Roughly 40% of adults worldwide are living with steatotic liver disease – most without knowing it. Yet despite its high prevalence, liver disease has remained a blind spot in global strategies addressing chronic conditions such as diabetes, cardiovascular disease, and cancer. That may be finally starting to change.

In 2023, an international consensus of experts from more than 50 countries introduced new terminology — metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) — aligning the language with the disease’s metabolic roots and its links to type 2 diabetes, obesity, and cardiovascular disease. Earlier this year, the Executive Board of the World Health Organization (WHO) approved a resolution on steatotic liver disease. If adopted by the World Health Assembly (WHA) in May, it would mark the first time this long-neglected set of diseases are formally recognised on the global NCD agenda

Yet recognition is only the first step.

What is measured gets prioritised

Experience from other global health responses shows that political recognition alone does not drive change. It must be linked to measurement and accountability. The HIV response offers a clear example. In Europe, the Dublin Declaration on HIV/AIDS required governments to track and publicly report progress. That transparency helped transform commitments into action.

Liver disease now needs a similar shift. Countries can begin by integrating steatotic liver disease into existing NCD monitoring systems — tracking how often people are diagnosed late, and whether liver risk assessment — often using a simple blood test — is part of routine care for people living with diabetes and obesity. To this end, laboratories should be supported to automatically calculate liver fibrosis scores and identify liver risk early.

Biomedical metrics alone are not enough. Systems should also measure patient understanding, stigma, and whether multidisciplinary clinics function effectively. Economic indicators — hospitalisations, transplant costs, and productivity losses — can help demonstrate the societal consequences of inaction.

What we measure ultimately shapes what health systems prioritise.

Shifting incentives upstream

If governments measure only late-stage complications, health systems will continue to focus on rescue care. If they measure late detection and integrated metabolic management, attention begins to shift upstream.

Financial incentives must align with that shift. Today, health systems tend to reward procedures and hospital care more than prevention. In liver disease, this imbalance is stark: resources remain concentrated at advanced stages, even though costs of late diagnosis — hospitalisation, transplantation, lifelong immunosuppression, and lost productivity — far exceed those of timely detection.

The drivers of liver disease extend well beyond clinical care. Some of the same forces driving other NCDs — ultra-processed food, alcohol marketing, and increasingly sedentary environments — are driving liver disease as well.

That means liver health belongs in the same policy conversations as sugar taxes, alcohol regulation, and urban design. Measures that reduce diabetes and cardiovascular disease will also reduce the burden of liver disease, preventing hundreds of thousands of cases of cirrhosis and liver cancer around the world.

The infrastructure to act is already in place. WHO and national governments have established systems for tracking NCDs. The challenge now is integration — ensuring that these systems include liver health, rather than overlooking it.

From recognition to action

Civil society also has a role to play. In the HIV response, patient advocacy helped hold governments accountable for their commitments. As awareness of steatotic liver disease grows, people living with the condition can help drive similar change.

For decades, steatotic liver disease remained common but largely invisible in global health policy. The proposed WHA resolution signals that this is beginning to change. But the real test will come next — when countries choose whether to measure liver health, integrate it into NCD strategies, and shift toward prevention.

The liver has been sending warning signals for years. Now governments must decide to act on them.