The best medicine for improving global health? Reduce inequality

The past few years have not been easy on the world’s health-care systems. When the United Nations set its Sustainable Development Goals (SDGs) in 2015, the threat of a pandemic sweeping the world would not have registered with most people.

In a series of weekly editorials marking the halfway point to the SDGs’ 2030 deadline, Nature is looking at each of the 17 goals in turn. It is no surprise that progress towards number 3 — “Ensure healthy lives and promote well-being for all at all ages” — has been stuttering, at best. But that does not mean that the targets embedded in this goal should be lowered when world leaders gather in New York City in September to assess progress towards achieving the SDGs. Instead, the health goal should be strengthened by increasing focus on the economic, social and power inequities that drive disease and disability worldwide — and researchers must play their part in making that happen.

The UN’s health and well-being targets cover a wide territory that includes reducing maternal mortality to one-third of current rates, halving road-traffic accidents and ending epidemics of diseases such as tuberculosis and malaria. Before the COVID-19 pandemic, there were a few encouraging signs of progress.

From 2015 to 2021, 146 countries out of 200 evaluated were on course to meet the SDG target of fewer than 25 deaths per 1,000 live births. One study using data from 2020 projected that the world’s shortage of health-care workers would fall from 15 million to 10 million by 2030 (M. Boniol et al. BMJ Glob. Health 7, e009316; 2022). This would have gone some way towards meeting the SDG target to substantially increase the health-care workforce in low-income countries.

Even before the pandemic, there was growing concern that progress was beginning to level off in some areas that previously looked promising. The rate of maternal mortality, which declined from 2000 to 2016, was fairly constant in the five years after the SDGs were established. At the last count, in February 2020, it was still around three times the SDG target of 70 maternal deaths per 100,000 live births by 2030.

But then the pandemic hit, taking millions of lives, leaving millions of people living with disability and disrupting health-care systems worldwide. There were indirect, as well as direct, effects. With world leaders focusing on the pandemic, global spending on tuberculosis services dropped by 10%, from US$6 billion in 2019 to $5.4 billion in 2021; over the same period, deaths from tuberculosis rose from 1.4 million to about 1.6 million. Malaria-associated deaths rose by 12%, from 558,000 in 2019 to 627,000 in 2020. Childhood vaccination rates against diphtheria, tetanus and pertussis fell between 2019 and 2021.

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