Despite the growing burden of chronic liver disease—particularly due to metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH)—these conditions remain absent from the global non-communicable disease (NCD) policy agenda. This exclusion is no longer justifiable, and the health community must now act with the same urgency and coordination we apply to other major NCDs.

This was the central message of the Global Think-Tank on Steatotic Liver Disease, whose recent briefing note sets out a clear and actionable case for integrating chronic liver disease—especially MASLD and MASH—into global, regional, and national NCD strategies. Liver disease is not an isolated issue; it is a core part of the metabolic health crisis. Yet policy frameworks, including the WHO Global Action Plan on NCDs, continue to overlook it.

In our Lancet correspondence, my co-authors and I responded to the Global Health 2050 report by pointing to the omission of metabolic conditions—especially MASLD—despite their massive and growing toll. With an estimated 38% of adults and up to 15% of children affected, MASLD represents one of the most widespread and under-acknowledged public health threats today. Its absence from global health forecasting is not just a gap—it is a blind spot with real-world consequences.

I expanded on this in our JAMA Network Open Health Policy commentary, where we called for a new framing: MASLD and MASH must be seen as integral to the broader NCD architecture, not peripheral liver issues. The policy implications are substantial. Addressing MASLD requires early detection, integrated care, and alignment with diabetes, cardiovascular disease, and obesity strategies—starting with primary care and extending to health system planning.

Fortunately, the momentum is building. The flagship convening of the Global Think-Tank, featured in The Lancet Regional Europe, is helping shift the narrative—bringing together science, policy, and lived experience to advance a unified public health response to MASLD and MASH. The think-tank’s briefing note is more than a policy document. It is a blueprint for action—so we stop missing the millions living with undiagnosed, unmanaged liver disease.

The challenge now is to translate growing awareness into sustained political commitment. If we are serious about reducing preventable deaths, tackling multimorbidity, and improving equity in metabolic health, MASLD must be named—and addressed—in future NCD policies. This includes the forthcoming 2025 UN High-Level Meeting Declaration* and the 2027 Universal Health Coverage agenda.

It’s time we stopped treating liver health as an afterthought. The evidence, the strategy, and the opportunity are all in front of us. We just need to act.

*As endorsers of the Global Metabolic Health Roundtables (GMHR) series, we encourage those attending United Nations General Assembly Week in New York to register for the Devex NCD Pavilion @UNGA80. This GMHR event will bring together key stakeholders from across the global health ecosystem to inform and shape policy direction ahead of the 2027 Universal Health Coverage milestone and the 2030 SDG target for NCD reduction.

Further reading

• Advancing the global public health agenda for NAFLD: a consensus statement
• The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?
• A global action agenda for turning the tide on fatty liver disease