WHO warns that global health inequities can shorten lives “by decades”

Underlying causes of illness often stem from factors beyond the health sector, cautions the WHO. Its World Report on Social Determinants of Health Equity report highlights that social determinants like a lack of quality housing, education, and job opportunities can dramatically reduce healthy life expectancy in high- and low-income countries, sometimes by decades. 

The WHO stresses that social determinants of health equity can influence people’s health outcomes more than genetic influences or access to healthcare. For example, in the country with the lowest life expectancy, people will, on average, live 33 years shorter than individuals born in the country with the highest life expectancy. 

“Our world is an unequal one. Where we are born, grow, live, work, and age significantly influences our health and well-being,” says WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “But change for the better is possible. This world report illustrates the importance of addressing the interlinked social determinants and provides evidence-based strategies and policy recommendations to help countries improve health outcomes for all.”

WHO calls for collective action from national and local governments and leaders within health, academia, research, civil society, and the private sector. The report says that “progression on reducing inequalities in health has been slow, and inequity is killing millions.” 

The report recommends four areas for action: 

• Addressing economic inequality and investing in social infrastructure and universal public services. 
• Overcoming structural discrimination. 
• Managing the challenges and opportunities posed by climate change and digital transformation to systematically promote health equity. 
• Establishing governance arrangements to maximize the coherence and impact of action.

Dietary disadvantages

The report highlights several structural social determinants impacting health and health equity: economic systems; social infrastructure; structural discrimination; conflict, forced migration, and displacement; and the megatrends of climate change and digitalization. 

The authors explain that these determinants and businesses also contribute to inequitable food systems that promote health-harming diets and increase malnutrition rates, obesity, and associated noncommunicable diseases. 

WHO calls for collective action from governments and leaders within health, academia, research, civil society, and the private sector.“Inequalities in malnutrition and access to nutritious foods persist between different social groups, exacerbated by recent crises and transitions. Those in poverty and on low incomes are less likely to be able to afford nutritious food, and they therefore face food insecurity, which contributes to inequitable burdens of infectious diseases, malnutrition, and obesity.” 

Moreover, low-income and racial and ethnic minority populations in the lowest-income neighborhoods with high deprivation and segregation are “disproportionately more likely to live in ‘food deserts’ — geographic areas with limited access to affordable and healthy food options — which contribute to poor health outcomes.” 

The authors highlight that these populations are disproportionately more likely to live in “food swamps.” These communities have far more exposure to marketing and businesses like fast food restaurants and stores selling unhealthy or highly processed foods and beverages than to affordable and nutritious options. 

“Food swamps are associated with poor health, including obesity and obesity-related chronic diseases, cancers, and mortality,” reveals the report. 

In addition, the authors highlight inequalities among population groups, with women and girls more likely to experience malnutrition, including obesity. They add that there are higher rates of food insecurity and a lack of access to healthy diets among people living in emergency and conflict settings, people with disabilities, and Indigenous Peoples. 

“Populations at dietary disadvantage are also more likely to access food through public institutions, including prisons, homeless shelters, public schools, hospitals, and care facilities, underlining the important role of the public sector in shaping food environments.”

Widening inequities

In 2008, the WHO Commission on Social Determinants of Health released targets for 2040 to reduce gaps between and within countries in life expectancy and childhood and maternal mortality. The current world report suggests these targets are likely to be missed. 

Low-income and minority populations in the lowest-income neighborhoods are more likely to live in food deserts, with little access to healthy food.“This report recognizes that improvements in health equity have been too slow and, alarmingly, inequities between social groups within countries are often deepening. In the pursuit of prosperity, countries have too often failed to integrate equity and fairness into policies.”

Health inequities are closely linked to degrees of social disadvantage and levels of discrimination. If people live in a more deprived area, their incomes are generally lower, and they have fewer years of education, poorer health, and fewer healthy years to live. 

In populations facing discrimination and marginalization, these inequities are exacerbated. For example, the report finds that Indigenous Peoples have lower life expectancy than non-Indigenous Peoples in high- and low-income countries. 

According to the findings, 3.8 billion people worldwide lack adequate social protection coverage, such as child or sick leave benefits. High debt burdens are further crippling governments’ capacity to invest in these services. 

Children’s and women’s health

The authors also highlight the need to focus on children’s and women’s health. 

WHO data suggests that children born in poorer countries are 13 times more likely to die before the age of five than in wealthier countries. Modeling indicates that enhancing equity between the poorest and most affluent populations in low- and middle-income countries could save the lives of 1.8 million children annually. 

The report finds that health equity improvements have been too slow and inequities between social groups within countries are deepening.Although maternal mortality declined 40% between 2000 and 2023, low- and middle-income countries still account for 94% of maternal deaths. Moreover, women from disadvantaged groups are more likely to die from pregnancy-related causes, also in high-income countries. 

In some areas, Indigenous women were up to three times more likely to die during childbirth. The report also highlights strong associations between higher levels of gender inequality, including child marriage, and higher maternal mortality rates.

Last month, the 2025 Lancet Countdown to 2023 report also called for picking up the pace in reaching the UN Sustainable Development Goal for health. The authors suggest that though most indicators showed progress, improvement falls short of the pace needed to achieve women’s, children’s, and adolescents’ health and nutrition targets. 

The WHO calls for measures to address income inequality, structural discrimination, conflict, and climate disruptions. For example, the authors say that climate change will push an estimated additional 68–135 million people into extreme poverty over the next five years.

“To enable improvements in living conditions and address underlying structural determinants, change is required, from policy-setting and legislation through to implementation. Governments and politicians are in the driving seat,” concludes the report.