Monday, October 2, 2023

Time is running out to meet the Sustainable Development Goals as health inequities widen and trust in government falls

More than 200 years ago, William Wordsworth illustrated in his sonnet “The world is too much with us” how the advancement of the Industrial Revolution was leaving too many people behind. The world is once again at a vital turning point, facing numerous linked challenges. The cost-of-living and climate crises, widening inequities, and increasing pressures on health and welfare services, are leaving more and more of us behind.

Pressure is growing and time is running out to meet the United Nation’s 17 Sustainable Development Goals (SDGs) by 2030, particularly SDG 10: reduced inequalities. The world’s leading economists, in a letter to the UN Secretary-General and the World Bank Group President have called for urgent action as “extreme poverty and extreme wealth have risen sharply and simultaneously for the first time in 25 years.”1

New analysis2 across the WHO European Region highlights an inextricable link between increasing health and social inequities. The ever increasing number of people living insecure lives is leading to a widening trust gap with more disadvantaged groups much less likely to trust other people and institutions, including government, compared to more prosperous groups. The analysis shows that when people do not feel the benefit of government policies—including those that protect health—yet see others benefiting, they increasingly turn away from government and other public entities and institutions.

“Transforming the Health and Social Equity Landscape”2 points to dramatic falls in mental health of our young people, many of whom are struggling to get ahead in life and to achieve their potential. An additional 40 out of every 100 young people reported poor mental wellbeing in 2022 compared with 2016.2 Inequities in wellbeing have also increased considerably. People on low incomes are now three times more likely to report low wellbeing compared with those on a high income.2 This gap has widened by 50% since the pandemic.2

Of the more than 2.2 million pandemic related deaths in the WHO European Region, some 600 000 were linked to low investment in health systems and low human development.2 The cost-of-living crisis could lead to 10 million more people in poverty and 4,500 more infant deaths in central Europe, the Caucasus, the Russian Federation and central Asia.3

The new analysis warns of missed opportunities to use green and digital investments to close health and social gaps. The data reaffirm the same message given to the UN and the World Bank by leading global voices from 67 countries that profit-only economic growth is widening inequities.1 The report stresses that health, the economy, and the social fabric of our daily lives are interwoven.

Five concrete actions any government can implement to deliver a better life and a healthier society for all, both today and for generations to come are laid out: investing in young people and their mental health, developing responsive and integrated social and health protection systems, ensuring all policies and services deliver higher trust in institutions, promoting wellbeing through equitable and green economic recovery and ensuring equitable distribution of health and care resources.2

“Transforming the Health and Social Equity Landscape” builds on the landmark Health Equity Status Report initiative in 2019,4 which provided evidence of the conditions that drive health inequities in all of the 53 Member States of the WHO European Region. It set out solutions for reducing these inequities. At the height of the pandemic the WHO European Region set up the Pan-European Commission on Health and Sustainable Development in 2021, which highlighted the importance of bringing health, business, and finance together around investing in solidarity based policies.5

In March this year the region held a ground breaking high level forum on how to shift investment, resources, and spend to a wellbeing economy approach, with the health sector as an enabler and driver.6 The challenge for WHO continues to be how to persuade sectors outside its core competence of health services to champion population health.

A new collaboration in Italy with the Instituto Superiore di Sanità (the Italian National Institute of Health, ISS) and Banca D’Italia (the Bank of Italy) in partnership with representatives from Finland, Iceland, Italy, Lithuania and Wales (United Kingdom), and renowned international experts from Greece, Ireland and the United Kingdom is paving the way.78

Now is the time for leaders to act, as 81% of Europeans believe reducing health inequities should be the top of governments’ agendas.9 It is our young people who are bearing the weight of widening inequities and falling health, just as they are bearing the weight of the climate crisis and associated economic downturn.

Championing wellbeing economies that focus on people, not just profit, is enabled by new laws such as those in Wales—where the Well Being of Future Generations Act places a legal duty for all public bodies to do just that—incorporate the wellbeing of future generations when developing policies. This is helped by the wellbeing budgeting approaches used in New Zealand and Iceland, with indicator frameworks connected with investment. These new economic models are also supported by new political alliances—such as Scotland’s cross-party group on health inequalities, and Finland’s National Equity Commission. The innovative Debt 2 Health financing mechanism is another example. It has seen 350 million USD in cancelled debt—and 220 million USD invested in health programmes.10

Health systems have a key role to play in delivering equitable wellbeing through their policies and service11 while health and equity dividends can be derived from new ways of governing public and private assets.12 For example, over 35 trillion USD are allocated to investments that aim to promote environmental, social, and governance (ESG) goals. Investors representing over 5 trillion USD recently committed to embedding health as one of their considerations in investment decision-making, a step towards ensuring that wellbeing and equity are at the heart of business priorities.13 More can be done to firmly embed health in ESG frameworks, including explicitly adding ‘H’ to the acronym: ESHG.

As 2030 approaches it is imperative equity of health and wellbeing is put at the heart of all government policies. Next year’s UN Summit for the Future14 prioritises: ensuring global financial institutions are fit-for-purpose, through for example scaling up financing and tax reforms for health and sustainable development; going beyond GDP by routinely measuring indicators of equity, trust and cohesion, and; ensuring the interest of future generations are reflected in decision-making, for example by establishing and strengthening youth forums and parliaments.

We know what to do. Greater participation in decision making is associated with lower inequities in life expectancy.15 A survey of governments across 25 countries in the WHO European region found open and inclusive policy making delivered greater trust in governments, high compliance with decisions reached, better outcomes at less cost, as well as driving innovative solutions.1617 Crucially, the voice of young people must be at the heart of decision making.

The wellbeing path ahead is not easy, but it is possible.


  • Competing interests: none declared

  • Disclaimer: The authors affiliated with the World Health Organisation (WHO) are alone responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO.

  • Provenance and peer review: not commissioned, not peer reviewed.


  1. ShareAction. Investor guide on health: A resource from the long-term Investors in People’s Health Initiative. 18 October 2022.

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