Inequality killing on a ‘grand scale’ globally, experts warn

Source: BMJ, 6 May 2025

Inequality continues to kill people on a “grand scale” across the world, experts have warned, with factors like poor housing and a lack of education and jobs influencing health more than genetics or care. It comes as a new report from the World Health Organisation (WHO) revealed targets designed to help tackle global health inequalities within a generation will not be met.

In 2008, the WHO commission on the social determinants of health highlighted how the conditions in which people are born, grow, live, work and age, as well as access to power, money and resources, have a powerful influence on health. One key target set out in the document was to halve the gap in life expectancy between countries and between social groups within countries by 2040. It also aimed to halve adult mortality rates in all countries and reduce child and material mortality rates by 90% and 95% respectively.

While WHO said progress has been made against all three targets, it warned that the “current rates of improvement are insufficient” to meet them in the next 15 years. The new report highlights that improvements in education, job opportunities, water, energy, sanitation, housing and transport “have contributed greatly” to progress, but this has been “brought to a halt by a series of predictable and preventable global crises” and also “driven by conflict and pandemics”.

Professor Sir Michael Marmot, director of the UCL Institute of Health Equity and chair of the 2008 commission, added:

“There is wide acceptance that the economy should work for the whole of society; similarly spending on defence protects the security of everyone. The same should be true for health because it is the outcome of action of the whole of government, not only of health departments. Our commission in 2008 laid out what needed to be done, yet too few countries have taken advantage of that technical advice. As such, the targets we set to close the health gap in a generation will be missed. It is a sad indictment on government leaders that social injustice continues to kill on such a grand scale.”

According to WHO, the gap in life expectancy at birth between the top and bottom third of countries declined by 5.6 years between 2000 and 2021, from a gap of 18.2 years to 12.5 years. The biggest increase in life expectancy was in the bottom third countries – from 59 years to 66 years – although WHO warned “progress has slowed significantly”.

Available data also shows that the gap in life expectancy between the most and least advantaged groups within some countries has widened in the last two decades. WHO said mortality among mothers and in children under five has improved, but needs to reduce further.