Public health

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Likewise, progress on maternal and child mortality has slowed considerably, and many countries are off- course for the 2030 targets, due to underfunding of primary health care and huge gaps in access to essential services, such as skilled care at birth, immunization and access to health workers.

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By the end of 2024, we estimate that the first target was already exceeded, but the second two are likely to be missed: about 1.4 billion more people were living healthier lives, but only 431 million more people were enjoying access to universal health coverage, and million more people were better protected from health emergencies – encouraging progress, but less than is needed to reach the SDGs.

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Acknowledgements This publication was produced by the WHO Division of Data, Analytics and Delivery for technical programmes and regional offices.

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A summary of global and regional trends towards the achievement of selected health-related SDG indicators is further presented in Annex 1.

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Key messages The major contributors to the 5.4-year pre-pandemic increase in global healthy life expectancy (HALE) at birth between 2000 (58.1 years) and 2019 (63.5 years) were mortality reduction from communicable and perinatal conditions among ages under 5 years, and from noncommunicable diseases (NCDs) among those 30 years and older.

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Between 2019 and 2021, the HALE loss can be almost entirely explained by mortality both directly and indirectly attributable to coronavirus disease (COVID-19) among those aged 30 years and older, both globally and in most WHO regions.

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This is expected to increase to only 697 million in 2025 – a substantial gain that nonetheless remains a little over 30% short of the one-billion target.

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On the plus side, an estimated 1.35 billion more people will experience healthier lives by 2024, rising to 1.5 billion by 2025, thus exceeding the original target of one billion.

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Change and inequality in longevity, an contributing Steady increases in life expectancy a (HALE) at birth were observed global by rapid declines between 2019 and pandemic.

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Unless otherwise stated, the principal source of data for this chapter is the World Health Organization (WHO) Global health estimates 2021 (1).

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Globally, the 5.4-year increase in HALE at birth between 2000 (58.1 years) and 2019 (63.5 years) was a result of declining mortality and morbidity over time, contributing 5.2 years (96.0%) and 0.2 years (4%), respectively.

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The gain attributed to NCD mortality reduction was concentrated in the adult age groups, with stroke contributing 0.37 years, ischaemic heart disease 0.28 years and chronic obstructive pulmonary disease 0.19 years among adults 30 years and older.

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Similarly, in the Eastern Mediterranean Region and the South-East Asia Region, reduction in mortality from communicable diseases was the primary driver of the HALE gain in 2000–2019.

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Also worth noting is the 0.3-year loss attributed to increasing diabetes morbidity among those aged 30 years and older in the Eastern Mediterranean Region, constituting the largest loss among all WHO regions.

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While gain due to continued decline in mortality from causes including HIV/AIDS and tuberculosis was observed in 2019–2021 in the African Region, the region suffered from a net loss of 0.66 years in HALE.

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Much of the 2.72-year HALE loss in the Region of the Americas can be attributed to COVID-19 mortality among adults aged 30 years and older (1.92 years) and morbidity for all ages (0.15 years).

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The COVID-19 pandemic had a very limited impact on HALE in the Western Pacific region in 2020 and 2021, resulting in virtually no change in HALE (68.4 years in and 68.2 years in 2021).

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On average, women live longer than men, as they benefit from lower mortality, especially from causes that are affected by behavioural or genetic factors (8,9,10,11).

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In 2019, just before the COVID-19 pandemic, the global female life expectancy was about 5.1 years longer than that of males (75.70 versus 70.61 years).

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What is most noteworthy is that lower female mortality from COVID-19 (0.72 years) and other COVID-19 pandemicrelated outcomes (0.17 years) have contributed to a 0.89-year HALE advantage over males globally.

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In the African Region, sex-difference in mortality from communicable diseases was the primary source of the HALE gap (1.35 years) between sexes in 2019.

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The South-East Asia Region had the second lowest male–female gap in HALE in 2019 after the Eastern Mediterranean Region, at 0.90 years.

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Drug use disorders 0.02 0.58 0.35 1.Ischaemic heart disease 0.39 0.35 2.Stroke 0.31 0.13 0.04 0.11 0.14 3.Lower respiratory infections 0.19 0.11 0.04 0.01 0.13 0.24 4.Diarrhoeal diseases 0.23 0.46 5.Chronic obstructive pulmonary disease 0.04 0.04 0.03 0.04 0.32 0.14 6.Tuberculosis 0.5 7.Preterm birth complications 0.38 8.Birth asphyxia and birth trauma -0.1 -0.09 14.

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Drug use disorders 0.37 0.62 1.Stroke 0.08 0.32 2.Ischaemic heart disease 0.05 0.31 3.Chronic obstructive pulmonary disease 0.03 0.03 0.1 0.01 4.Road injury 0.08 0.06 5.Stomach cancer -0.03 -0.1 7.

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However, the different impacts of the COVID-19 pandemic in individual income groups has influenced the gaps in HALE to various degrees compared with high-income countries.

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Taking into account of the changing population structure over time and its difference across regions, the age-standardized death rate (ASR) for ages under 70 years was in steady decline from 2000 until the start of the COVID-19 pandemic in 2019, both globally and at regional level.

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In 2019, the African Region had the highest ASR of all deaths under age of years (665 per 100 000 population) among all WHO regions, over 80% higher than the global average (366 per 100 000 population) and nearly triple that of the Western Pacific Region (233 per 100 000), the region with the lowest ASRs.

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Premature mortality had been in decline globally and in all WHO regions, from 2000 to the onset of the COVID-19 pandemic.

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Globally, a newborn had about 40.4% chance of dying before reaching the age of 70 years in 2000, declining to 29.9% in 2019.

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The global decline would have to be 1.4 times the observed rate in 2000–2019 to cut the premature mortality in 2019 by half by mid-century.

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At the projected ARR for 2019–2050, a minimum of 2.5 times acceleration is required to halve premature mortality by 2050 globally, and a minimum of about a threefold acceleration in the African Region and low-income countries.

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Levels & trends in child mortality: report 2024 – estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation.

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This represents a decline in the global MMR by 40% since 2000, when the rate was 328 (UI: 308–352) per 100 000 live births.

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This represents an unprecedented challenge and would be equivalent to almost 700 000 deaths averted between 2024 and 2030, compared with a scenario where the 2016–2023 global ARR continues.

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In 2023, the African Region had a high MMR of 442 (UI: 376–560) per 100 000 live births and alone accounted for approximately 70% of global maternal deaths in 2023.

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The MMR was also low in the Region of the Americas, at 59 (UI: 52–66), and the Western Pacific Region, at 35 (UI: 30–42).

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This has led to a larger share of global newborn deaths among total under-five deaths, up from 41% in 2000 to 48% in 2023 (3).

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The African Region had the highest regional NMR in 2023, at 26 (UI: 23–31) deaths per 1000 live births, followed by the Eastern Mediterranean Region with 24 (UI: 21–29) deaths per 1000 live births.

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The greatest burden was observed in South-East Asia Region, with around 318 000 (UI: 283 000–358 000) deaths, or 28% of the global burden, and the Western Pacific Region with almost 296 000 (UI: 276 000–316 000) deaths, or 25% of the global burden.

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By World Bank income levels, the highest death rate from road injuries was observed in LICs, at 21.1 (UI: 16.8–25.2) per 100 000 population, while the lowest was in HICs, at 8.1 (UI: 7.5–8.6) per 100 000 population.

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This is equivalent to a decline from 17.9 (UI: 15.7–19.9) deaths per 100 000 population to 14.9 (UI: 13.2–16.6) deaths per 100 000 population, and is in spite of the growth in global population and number of vehicles.

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This indicates that while efforts to enhance road safety are making progress, they remain insufficient to achieve the United Nations Decade of Action for Road Safety 2021– goal of reducing deaths and injuries by half by 2030 (6).

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The greatest decline in CDR was achieved in the European Region, with a decline of nearly two thirds between 2000 and 2021, followed by the South-East Asia and Eastern Mediterranean Regions, with a 36% and 30% decline, respectively.

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The Region of the Americas and the European Region saw the highest male-to-female ratios, at 2.2 and 2.6 respectively, whereas the lowest ratio was in the African Region, at 1.4.

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Four health outcomes – diarrhoea, acute respiratory infections, undernutrition and soil-transmitted helminthiases – are included in the SDG indicator 3.9.2 on mortality attributed to unsafe WASH.

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The global WASH-attributable mortality rate was 18.3 deaths per 100 000 population, ranging from 3.7 in HICs up to 41.7 in LICs (10).

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In the infectious disease section, the indicators on new HIV infections, tuberculosis and malaria incidence, hepatitis B and neglected tropical diseases are monitored towards progress within SDG target 3.3.

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Globally, an estimated 39.9 million (UI: 36.1–44.6 million) people were living with HIV by the end of 2023, of which 30.7 million (UI: 27.0–31.9 million) were receiving lifesaving antiretroviral therapy (12,13).

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The global increase in new TB cases that has been observed since the start of the COVID-19 pandemic has slowed and is now stabilizing.

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Among those affected who developed TB in 2023, some 55% were men, 33% were women and 12% were children and young adolescents aged 0–14 years.

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In 2023, there were an estimated 263 million (UI: 238–294 million) malaria cases globally, an increase of 11 million cases from the previous year.

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Health-related Sustainable Development Goals The Global technical strategy for malaria 2016–2030 (GTS) target for reducing malaria case incidence by 90% by 2030 from the 2015 baseline is unlikely to be achieved (20).

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As of December 2024, 54 countries, areas and territories worldwide have eliminated at least one NTD, as acknowledged by WHO.

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This is still only about halfway towards the global target of at least 100 countries eliminating at least one NTD by 2030 (24,25).

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In 2022, median resistance proportions were 45.5% (interquartile range [IQR]: 18.2–70.6) for E. coli and 32.2% (IQR: 12.5–54.6) for MRSA, up from 26.9% (IQR: 11.1–42.4) and 13.4% (IQR: 3.6–36.7) in 2016 (27).

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The 2024 WHO Bacterial Priority Pathogen List (26) classifies E. coli resistant to third-generation cephalosporins as a critical priority due to increasing trends, while MRSA is considered as high priority based on its prevalence and impact in health-care settings, and decreasing trends.

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This pace of reduction is insufficient to achieve the global target of halving the number of children affected by stunting by 2030 from the 2012 baseline (28,29).

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While there was a sign of slight decline in the global prevalence of overweight among children under 5 years of age in the 2010s, it has slightly increased again since to reach 5.5% (UI: 4.9–6.1%) in 2024.

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If this pace of decline is maintained, the global prevalence would be reduced by 25% by 2025, short of the 30% reduction target.

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However, the fastest reduction among male tobacco users was seen in the “initiation ages” (age group 15–24 years), a 20% relative reduction since 2010, which bodes well for continuing reductions in prevalence of tobacco use among men in the future (31).

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Health-related Sustainable Development Goals SDG indicator 3.5.2 is defined as total alcohol per capita consumption (APC) in persons aged 15 years and older within a calendar year, measured in litres of pure alcohol.

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Despite this progress, if current trends continue the world will not achieve universal coverage of safe WASH by 2030 (35).

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An estimated 56% of household wastewater was safely treated in 2024, based on data from 142 countries and areas (representing 88% of all household wastewater flows and 84% of the global population) (37).

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While current data are insufficient to accurately assess progress since the start of the SDG era (mainly due to the lack of baseline data for 2015), data availability has greatly improved.

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Globally, air quality levels for particulate matter are still more than six times the recommended level for protecting public health according to the WHO air quality guidelines, which is set at the annual mean of 5 μg/m3.

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However, the proportion of population in LICs and MICs exposed to levels above the interim target 4 (annual mean of 10 μg/m3) is twice that in HICs, at 93.5% and 47.1%, respectively.

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According to the latest available global estimates, in over a quarter (26%, UI: 22–30%) of ever-partnered women aged 15 years or older had experienced IPV at least once in their lifetime (SDG indicator 5.2.1) and 10% (UI: 8–12%) in the past 12 months (42).

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Health-related Sustainable Development Goals In 2018, an estimated 6% (UI: 4–9%) of all women globally had been subjected to non-partner sexual violence in their lifetime since the age of 15 (SDG indicator 5.2.2).

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As of 2024, the WHO Region of the Americas and Western Pacific and European Regions have achieved universal or nearly universal coverage, while only 74% of births are attended by a medical doctor, nurse or midwife in the WHO African Region (49).

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For third dose diphtheriapertussis-tetanus containing vaccine (DTP3), which is a useful marker of vaccination system functioning, in vaccination rates had still not fully returned to their 2019 pre-pandemic level, suggesting substantial residual dysfunction in global vaccine delivery systems.

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