programmes and overturning the health financing landscape as we knew it.

The era of poly-crisis is upon us, with pandemics, climate change, conflicts and humanitarian crises locking horns in all corners of the world.

At the centre of this storm are people living with NCDs and vulnerable children exposed to NCD risk factors.

I would like to take a moment to hold space for the 215 million people that lost their lives due to NCDs in these last five years. 215 million. To put that into context, that is the population size of Nigeria. These aren’t anonymous numbers, these are people we know, members of our community, our family members and friends, whose precious lives could have been saved.

156 million of those people lived in low- and middle-income countries, such as my home country India.

Agonisingly, 90 million of these deaths happened before their 70th birthday. They could have been prevented or delayed.

Ladies and gentlemen, these numbers are unacceptable. To put it bluntly, promises made by governments are ringing hollow. Progress towards the 2025 targets is wildly off track, and the 2030 SDGs hang in the balance.

As a result, we are living in a world where NCDs, ill health and disability are the norm rather than the exception. Today there are 1 billion people living with obesity, 1.3 billion are hypertensive, a billion are living with a mental health disorder, and half a billion people are living with diabetes and chronic respiratory diseases. These numbers dwarf many other health issues combined, and are likely to be just the tip of the iceberg.

We know well that prevention is the answer for turning the tide on NCDs. COVID-19 was, and still is, a wakeup call for investing in healthy resilient populations. Strong inroads have been made thanks to the hard work of many in this audience in creating healthier environments and reducing the risk factors.

More countries today have legislation in place to tax unhealthy products, restrict marketing and improve front of pack labelling, than five years ago.

Yet still, prevalence of the risk factors remains stubbornly high, and the world is on a collision course to miss all of the 2025 risk factor targets. No doubt the multinational companies that are fuelling this epidemic are celebrating this as a win. Profits are still trumping lives.

The burden of NCDs not only impacts health in our societies but adversely human capital development and economic prosperity of our countries. For governments and families alike, they represent an economic emergency, draining health budgets, undermining productivity and pushing whole families into cycles of poverty.

Still today, access to care remains a distant reality for millions of people living with NCDs in low- and middle-income countries. Postcode lotteries are still determining if you have access to life saving treatment or not, if you live or die. Health systems are not wired to respond to and manage chronic diseases.

But it does not have to be this way. It shouldn’t be. The solutions, the science, and the levers are at our fingertips. We are ready to go when it comes to the how. What is needed is political leadership and financing to rapidly scale implementation.

And we are seeing glimmers of hope. Glimmers of success that we can point to and be reenergised by. The promise that integrated care models are bringing for multiple health gains. The opportunity of novel innovative medicines that are improving outcomes. The victories of legislation that are promoting healthier environments. The step change we have seen in commitment to meaningfully involve people living with NCDs, something we were calling for 5 years ago in Sharjah. And the leadership and growth of NCD civil society that is so evident in this hall today.

It is important we celebrate these successes, learn from them, and unite. Particularly this year, the year of the fourth UN High-Level Meeting on NCDs.

And this is why we are gathered here in Kigali. Over the next three days, we come together as 700 delegates across all sectors and from over 66 countries under a shared objective - to ensure this High-Level Meeting year is truly a turning point in the NCD response. We have 72 national and regional NCD alliances present, many of our members, and strong lived experience advocates. We also have 60 youth delegates with us to shape the NCD agenda and response. We look forward to the launch of the Call to Lead and the Kigali Youth Statement into a comprehensive and equitable response to NCDs.

Our vision and goal for this Forum is that it is a fuelling station, a strategy touch point and a catalyst for action and partnerships. Our programme spans 5 plenaries, 21 parallel sessions, 18 satellite sessions. And is structured around 3 themes or ingredients needed to move the needle – leadership, financing and community.

In these turbulent times, we need bold leadership that embraces solidarity over division, co-creation over isolation, and collaboration over self-interest. The NCD community is impatient for change, and this year’s Forum is our opportunity to see it happen.

Thank you.