Connecting the pieces: the Global Think-tank on Steatotic Liver Disease at the World Health Summit 2026

On the opening day of the World Health Summit, the Global Think-tank on Steatotic Liver Disease brought policymakers, clinicians, patient advocates and researchers together around a key question: what will it take to move steatotic liver disease (SLD) from an isolated condition into integrated metabolic health, noncommunicable disease (NCD) and universal health coverage (UHC) pathways?

The session, “The Future of Metabolic Health, Liver Disease and Related NCDs: Reimagining Care Pathways and Policies for the Next Decade,” drew a full room in Berlin, along with participants online. It looked 10 years ahead, imagining a patient pathway from diagnosis and linkage to care through to treatment.

The panel

Moderated by Prof. Jeffrey V. Lazarus, Director of the Global Think-tank on Steatotic Liver Disease, the panel brought together H.E. Dr Hanan Mohamed Al Kuwari, Advisor to the Prime Minister for Public Health Affairs, Qatar; Prof. Gauden Galea, University of Malta; Achim Kautz, patient advocate, International Liver Cancer Movement; and Johanna Ralston, CEO, World Obesity Federation.

The timing gave the discussion urgency. In May 2026, the World Health Assembly adopted its first resolution on SLD, calling on countries to bring liver health into their national NCD strategies. The panel kept returning to the distance between that commitment and its delivery.

Prof. Galea put it plainly: “a health system being in place is not enough. It has to be robust.”

What the room told us

Participants voted anonymously on Slido throughout the session, and the panellists responded to the results as they came in.

Asked to name the biggest barrier to integrating liver health into metabolic care in one word (45 responses from 38 participants), participants most often answered cost, ignorance and unawareness, alongside silos, funding, overspecialisation and misconceptions about liver health. Gaps in knowledge ranked alongside gaps in money: integration depends on understanding as much as on resources.

The strongest result confirmed the session’s central premise. 82% (n=44) agreed that novel MASH therapies and next-generation metabolic drugs will fail to reduce global liver disease mortality by 80% by 2030 unless health systems address fragmented care across hepatology, endocrinology and primary care. No participant strongly disagreed.

Other results were less settled. Just under half (49%, n=43) agreed that UHC frameworks currently fail to recognise liver disease as a core NCD, while a third (33%) were undecided. That uncertainty is itself a finding: many people working in global health are unclear where liver health stands in coverage frameworks today.

Expectations for national action were similarly split. Five months after the WHA resolution, 49% (n=47) expected their country or region to have a dedicated SLD strategy, or to have integrated SLD into national NCD policy, by 2030. Another 24% disagreed that it would happen and 28% were unsure.

On technology, 55% (n=51) agreed that by 2030, AI and automated electronic health record algorithms will transform SLD care by flagging high-risk liver fibrosis in primary care before symptoms appear. Nearly a quarter disagreed.

Key takeaways

The discussion pointed to four priorities for health systems:

Use the 2026 WHA resolution to bring liver health into national NCD policies, UHC targets and strategies on commercial determinants, from food environments to alcohol regulation.
Build SLD tracking into national NCD monitoring, with standardised, publicly reported metrics and a consensus continuum of care.
Shift care upstream with eHealth and AI-driven risk stratification that identifies high-risk fibrosis earlier.
Realign fragmented delivery models to enable multi-specialty care and equitable access to prevention and therapies.

Keeping the liver in the conversation

To extend the discussion beyond the session, the Think-tank shared Connect the pieces, a three-day crossword booklet on liver and metabolic health, with more than 100 summit participants. Its three puzzles, Systems, Policy and Place, led to an invitation to join MASH Cities, the Think-tank’s initiative to embed metabolic liver health into urban health agendas.

Watch the full session

*The session was supported by Novo Nordisk and Madrigal Pharmaceuticals.

*Percentages are rounded and may not total 100%. Sample sizes (n) refer to the number of votes cast in each anonymous Slido poll.

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Registration fees

Category	Early Bird (before 1 April)	On-site
Private Sector/Industry	495	695
Start-up*	150	200
Healthcare Professional, Academic, Public Health/Professional Association, NGO	100	150
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	50	50
Patient or Patient Representative *	50	50

* Registration fee scholarship offered on application, please email: lisa.rice@isglobal.org

Criteria for start-ups:

Early-stage start-up (e.g., pre-seed, seed, or Series A) / Incorporated for under 5 years

Raised under $5 million in funding / Annual revenue less than $1 million

Fewer than 50 employees

What’s included in your ticket?

Entry to all main agenda sessions starting 2pm on 5 June

5 June: Lunch and afternoon networking coffee, and networking buffet reception

6 June: Morning and afternoon networking coffee, and networking lunch

1. Launch a Ministry of Health-led whole-of-government strategy

The growing prevalence of MASLD and MASH in Spain, projected to affect over 27% and 5.9% of the population, respectively, by 2030, necessitates an integrated, cross-sectoral policy response,³ led by an intersectoral working group under the leadership of the Ministry of Health. This whole-of-government initiative could facilitate the mainstreaming of MASLD/MASH into key national strategies addressing chronic diseases in general, and obesity, diabetes, and cardiovascular health specifically through a “health in all policies” approach. These strategies include the Strategy for Addressing Chronic Diseases (2012),³⁰ the Diabetes Strategy (2006)³¹ and its 2012 update³², and the Cardiovascular Health Strategy (2022),³³ where MASLD/MASH remain largely underrepresented despite their metabolic underpinnings. This omission contributes to fragmented care and missed opportunities for early intervention. Systematic integration of MASLD across these strategies, identifying common policy-actionable targets such as commercial determinants of health, would allow Spain to align with recommendations from the European Association for the Study of the Liver (EASL)–Lancet Liver Commission, which urges countries to address liver diseases through upstream, equity-based, and multisectoral policies.³⁵

Crucially, national leadership must be paired with urban action. Cities are where obesogenic environments, food insecurity, and social inequalities converge with high diabetes and obesity prevalence.^36,37 An initiative to address this, “MASH Cities,” calls on municipalities to integrate MASLD/MASH into local health promotion, food policy, urban mobility, and primary care services to mitigate disease progression.³⁸ Major cities in Spain should consider joining this growing platform for sharing learned lessons and best practices. Empowering cities with the mandate and resources to act on liver health can serve as a scalable, equitable response to this growing challenge, as was proposed for Barcelona in May 2025.³⁹

Additionally, inclusion of MASLD/MASH in Spain’s Public Health Surveillance Strategy (2022)⁴⁰ could strengthen early detection and monitoring by enabling systematic data collection and risk assessment in both health and non-health sectors, such as urban planning and food policy. Primary care would be central to this approach, serving as the frontline for MASLD active case finding, fibrosis risk stratification, and referral, with a focus on shared-care pathways between primary care and specialist care. Integration can help standardise primary care practices, including routine FIB-4 risk stratification of individuals with obesity, T2D, metabolic syndrome, or hepatic steatosis, which are often undetected until advanced stages.⁴¹ Primary care should be adequately funded and equipped to screen, stratify, manage cardiometabolic risks, and refer high-risk patients, forming the backbone of MASLD/MASH prevention and control at the national, autonomous community, and city levels.^42,43

Spain’s commitments as a World Health Organization (WHO) Member State provide immediate momentum for national action. The landmark World Health Assembly (WHA) resolution on steatotic liver disease outlines 12 core action item, including incorporating liver health into national NCD strategies and strengthening primary care pathways to tracking liver health indicators, and which now mandates a clear shift toward national action.⁴⁴

2. Create a national MASLD registry, cohort, or observatory

Establishing a national MASLD registry, cohort or observatory is a critical step toward advancing clinical management, research, and policy evaluation. A national registry would enable the systematic collection of epidemiological, clinical, and sociodemographic data, essential for monitoring disease prevalence and progression, identifying high-risk subgroups, and assessing territorial disparities in access to care. While the Epidemiological sTudy of Hepatic infectiONs (ETHON) cohort estimated that 1.33%% of the Spanish population from 2015-2020 had MASH with fibrosis (stage F2-F3), these findings are limited to participants from primary care centers in Madrid, Santander and Valencia.^13,45 Additionally, while national clinical registries like HEPAmet and REGHNA (focused on hospital settings) provide important data, they are not population-based, nor are they consistently linked with public health surveillance systems.⁴⁶ A standardised and centralised MASLD registry would enable longitudinal tracking of this more prevalent disease, facilitate research on progression and treatment outcomes, and help evaluate the impact of interventions over time. Furthermore, registry data could support regional health planning and inform clinical practice guidelines aligned with Spain’s digital health transformation efforts.

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

Despite the rising clinical, social, and economic burden of MASLD, the condition is not currently included in Spain’s list of Mandatory Reporting Diseases. This may not be unusual, given that no noncommunicable disease (NCD) is currently included on this list; however, as a Member State of the United Nations (UN), Spain is committed to the Political Declaration of the Fourth High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and Well-being, adopted in 2025.⁴⁷ However, nor is it included among Spain’s Key Health System Indicators, which guide monitoring, evaluation, and resource distribution across the National Health System, including NCDs.¹⁶

Integrating MASLD/MASH as a formal indicator would recognise the disease as a strategic health priority by integrating it into the national health information system, guiding decision-making on screening, diagnosis, and care pathways. Failure to track this disease risks underestimating its long-term economic and public health impacts. Incorporation into the indicator framework aligns with Spain’s commitment to data-driven governance and would support benchmarking across autonomous communities. To support targeted local action on MASLD, tools at the autonomous community level should be developed to guide policy and programme implementation. A MASLD risk index, combining aggregated clinical data, social determinants of health, and population-level metrics, can help identify high-need areas and inform municipal-level screening strategies.

In parallel, a MASLD Impact Score should be created to assess the effectiveness of local policies related to metabolic health, food regulation, healthy environments, early detection practices, and workforce training. This metric could be implemented through municipal initiatives such as “Santander se mueve,” an annual health promotion program.

4. Increase awareness and education of MASLD/MASH among the general public, at-risk groups and healthcare professionals

Enhancing awareness of MASLD/MASH among both at-risk populations, such as those living with obesity, diabetes, and metabolic syndrome, and frontline healthcare workers is critical for early identification, appropriate risk stratification and timely intervention. Given its silent clinical course, MASLD is often underdiagnosed until advanced stages, particularly in primary care settings where patients with obesity, diabetes, or metabolic syndrome are commonly managed.⁴⁸

Spain’s Strategic Framework for Primary and Community Care (2019) already emphasises chronic disease prevention, making it an ideal entry point for MASLD/MASH education.²⁹ Yet, existing knowledge gaps among primary care providers regarding liver disease etiology, progression, and appropriate screening necessitate awareness or education campaigns and professional training modules that build the knowledge and clinical skills needed to manage MASLD in frontline settings.^27,49 A cohesive and comprehensive educational strategy is essential and could begin with the integration of MASLD/MASH-specific content into undergraduate, specialty, and continuing medical education curricula to foster competency in metabolic hepatology across the care continuum. A national interdisciplinary training strategy could bring together professionals from family medicine, endocrinology, cardiology, nephrology, internal medicine, endoscopy, clinical nutrition, and hepatology to address MASLD/MASH as a complex, multisystemic disorder.

A comprehensive communication and engagement health literacy strategy should position MASLD/MASH as serious, progressive, and multisystemic conditions. This involves dismantling the minimising narrative of “fatty liver” and clearly linking MASLD to major outcomes such as cardiovascular, renal and metabolic disease. Such a campaign should incorporate Metabolic Dysfunction and Alcohol-Associated Liver Disease (MetALD), which captures the under-recognised harm of moderate alcohol use in people with MASLD. Establishing a national MASLD/MASH patient platform would also enable the co-design of care pathways, educational materials, public campaigns, and research priorities, ensuring patient-centered policy and practice. Generating local data is vital for municipal- or community-led strategies; notably, an in-progress study by the MASH Cities³⁸ network is currently evaluating awareness of MASLD and its underlying risk factors among representative population samples across major Spanish cities including Barcelona, Bilbao, Málaga, Madrid, and Valencia as well as the autonomous community of Cantabria, to directly inform tailored local interventions and public health campaigns.

Finally, it is critical to explicitly position MASLD within the so-called cardio-renal-metabolic axis, evolving toward a CHRM (cardiovascular-hepatic-renal-metabolic) model that is rooted in the dysfunction and accumulation of visceral fat, regardless of the body mass index (BMI).⁵⁰ A revised, more accurate paradigm further recognises the liver as a pivotal organ in systemic metabolic dysfunction. The CHRM paradigm reflects the shared pathophysiology and clinical trajectories of MASLD, T2DM, chronic kidney disease, and cardiovascular disease. Scientific societies and patient organisations in Spain must collectively support and disseminate this integrative model, aligning MASLD policy with broader strategies for non-communicable diseases.

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

Integrating MASLD/MASH screening algorithms into existing EHR systems can substantially enhance early detection and risk stratification in primary and secondary care. Automated tools such as intelligent liver function testing (iLFT), which systematically interprets routine liver function tests, performs reflex testing, and identifies likely liver diseases for physicians to consider, and automated calculation of simple non-invasive fibrosis scores such as FIB-4 have shown promise in improving early diagnosis and care pathways, particularly in underdiagnosed conditions like MASLD and MASH.⁵¹ In the Spanish context, where nearly 10 million individuals may be living with MASLD by 2030,³ embedding such tools in the primary care EHR systems used across autonomous communities could standardise assessment, reduce diagnostic delays, and promote timely secondary referrals. Moreover, this approach complements digital transformation priorities already outlined in Spain’s National Health System and aligns with the objectives of the Strategic Framework for Primary and Community Care (2019).^29,52

6. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing and equitable access to approved pharmacological treatment for MASH

Primary care has a well-established network of health centres across Spain. In the last years, there has been an increase in the number of community-based activities promoting well-being and reducing the metabolic risk profile through social prescribing. These activities usually integrate exercise through increasing physical activity.⁵³ Strengthened primary care systems can reinforce the role of community health services by incorporating social prescribing models to address lifestyle drivers of MASLD in vulnerable populations, such as physical activity, which is a recommended first-line therapy of people with MASLD, and can improve psychosocial health,⁵⁴ which is often reported as poor by people living with MASLD.⁵⁵ By facilitating participation in community-based activities like group exercise, arts, or wellness programs, social prescribing addresses both physical inactivity and the isolation or low mood commonly seen in this population.⁵⁶ In Catalonia, the Programa de Prescripció Social i Salut exemplifies this approach by linking patients to local community assets via an integrated system in primary care, particularly targeting conditions such as anxiety, depression, and social isolation,⁵³ and which may be beneficial for people living with MASLD/MASH. Elsewhere, social prescribing has demonstrated benefit for people living with diabetes.⁵⁷ Evaluation data from Catalonia show that over 70% of participants report improvements in emotional well-being and social support after engaging in prescribed community activities frequently related to physical activity.⁵³

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Category	Early Bird (before 1 April)	After / onsite
Private Sector/Industry	295	350
Start-up*	95	150
Healthcare Professional, Academic, Public Health/Professional Association, NGO	75	100
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	45	60
Patient with lived experience *	free	free
Patient or Patient Representative *	45	50