Hidden in plain sight: the fourth UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and Well-being missed the mark on chronic pain and mobility impairment.

The fourth United Nations High-Level Meeting on the Prevention and Control of Noncommunicable Diseases (NCDs) and Promotion of Mental Health and Well-Being developed a timely Political Declaration intended to accelerate progress among Member States towards the targets of Sustainable Development Goal 3.4. The Declaration emphasises appropriate cross-cutting actions for prevention and control of NCDs generally, yet over the consultation period, it evolved to include a range of specific diseases beyond the SDG 3.4 targets. The Declaration omits explicit attention to chronic pain and mobility impairment due to musculoskeletal conditions, despite their substantial contribution to disability and NCD multimorbidity across the life course. The omission creates a missed opportunity for health gain across NCDs, particularly in low- and middle-income countries experiencing rapid population ageing and expansion, and it disrupts implementation of aligned global technical products. Chronic pain affects a substantial proportion of the global population, and musculoskeletal conditions are among the leading causes of years lived with disability, yet global NCD policy frameworks continue to privilege mortality reduction over morbidity. Embedding prevention and management of chronic pain and mobility impairment within integrated NCD and mental health strategies offers a pathway to reduce avoidable disability and improve global healthy life years beyond 2030.