6 May 2025 I Geneva- Aglobal report published by the World Health Organization (WHO)highlights that theunderlying causes of ill healthoften stem fromfactorsbeyond the health sector, such as lack of quality housing, education and job opportunities.
The newWorld report on social determinants of health equity shows thatsuch determinants can be responsible fora dramatic reduction of healthy life expectancy—sometimes by decades—in high- and low-income countries alike.For example, people in the country with thelowestlife expectancy will, on average, live 33 yearsshorter than those born in the country with thehighest life expectancy. The social determinants of health equity caninfluence people’s health outcomes more than genetic influences or access to health-care.
“Our world is an unequal one. Where we are born, grow, live, work and age significantly influences our health and well-being,” said 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.”
The reportunderscoresthat inequities in health are closely linked to degrees of social disadvantage and levels of discrimination. Health follows a social gradient whereby the more deprived the area in which people live, the lower their incomes are and they have fewer years of education, poorer health, with less number of healthy years to live.These inequities are exacerbated in populations that face discrimination and marginalization. One of the vividexamples is the fact thatIndigenous Peoples have lower life expectancy than non-Indigenous Peoples in high- or low-income countries alike.
Social injustice driving inequities
The Worldreport on social determinants of health equity isthe first of its kind published since2008 when the WHO Commission on Social Determinants of Healthreleased its final report laying out targets for 2040 for reducing gaps between and within countries in life expectancy, childhood and maternal mortality. The 2025Worldreport,showsthatthese targets are likely to be missed.
Although data is scarce, there is sufficient evidence to show that health inequities within countries are often widening. WHO data cites that children born in poorer countries are 13 times more likely to die before the age of 5 than in wealthier countries. Modelling shows that the lives of 1.8 million children annually could be saved by closing the gap and enhancing equity between the poorest and wealthiest sectors of the population within low- and-middle-income countries.
The report shows that while there was a 40% decline in maternal mortality globally between 2000 and 2023, low- and lower-middle-income countries still account for 94% of maternal deaths.
Women fromdisadvantaged groups are more likely to die from pregnancy-related causes. In many high-income countries, racial and ethnic inequities in maternal death rates persist, for example, in some areas Indigenous women were up to three times more likely to die during childbirth. There are also strong associations between higher levels of gender inequality, including child marriage, and higher maternal mortality rates.
Situation in the Americas
The report shows that Latin America and the Caribbean remain the Region with the highest levels of inequality in the world. The pandemic deepened this situation: In 2020 the regional economy contracted by 7 percent—the steepest decline in 120 years— with millions of people losing income and social protection.
These economic shocks translate directly into higher levels of avoidable mortality and morbidity, due to deteriorating conditions of employment (for example, more than 60% of workers in Latin America and the Caribbean work in the informal sector), housing, and migratory processes, among others. The report also highlights that these effects are compounded by structural racism and the enduring legacy of colonialism, which continue to exert a significant negative impact on health and life expectancy, particularly for Indigenous and Afro‑descendant populations.
The report reveals that those Latin American cities that have employed a participatory approach to budget allocation for housing, green spaces, and transportation, have also seen positive effects on both health and social cohesion, when it comes to tackling some of these social determinants.
Breaking the cycle
WHOemphasizes that measures to addressincome inequality, structural discrimination, conflict and climate disruptionsare key to overcoming deep-seated health inequities.Climate change, for example, is estimated to push an additional 68–135 million people into extreme poverty over the next 5 years.
Currently,3.8 billion people worldwide are deprived of adequate social protection coverage, such as child/paid sick leave benefits, with direct and lasting impact on their health outcomes. High debt burdens havebeen crippling the capacityof governmentsto invest in these services, with the total value of interestpayments made by the world’s 75 poorest countriesincreasing fourfold over the past decade.
WHO calls for collective action from national and local governments and leaders within health, academia, research, civil society, alongside the private sector to:
- address economic inequality and invest in social infrastructure and universal public services;
- overcome structural discrimination and the determinants and impacts of conflicts, emergencies and forced migration;
- manage the challenges and opportunities of climate action and the digital transformation to promote health equity co-benefits; and
- promote governance arrangements that prioritise action on the social determinants of health equity, including maintaining cross-government policy platforms and strategies, allocating money, power and resources to the most local level where it can have greatest impact, and empowering community engagement and civil society.
Situation in the Americas
Editor’s note
In resolution WHA74.16 (2021), the Seventy-fourth World Health Assembly requested theWHODirector-General to prepare an updated report on the social determinants of health, their impact on health and health equity, progress made so far in addressing them, and recommendations for further action.This World report on social determinants of health equityprovides an update to the conclusion of the WHO Commission on the Social Determinants of Health in 2008 which stated that “social injustice kills on a grand scale”.
