(Credit: WHO)
On 6 May 2025, the World Health Organization (WHO) launched its new report ‘World Report on the Social Determinants of Health Equity’. The report demonstrates how a person’s health is profoundly shaped by social determinants – like where they are born, their income, gender and race –, and confirms: achieving health equity demands radical transformations in our social, economic and political systems, including global financial reforms.
At Wemos, we have long supported a broader understanding of health – one that recognizes how social and economic conditions shape people’s chances to live healthy lives. We welcome this report and its renewed global focus on the root causes of health inequities. It offers new evidence, strong policy recommendations, and a clear message: achieving health equity is not only a matter of access to health services, but of transforming the systems that shape our societies.
Progress has been made – but we are still off track
This new publication is a follow-up on the 2008 report ‘Closing the gap in a generation’, released by WHO’s Commission on Social Determinants of Health. It aimed to foster a global movement towards health equity with the goal of closing health gaps between the rich and the poor, within and among countries, by 2040.
The current report shows that considerable progress has been made in health outcomes since the 2000s, particularly in reducing health disparities. For example, the gap in life expectancy between the top and bottom third of countries has significantly narrowed, with the greatest gains seen in lower-income nations. Similarly, adult mortality rates have fallen across the board, with low-income countries experiencing the steepest declines. While reductions of around 50% have been achieved in both child and maternal mortality globally, significant disparities persist, with lower-income countries still accounting for the vast majority of these deaths and facing child mortality rates dramatically higher than their high-income counterparts.
We can draw insightful conclusions from these headline figures:
- One, progress is possible. There have been substantial improvements in health outcomes, meaningfully impacting and saving lives. Importantly, most progress has been driven by improvements in low- and middle-income countries, narrowing the gap with high-income countries.
- Nonetheless, wide health inequities persist. Evidence from 27 African countries shows that women living in rural areas delivered their babies in a health facility 25% less often than women in urban areas. This is largely explained by household wealth and maternal education.
- Progress is slowing – and currently off track. Most gains were achieved in the first decade, with substantially slower improvement in the second. Despite the progress made, the world is not on track to reach the goals proposed in the 2008 report, or the targets of the 2030 Sustainable Development Goal 3 for health and well-being (SDG3). In fact, there is a serious risk of losing ground.
Funding public health through fair systems
A core focus of the report is how progressive taxation and debt relief can expand public financing for health, addressing structural barriers that hinder equitable investment in social infrastructure. The report identifies a lack of public finance, or fiscal space, as a key barrier preventing countries from investing in universal public services. When governments lack resources, public systems like healthcare tend to become underfunded or increasingly privatized, reducing their redistributive effect.
Yet, this redistributive quality is a fundamental determinant of health equity. Effective realization of universal health coverage (UHC) requires a fair and progressive financing system, which distributes the burden according to ability to pay, and the benefits of spending according to need. Progressiveness in health financing means that households with higher incomes contribute a higher share of their income than those with lower incomes.
The 2025 report significantly expands on this theme, first highlighted in 2008, by explicitly calling for robust universal public services funded through progressive taxation, referring to them as “pivotal aspects of social infrastructure”. This is highlighted as a way to expand fiscal space, alongside health taxes on alcohol, tobacco and sugary beverages, and complementing redistributive policies to combat health inequities.
The report also calls for greater global coherence on tax policy, raising concerns about the “race to the bottom” in international tax competition. It critiques inappropriate austerity policies and recognizes external debt as a major constraint on countries’ ability to invest in social infrastructure. Past programmes from the International Monetary Fund (IMF) are criticized for reducing domestic spending on health.
We are pleased to see that these topics received such strong emphasis. At Wemos, we have done collaborative research on structural factors like debt and debt relief that influence lower income countries’ fiscal space for social spending and infrastructure. Debt restructuring by the IMF, imposing several austerity measures in Zambia, was associated with strained access to healthcare and increased poverty, which are both likely to impact health. In Mozambique, the external debt-to-GDP ratio was 35.5%, while health accounts for only 3.63% of GDP. There, progressive and fair taxation and debt cancellation are viable solutions that expand fiscal space and free up resources for health.
The WHO report resonates with our advocacy: we need financial justice through reforms in the international financial architecture – especially tax and debt systems – to advance health equity and security.
It is time to make political commitments to achieve health equity
The report ends with the sobering yet clear conclusion: pursuing social equity is a political choice. The current pace of progress is far too slow, and getting back on track requires sound policymaking, strong legislation, and meaningful implementation. This can only happen if governments, politicians and leaders choose to make health equity a priority.
The social determinants of health cut across all sectors and shape our health throughout our lives. As the report puts it, addressing them can feel like doing “everything, everywhere, all at once” – but it rightly adds that “complexity must not be an excuse for inaction.” Achieving health equity requires coordinated, sustained action across policies, institutions and borders.
We echo the report’s urgent message: achieving health equity is not a technical challenge – it is a matter of political will. Now is the time for governments and global leaders, especially in high-income countries, to step up and commit to global financial reforms, with the ultimate aim of making real progress in health equity.
Endorsing a UN Framework Convention on International Tax Cooperation and supporting a Sovereign Debt Workout Mechanism are key steps toward building a fairer international financial system. These reforms can expand countries’ fiscal space, reduce harmful inequalities, and enable sustainable investment in health and social protection. The choices made in upcoming negotiations – especially at the fourth International Conference on Financing for Development in Seville (FFD4), between 30 June-3 July 2025 – will shape the health and wellbeing of billions for decades to come.
