WHA74.4

Having considered the consolidated report by the Director-General; 2

Recalling WHO's global action plan for the prevention and control of noncommunicable diseases 2013–2030 and the following five voluntary global diabetes-related targets for 2025: a 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases; halt the rise in diabetes and obesity; at least 50% of eligible people receive medicinal treatment (including glycaemic control) and counselling to prevent heart attacks and strokes; an 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases (including diabetes) in both public and private facilities; and a 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years;

Recalling also the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (United Nations General Assembly resolution 66/2 (2011), which recognizes the primary role and responsibility of Governments in responding to the challenge of noncommunicable diseases by developing adequate national multisectoral responses for their prevention and control;

Also recalling resolution WHA66.10 (2013) on the endorsement of WHO's global action plan for the prevention and control of noncommunicable diseases 2013–2020 and decision WHA72(11) (2019), which extended the global action plan until 2030;

Reaffirming the right of every human being, without distinction of any kind, to the enjoyment of the highest attainable standard of physical and mental health;

Recalling United Nations General Assembly resolution 70/1 (2015), which adopted the 2030 Agenda for Sustainable Development and defined the Sustainable Development Goals, as well as the associated target 3.4 of reducing the risk of premature mortality from diabetes and other major noncommunicable diseases by one third by 2030;

Having considered Annex 11 to the report of the Director-General in document A74/10 Rev.1 on major obstacles to achieving the diabetes-related targets in the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2030, including that halting the rising prevalence of diabetes, and reducing its impact, will not happen unless the five diabetes-related targets are achieved, including through reducing obesity;

Reaffirming our commitment in United Nations General Assembly resolution 74/2 (2019) to progressively cover 1 billion additional people by 2023 with quality essential health services and quality, safe, effective, affordable and essential medicines, vaccines, diagnostics and health technologies, with a view to achieving universal health coverage by 2030;

Noting that more than 420 million people are living with diabetes worldwide today, and that this number is estimated to rise to 578 million by 2030, and 700 million by 2045; 3

Noting that the increasing number of people living with diabetes is strongly associated with insufficient prevention of risk factors that underly diabetes, such as overweight and obesity, unhealthy diets, physical inactivity and tobacco use, and related to socioeconomic status and the impact of the social, economic and environmental determinants of health;

Highlighting also the commitment made to promote and implement policy, legislative and regulatory measures, including fiscal measures as appropriate, aiming at minimizing the impact of the main risk factors for diabetes, and to promote healthy diets and lifestyles;

Concerned that the number of people living with diabetes is increasing when at the same time some types of diabetes can be largely prevented with healthy diets and physical activity;

Aware that one in two adults living with diabetes type 2 are undiagnosed, and that four out of five adults living with diabetes live in low- and middle-income countries;

Deeply concerned that, while the probability (risk) of premature death from any one of the four main noncommunicable diseases decreased by 18% globally between 2000 and 2016, diabetes is showing, for the first time ever, a 5% increase in premature mortality during the same period; 4

Noting with concern that, in high-income countries, the premature mortality rate due to diabetes increased in 2010–2016, following a decrease from 2000 to 2010, and that in low- and middle-income countries, the premature mortality rate due to diabetes increased across both periods; 4

Concerned that people living with noncommunicable diseases, including diabetes, have a higher risk of becoming severely ill or dying from coronavirus disease (COVID-19), and are among those most impacted by the COVID-19 pandemic; 5

Concerned also that complete or partial disruptions to diabetes prevention and control due to the COVID-19 pandemic, including in respect of early detection and diabetic complication management services, represent significant threats to the life and health of people living with diabetes;

Noting that overweight and obesity with metabolic changes and hypertension can increase the risk of noncommunicable diseases, such as diabetes and other cardiovascular diseases;

Reaffirming that universal health coverage implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative and palliative essential timely measures and health services, promotion of lifestyle changes, healthy and balanced diets and regular physical activity and essential, safe, affordable, effective and quality medicines and vaccines, while ensuring that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor, vulnerable and marginalized segments of the population; 6

Reaffirming also our commitment in United Nations General Assembly resolution 73/2(2018) to further strengthen efforts to address diabetes as part of universal health coverage through intensified interventions at the primary health care level, including in low- and middle-income countries, on prevention and control of diabetes;

Emphasizing the importance of prevention and control of diabetes over the life course, especially among children and adolescents and their families, through reducing major risk factors, including unhealthy diets and physical inactivity, as well as raising awareness of and reducing the impact of the main risk factors and recognizing that early detection of diabetes offers an opportunity for timely initiation of treatment to improve health and well-being and reduce morbidity, disability and mortality;

Recognizing the role of insulin in the treatment of type 1 diabetes and of type 2 diabetes resistant to lifestyle changes and other drug therapies;

Noting that, out of 420 million people living with diabetes, all require appropriate diabetes management, and an estimated nine million people with type 1 diabetes require insulin to survive and around 60 million people with type 2 diabetes require insulin to manage their condition; and further noting that the need for insulin required to treat type 2 diabetes is expected to increase by more than 20% by 2030;

Recognizing that insulin is an essential life-saving medicine, but deeply concerned that despite being discovered 100 years ago in 1921, globally about half of the people in need of insulin have no or irregular access, with unacceptable inequities between and within countries;

Concerned that insulin is largely unaffordable for people paying out-of-pocket and that its high prices are a burden for national health systems, and noting the significant role that mark-ups along the value chain may play in pricing for patients and health systems;

Recognizing the importance of international cooperation in support of national, regional and global plans for the prevention and control of diabetes, including to increase access to treatment such as insulin, with a view to reducing the negative socioeconomic impact of diabetes that significantly affects the quality of life of persons with diabetes and their families in every country, especially in developing countries;

Noting with appreciation the WHO Global Diabetes Compact initiative – launched on 14 April 2021 during the Global Diabetes Summit, co-hosted by WHO and the Government of Canada, with the support of the University of Toronto – which aims to reduce the risk of diabetes, and ensure that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care,