ForumCCNTs' and partners' response to Zero Draft of the Political Declaration on NCDs and Mental Health 2025

The Intersectoral Forum of Noncommunicable Conditions in Brazil (FórumCCNTs), in partnership with specialists and representatives from various partner institutions who jointly signed the document, submitted a technical letter to the Minister of Health, Dr. Alexandre Padilha. The letter requests that Brazil propose the inclusion of three strategic themes currently absent from the Zero Draft of the new UN Political Declaration on NCDs and Mental Health:

🔹 Sleep disorders as a relevant risk factor for chronic health conditions; 

🔹 Vaccination as a priority protective measure for people with CCNTs; 

🔹 Social participation as a structuring principle for prevention and care policies.

The UN Political Declaration is an official international document, agreed upon by Heads of State and Government, which defines priority commitments for global public health. It guides national actions, investments, and policies, and is considered one of the most influential tools in the field of global health. The next version will be launched during the 4th High-Level Meeting of the UN General Assembly on CCNTs and Mental Health, scheduled for September 2025, in New York.

The FórumCCNTs' recommendations are based on scientific evidence and successful Brazilian experiences, such as the update of the Type 2 Diabetes Mellitus Clinical Protocol and Therapeutic Guidelines (PCDT), which now recognizes obstructive sleep apnea (OSA) among the main risk factors for T2DM and cardiovascular diseases. This change, built with technical support from CONITEC and active contribution from FórumCCNTs, represents an evidence-based public policy that can serve as an example for other countries.

FórumCCNTs also highlights the importance of annual vaccination, especially against influenza and COVID-19, as a vital tool to reduce hospitalizations and deaths in people with CCNTs — a gap not yet addressed in the Zero Draft. Furthermore, it reiterates Brazil's leadership role in social participation, recalling that the country was one of the proponents of the resolution on the topic at the 77th World Health Assembly, although the current UN text omits explicit mention of this essential principle for ensuring inclusive, legitimate, and effective policies.

Read the full letter below:

Official Letter No. 007/2025 - FórumCCNTs

São Paulo, May 26, 2025.

To His Excellency, Dr. Alexandre Rocha Santos Padilha Minister of Health Ministry of Health of Brazil Telephone: (61) 3315-2393/2580

Subject: DEADLINE MAY 27, 2025 - Recommendation for intervention with WHO regarding the Zero Draft on NCDs for the 4HLM-NCDs-UNGA.

Your Excellency, Minister of Health,

FórumCCNTs, an initiative aimed at fostering partnerships between the public sector, private companies, and third-sector entities (Sustainable Development Goal - SDG 17) for the development and implementation of effective, sustainable, and scalable solutions for Non-Communicable Conditions (CCNTs), currently counts on the participation of over 250 institutions committed to Brazil achieving SDG 3, target 3.4. We respectfully, through this official letter, on behalf of dozens of specialists and participating institutions of the Brazilian Intersectoral Forum on Non-Communicable Conditions (FórumCCNTs), representing millions of people with CCNTs in the country, request, with utmost urgency, the intervention of the Brazilian Ministry of Health with the World Health Organization (WHO), by submitting a proposal for adjustments and improvements to the Zero Draft document of the new Political Declaration of the 4th UN High-Level Meeting on CCNTs and Mental Health (1). Only WHO Member States can request adjustments to this document, and the deadline is May 27, 2025.

The objective of this intervention is to ensure the inclusion of three essential, evidence-based points, currently absent from the text, in which Brazil has demonstrated global leadership: sleep disorders, vaccination as a cost-effective measure to prevent the worsening and complications of CCNTs, and social participation as a structuring principle for the formulation and implementation of public health policies.

Sleep disorders significantly impact physical, mental, and metabolic health, being highly prevalent and risk factors for the most common CCNTs, including: type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), obesity, and mental disorders (3)(5)(6). Obstructive Sleep Apnea (OSA) is estimated to affect up to 1 billion people worldwide (5) and between 32.9% to 83% of the Brazilian population, depending on the diagnostic criteria used (16). OSA directly contributes to the development of T2DM through mechanisms such as insulin resistance, systemic inflammation, and sympathetic nervous system activation (15)(16), and is present in 77% of obesity cases, 30–83% of hypertension, 48% of T2DM, and up to 65% of stroke cases (7)(8)(9).

Despite this, sleep disorders are still not treated with the same priority as other modifiable factors, such as smoking and sedentary lifestyle (5)(6). Their association with hormonal, inflammatory, and immunological changes exacerbates the course of CCNTs, increasing morbidity and mortality, in addition to impairing quality of life (11)(12)(13). When treated, significant improvements in clinical indicators and a reduction in the burden on health systems are observed (10)(14). In an article published in the British Medical Journal, Brazilian specialists — including FórumCCNTs members — warn of the urgency of including sleep disorders, especially OSA, in global CCNT prevention strategies, as well as the risks of not achieving SDG 3.4 by failing to include them among the risk factors for the most prevalent CCNTs and addressing this problem that affects over 50% of the adult population (6)(26).

In this regard, we highlight the recent update of the Clinical Protocol and Therapeutic Guidelines (PCDT) for Type 2 Diabetes Mellitus, conducted by the National Commission for the Incorporation of Technologies in the SUS (CONITEC) (2) and with the collaborative involvement of FórumCCNTs (3)(4)(5), whose recommendations were accepted and integrated into the national guideline, which now recognizes sleep disorders, especially OSA, among the main risk factors for T2DM and CVD. Given Brazil's leadership, with this important adjustment to the T2DM PCDT, we believe it will be fundamental to guide the WHO to include sleep disorders in this important document to be agreed upon, thus adjusting the Zero Draft.

Another point not included in the Zero Draft document is vaccination as a priority risk reduction measure for people with CCNTs. During the pandemic, people with CCNTs were disproportionately affected, with a higher risk of hospitalization, severe complications, and mortality, even in countries with structured health systems (17). Respiratory infections — such as influenza and COVID-19 — pose a high risk for these individuals, potentially worsening conditions such as T2DM, CVD, COPD, and obesity, leading to avoidable hospitalizations, clinical decompensations, and deaths (17)(18).

International studies demonstrate that annual influenza vaccination significantly reduces cardiovascular mortality, being even more effective than statins in preventing acute cardiac events in certain populations (19). Vaccination also has indirect effects on reducing hospital overload, hospitalization costs, and the interruption of chronic condition management (20)(21).

Despite this, vaccination as a specific strategy for people with CCNTs - except for HPV and hepatitis B vaccines for cancer prevention - is not reflected in the Zero Draft, representing a worrying technical gap to be corrected. Brazil, which stands as a global reference in vaccination coverage, with a robust, free, and universal National Immunization Program (PNI) (22), is concrete evidence that vaccination can be operationalized on a large scale with equity and effectiveness and reinforces the urgency of its inclusion in the final text of this Political Declaration.

Finally, Brazil has distinguished itself as a global reference for its firm commitment to participatory democracy in the formulation and monitoring of public health policies, even being one of the proponents of the resolution "Social participation for universal health coverage, health and well-being," approved during the 77th World Health Assembly in 2024 (23).

Despite some allusions to civil society participation, the term "social participation" does not appear in the document, nor is there a reference to the main documents that guide the implementation of this strategy, including especially the WHO Social Participation for Universal Health Coverage technical paper (24) and the WHO Framework for Meaningful Engagement of People Living with Noncommunicable Diseases and Mental Health and Neurological Conditions (25). The absence of this dimension in the Zero Draft contrasts with the commitments made by Member States and with the principles of equity, social justice, and inclusive governance — all fundamental for addressing CCNTs and promoting well-being. The explicit inclusion of social participation in the final text of the Political Declaration strengthens accountability, expands the reach of actions, and contributes to more effective and sustainable public policies, considering that the effectiveness and legitimacy of public health policies are enhanced when there is active listening from people with lived experience, co-responsibility, and social control.

We take this opportunity to mention that we support the adjustments to the Zero Draft recommended by the NCD Alliance entity, while believing that the three aspects above should be prioritized, as they are Brazil's strengths, with the potential to significantly improve this document. We reiterate, therefore, our request that Your Excellency forward to the UN, by May 27, 2025, the formal request for the inclusion of sleep disorders, regular vaccination for people with CCNTs, and social participation as essential components of the new Political Declaration on CCNTs and Mental Health.

We remain available to contribute with additional technical information and institutional support to the Brazilian Government in this important diplomatic advocacy movement for global public health.

Respectfully,

Mark Barone, PhD 

Founder and General Coordinator 

Intersectoral Forum of NCCs/NCDs in Brazil (FórumCCNTs)

Ana Carolina Micheletti Gomide Nogueira de Sá, PhD 

Associate Professor, Maternal-Child and Public Health Nursing Department School of Nursing, UFMG

Adriana Mazzuco, PT, PhD 

Physical Therapist Supervising Professor, Physical Therapy Department, Paulista University - Health Clinic of Paulista University - Health Clinic, Collective Health and Geriatrics area 

Member of the Physical Activity Working Group of FórumCCNTs

Átila Alexandre Trapé, MD, PhD 

Associate Professor, Ribeirão Preto School of Physical Education and Sports (EEFERP-USP) 

Leader, Study and Research Group on Physical Education and Collective Health (GEPEFSC) 

Member of the Physical Activity Working Group of FórumCCNTs

Balduino Tschiedel, MD 

President 

Children with Diabetes Institute

Camila Medeiros da Silva Mazzeti 

Associate Professor, Faculty of Pharmaceutical Sciences, Food and Nutrition (FACFAN)

Coordinator, Observatory of Chronic Conditions and Food (OCCA) Federal University of Mato Grosso do Sul (UFMS)

Camila Mendes Kneip 

Nutritionist, postgraduate in public management (UTFPR) and specialist in positive psychology 

Social projects manager and associate of Instituto Bem do Estar 

Founding member of Vertentes - Mental Health Ecosystem

Claudia Roberta de Castro Moreno, PhD 

Full Professor, Department of Health and Society Faculty of Public Health University of São Paulo 

Vice-president of the Brazilian Academy of Sleep (2019-2022) 

Member of the Brazilian Academy of Sleep

Dani Mothci 

CEO, International Alliance of Patients' Organizations (IAPO)

Daniel Wainstock, JD 

Lawyer Researcher in Public Policy and Global Health Youth Leader of Rare Diseases International (RDI) 

Co-Founder of Instituto Raízes

Dhiãnah Santini de Oliveira Chachamovitz, MSc, PhD 

Endocrinologist and Metabolist Physician 

Director of Education and Campaigns, Brazilian Diabetes Society Member of the Brazilian Society of Endocrinology and Metabology 

Professor of Endocrinology and Internal Medicine at IDOMED Researcher at DASA

Elton Junio Sady Prates, BSN 

Secretary-General Brazilian Nursing Association, Minas Gerais Section (ABEn-MG)

Emerson Cestari Marino, MD 

Endocrinologist and Metabolist Physician 

Counselor of the Institute of People with Diabetes (IPD) - Curitiba-PR 

Member of the Brazilian Diabetes Society Member of the Brazilian Society of Endocrinology and Metabology

Fadlo Fraige Filho, MD, PhD 

President 

National Association for Diabetes Care (ANAD) 

National Federation of Diabetes Associations and Entities (FENAD)

Fernanda Rodrigues Junqueira 

Physical Therapist Master's student in Primary Health Care, UFRJ 

Postgraduate in Traumatology and Orthopedics Postgraduate in People Management 

Public servant in the Municipal Health Secretariat 

University professor

Flávia Martins Farias Nunes 

Government Relations Manager - Roche 

Member of the Oncology Working Group of FórumCCNTs

Gabrielle de Andrade Quaglioni 

Nutrition student (Universidade do Grande Rio - UNIGRANRIO) 

Member of the Obesity Working Group of FórumCCNTs

Glenda Alcantara Torres Santiago Cardoso

Esp Marketing Professional and Nutrition Graduate Specialization in Obesity and Weight Loss 

PWLE - People with Lived Experience in Obesity Obesity activist and digital influencer

João Eduardo Salles, MD, PhD 

Director, Department of Medicine and Associate Professor and Coordinator, Endocrinology and Metabology Discipline, Santa Casa de São Paulo School of Medical Sciences 

President-elect (2026-2027), Brazilian Diabetes Society (SBD)

José Vanilton de Almeida, MSc 

Coordinator, CCNTs Committee Regional Pharmacy Council of the State of São Paulo (CRF-SP)

Juliana Fleury 

Executive in Social Impact from UPenn-USA 

President, Association for Emotional Health Founding 

Member, Vertentes Mental Health Ecosystem Americas Representative, Global Mental Health Action Network (GMHAN) 

Member, Global Mental Health Group, IUHPE (International Union of Health Promotion and Education)

Karla Melo, MD, PhD 

Coordinator of Public Health, Epidemiology, Health Economics, and Advocacy Brazilian Diabetes Society (SBD)

Luiz Roberto Carvalho 

CEO, Soulbeegood 

Founding Member, Vertentes Mental Health Ecosystem Co-Chair Environment, Global Mental Health Action Network (GMHAN)

Maíra Helena Micheletti Gomide, MSc 

Lawyer Researcher in Public Law

Postgraduate Program, Pontifical Catholic University of Minas Gerais 

Collaborator of FórumCCNTs

Maria Odete Pereira, PhD 

Associate Professor, Department of Applied Nursing, Mental Health area, School of Nursing, Federal University of Minas Gerais. 

Education Director, Brazilian Nursing Association, Minas Gerais section. 

Co-facilitator, Mental and Neurological Health Working Group of FórumCCNTs

Marta Morena Pires D'Avila Axthelm 

Vice-president, ABRATA - Brazilian Association of Family Members, Friends, and Sufferers of Affective Disorders

Monica Soares Amaral Lenzi 

Clinical pharmacist specializing in Endocrinology, Metabology, and Obesity Education

Director, Movimento Influencers Diabetes Brasil Member

Pharmacy Department, Brazilian Diabetes Society Member, Diabetes 

Technical Working Group, CRFMG

Patrícia Nelly Alves Meira Menezes 

Physical Education Professional

Executive Secretariat of Health Care - Academia da Cidade Program / Recife/PE

Assistant Professor, School of Physical Education, University of Pernambuco 

Member of the Physical Activity Working Group of FórumCCNTs 

Member of the Alliance for Adequate and Healthy Food

Patrícia Vieira de Luca, MSc

CEO, Brazilian Association of Familial Hypercholesterolemia 

Co-founder, Brazilian Federation of Rare Diseases - FEBRARARAS 

Co-founder, Cardiovascular Advocacy Group - GAC 

Co-founder, FórumCCNTs

Ronaldo José Pineda Wieselberg, MD, MPH 

President ADJ Diabetes Brasil

Rosane da Silva Alves Cunha, MSc 

Physical Therapist Master in Laboratory Medicine and Forensic Technologies – UERJ Works at CER III Volta Redonda. SMS/PMVR RJ 

Co-Facilitator of the Heart Attack and Stroke Working Group of FórumCCNTs Specialization in Evidence-Informed Health Policy Management – HSL/PROADISUS/CONASEMS/MS Specialization in Micropolicies of Health Work Management – UFF 

Member of the World Stroke Organization 

Associate Member of Rede Brasil AVC 

Volunteer at Associação Ação AVC - Maceió 

Alternate Counselor of CMS of Volta Redonda RJ

Tércia Moreira Ribeiro da Silva, PhD 

Associate Professor, Maternal-Child and Public Health Nursing Department School of Nursing, UFMG

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