Geneva: Social inequities, driven by inadequate housing, limited education, and scarce job opportunities, are drastically reducing healthy life expectancy by decades across high- and low-income countries, a World Health Organization (WHO) global report revealed today.
The World report on social determinants of health equity underscores that factors beyond the health sector, such as social disadvantage and discrimination, exert a greater influence on health outcomes than genetic factors or access to healthcare services. It highlights a stark gap, with people in the country with the lowest life expectancy living, on average, 33 years less than those in the country with the highest.
WHO Director-General Dr Tedros Adhanom Ghebreyesus declared, “Our world is an unequal one. Where we are born, grow, live, work, and age significantly influences our health and well-being.” He emphasised that the report offers evidence-based strategies and policy recommendations to address these disparities, asserting that transformative change is achievable.
The report illustrates that health follows a social gradient, where lower incomes, fewer years of education, and residence in deprived areas correlate with poorer health and reduced healthy lifespans. Populations facing discrimination and marginalisation, such as Indigenous Peoples, experience significantly lower life expectancies than non-Indigenous groups in both high- and low-income nations, exemplifying the pervasive impact of inequity.
Building on the 2008 WHO Commission on Social Determinants of Health, which established 2040 targets to narrow gaps in life expectancy, childhood mortality, and maternal mortality, the 2025 report warns that these goals are unlikely to be achieved. Health inequities within countries are frequently widening, with children born in poorer nations 13 times more likely to die before age five than those in wealthier ones. Modelling indicates that closing equity gaps in low- and middle-income countries could save 1.8 million children’s lives annually.
Despite a 40% global reduction in maternal mortality between 2000 and 2023, low- and lower-middle-income countries account for 94% of maternal deaths. Women from disadvantaged groups face elevated risks, with Indigenous women in some high-income countries up to three times more likely to die during childbirth. The report also links higher gender inequalities, including practices like child marriage, to increased maternal mortality rates.
The report identifies social injustices—encompassing income inequality, structural discrimination, conflict, and climate disruptions—as primary drivers of health inequities. Climate change is projected to drive an additional 68–135 million people into extreme poverty over the next five years, further exacerbating health challenges. Moreover, 3.8 billion people worldwide lack adequate social protection, such as child or paid sick leave benefits, directly impacting their health outcomes. High debt burdens, with interest payments by the world’s 75 poorest countries quadrupling over the past decade, severely limit governments’ capacity to invest in essential health services.
WHO calls for urgent collective action from national and local governments, health leaders, academia, research, civil society, and the private sector to address these inequities. Recommended measures include tackling economic inequality, investing in social infrastructure and universal public services, overcoming structural discrimination, addressing the impacts of conflicts and forced migration, managing climate action and digital transformation to promote health equity, and establishing governance frameworks that prioritise health equity. These frameworks should include cross-government policy platforms, allocation of resources to local levels for maximum impact, and empowerment of community engagement and civil society.
The report responds to a 2021 World Health Assembly resolution (WHA74.16), which mandated an updated analysis of social determinants’ impact on health and health equity, progress made, and recommendations for action. It reaffirms the 2008 WHO Commission’s assertion that “social injustice kills on a grand scale,” providing a comprehensive roadmap to bridge health equity gaps and improve global health outcomes.
– global bihari bureau
