Tackling Health Inequality: Evidence, Action, Outcomes

The Global Context: Progress, Challenges, and Structural Drivers 

The COVID-19 pandemic laid bare the deeply entrenched inequities in health outcomes, both between and within countries. These disparities are not new, but the pandemic amplified their impact and urgency. In response, WHO member states called for an updated world report on the social determinants of health—focusing on the underlying factors that shape who lives longer, healthier lives and who does not. 

Since the landmark 2008 Commission on the Social Determinants of Health, there has been measurable progress. Life expectancy gaps between countries have narrowed somewhat, largely due to improvements among the world’s poorest nations. Child mortality has halved, and maternal mortality has dropped by 40%. However, these advances are slowing, and in many places, health inequalities within countries are actually widening—particularly along lines of income, education, ethnicity, and other markers of social position. 

Several structural forces are driving these trends: 

• Rising income and wealth inequality within countries 

• Underperforming social protection systems, leaving billions without safety nets 

• Intensifying debt distress in the poorest countries, limiting investment in health and social infrastructure 

• Climate change and conflict, which disproportionately affect vulnerable populations and have led to a tripling of forced displacement in the last 15 years 

• Embedded discrimination in institutions and policies, including structural racism, gender inequality, and barriers for people with disabilities or other marginalised identities 

The report makes clear: unless we address these root causes, health inequities will persist, regardless of advances in medical care or public health interventions. 

From Evidence to Action: What Works and Where Gaps Remain 

One of the most striking messages from the event was the sheer growth in evidence since 2008. There are now thousands of published articles and hundreds of systematic reviews exploring the pathways from social determinants—such as work, housing, education, and income—to health outcomes. The evidence base is robust and growing, especially on what works to reduce health inequalities. 

Key areas of focus include: 

• Progressive taxation and fairer economic systems to enable investment in universal public services 

• Regulation of commercial determinants of health, including health-harming industries and the positive role of responsible private sector engagement 

• Expanding social protection across the life course, such as sick leave and child benefits 

• Addressing structural discrimination, including redressing historical injustices and upholding the rights of indigenous peoples 

• Harnessing megatrends—like digitalisation and climate action—to ensure that new developments reduce, rather than exacerbate, inequalities 

However, some gaps remain. Much of the evidence still comes from the Global North, particularly the United States. There is a need for more research from, and about, the Global South, as well as better recognition of knowledge that exists outside mainstream academic channels. Emerging areas such as the health impacts of artificial intelligence, digital platforms, and climate change require urgent attention. 

Implementing Change: The Local and Systemic Imperative 

While the evidence on what needs to be done is strong, there is still a relative gap in understanding how to take action—especially at the practical, local, and organisational levels. Barriers include political resistance, vested interests, and the complexity of system-wide change. 

Yet, promising initiatives are emerging: 

• Local-level innovation: Across the UK and internationally, regions, cities, and communities are taking the lead, developing systems and partnerships to address the social determinants of health despite limited national focus. 

• Learning from practice: Initiatives like the WHO’s multi-country action on health equity and the “Marmot Places” in the UK are generating valuable insights into culture shifts, organisational change, partnerships, and the redistribution of power. 

• Embedding equity in governance: Action requires accountability, targeted resource allocation, and operational systems that prioritise health equity across all sectors—not just health and care services. 

The clear message: action is possible. Even in the face of daunting global challenges, collective and coordinated efforts at every level can make a tangible difference. 

Reflections and the Way Forward 

Sir Michael Marmot, a leading voice in the movement for health equity, emphasised that progress is both necessary and achievable. The evidence is clear, and the recommendations are actionable. The challenge now is to move from knowledge to implementation, breaking down overwhelming problems into practical steps and supporting each other to create change. 

The movement for health equity is global and growing. As more countries, communities, and organisations step up, there is a renewed sense of momentum and hope. The task ahead is to ensure that health equity is not just a health sector issue, but a whole-of-government—and whole-of-society—priority.