There is a 33-year gap in life expectancy between people born in the country with the highest life expectancy and those born in the country with the lowest life expectancy, while 94% of maternal deaths happen in low- and middle-income countries (LMICs), according to a World Health Organization global report on the social determinants of health released on Tuesday.

“Where we are born, grow, live, work and age significantly influences our health and well-being,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the release of the report, the first on the issue since 2008.

While some progress has been made in addressing inequity –  there was a 40% decrease in maternal morality between 2000 and 2023, for example – income inequality is increasing within countries, and this is impacting on health outcomes. The COVID-19 pandemic also reversed some of these gains, as have worsening economic conditions in the aftermath of the pandemic.

Dr Etienne Krug, director of the WHO’s Social Determinants of Health department, said that “broad societal factors” are more important than our genes for health – including people’s  level of education and employment, structural discrimination like racism and gender inequality, weak public services, social isolation and loneliness, climate change, access to digital systems and conflicts and displacement.

Race and education

“The gap in life expectancy between the Indigenous and non-Indigenous population is 12.5 years for the Inuit in Canada, 10 years for Indigenous Australians, 21.5 years for the Baka in Cameroon and 13 years for the Maasai in Kenya,” according to the report.

Meanwhile, in Hungary, Poland, Latvia and Slovakia, “there are gaps in life expectancy of 10 years and more between men with high and low education levels”.

“In the United States in 2020, the maternal mortality rate for non-Hispanic Black women was nearly three times higher than that of non-Hispanic White women (55.3 vs. 19.1 deaths per 100 000 live births),” according to the report.

During the COVID-19 pandemic, death rates were higher across the globe in poorer communities.

Where a person lives in a country also affects their health. Over half the world’s population currently resides in cities, and approximately a quarter of the global urban population lives in slums where they are more susceptible to disease.

Air quality is also an important determinant of health, with the combined effects of ambient air pollution and household air pollution associated with almost seven million premature 

Commercial interests

The report also points to four health-harming commercial actors – junk food and drinks, fossil fuels, alcohol and tobacco – pointing out that these account for at least a third of global preventable deaths, collectively in 2021 causing 19 million deaths annually.

“Experience has shown that these industries can and will prevent and undermine public-sector action to limit health-harming products, services and practices, including by seeking to shape public discourse, and to bias or undermine research,” the report notes.

It singles out the unhealthy food industry as being “particularly effective in influencing national governments to reduce or not implement regulations, and in marketing products which misinform about their effects on health, the environment and other social determinants”. 

Debt distress

“Countries are facing serious challenges when it comes to fiscal space, meaning there’s inadequate resources for universal public services such as social protection, housing, education and health,” said Dr Sudhvir Singh, unit head for equity and health in WHO’s Department of Social Determinants of Health.

“We have a current spike of inflation and reduced development assistance for health and development, but we also have an incredible challenge with debt distress. Over the last decade, the total value of debt interest payments in the world’s 75 poorest countries and interest payments has quadrupled,” said Singh.

Over 3.8 billion people have no social protection coverage, while 2024 was not only the hottest year on record, but the year with the highest number of conflicts since the Second World War, he added.

This has resulted in a tripling of the number of people facing forced displacement in the last 15 years.

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.