The document summarizes reflections on the United Nations High-level Meeting on Non-communicable Diseases (NCDs). It notes that there was a startling consensus reached between countries on pathways to address NCDs. The meeting declarations were more comprehensive than expected in addressing the social determinants of health. However, it raises three conundrums: whether to take a horizontal approach that addresses the underlying causes or a vertical approach focused on specific diseases, whether to focus on low-cost interventions or broader determinants of health, and managing conflicts of interest from economic stakeholders. It concludes there is an opportunity to think big in addressing the global threat of NCDs.