Differential exposures to the behavioural and environmental risk factors for NCDs and access to prevention and treatment services are rooted in public policy choices. The 2030 Agenda for Sustainable Development recognizes that current NCD trends and sustainable development cannot coexist. For an effective response, NCDs must be integrated within countries’ development priorities and reflected in their planning frameworks for development, including for achieving the SDGs. Yet, progress on NCDs has been deemed ‘insufficient and highly uneven.’ Global and regional frameworks identify enablers for successful multisectoral action on NCDs and health more broadly: high-level political commitment, governance mechanisms to facilitate and coordinate multisectoral responses, and robust structures for monitoring, evaluation and accountability. So what is happening? - core governance and accountability challenges persist and include: lack of ownership and resourcing of the agenda across government and international entities; the need to develop and entrench understanding of the social and economic costs of inaction; overcoming policy incoherence and the inability to adequately balance trade-off between institutions and their incentives.