Despite considerable improvement in the state of world health since the 1950s, unequal access to care is not diminishing, with women and children particularly affected. The goal of universal health care is far from being attained and the health consequences of environmental damage are only adding new threats.

Human health throughout the world has improved considerably since the 1950s. In the years 1990-2015, average life expectancy rose from 64 to 71 years, with an annual average rise of 4 months. These improvements in life expectancy have been particularly strong in countries where the situation was particularly disastrous (49 to 58 years in sub-Saharan Africa, 58 to 68 years in Central and Southern Asia, 65 to 71 years in Southeast Asia, 70 to 77 years in East Asia and 68 to 75 years in Latin America).

Life expectancy at birth, 1960-2015

Source: World Bank ,

Comment: For selected countries, the graph enables a comparison to be made between the situation at the latest date (2015), with a 33-year gap between the lowest life expectancy (between 50 and 60 years for 8 African countries) and the highest (more than 80 years for 17 countries in Europe and Asia). It also shows some remarkable improvements with over 30 years of increased life expectancy for 30 countries. However, these national averages may conceal considerable differences within each country.

Living Longer

The reductions seen since the early 2000s in infant mortality (-32 %), maternal mortality (-25 %) and deaths related to AIDS (-50 %) and malaria (-49 %) are due to better education, falling birthrates, improved living conditions and major aid programs (vaccinations, antiretroviral drugs, insecticide-treated mosquito nets, drinking water, etc.) implemented by many global actors (United Nations agencies, NGOs, private foundations, global funds, bilateral aid and civil society).

However, within this overall picture great inequalities persist, both between and within societies, and in some cases they are growing, and this despite the fact that fairness in relation to heath has been on the agenda of international organizations and NGO s since the late 1970s (1978, Declaration of Alma-Ata ; 1994, International Conference on Population and Development. Cairo; 2000, Millennium Development Goals 4, 5 and 6; 2015, sustainable development goals 3 and 6). The persistence of disparities can be explained by unequal access to adequate, nutritionally balanced food, proper hygiene and regular health care, and by differences in schooling, working conditions, housing and, increasingly, environmental conditions. Poor populations in the countries of the South are those most at risk of health problems, but those in the societies of the North who cannot get proper health care are also at risk. In 2017 the also highlighted health issues among refugees and displaced persons (65.5 million 2016), who are exposed to all kinds of violence and health risks.

Child mortality, 2016

Source: World Bank ,

Comment: Although, on a worldwide scale, the deaths of children under 1 year old has seen a rapid decrease, this has slowed in Africa and Western Asia where mortality rates remain very high, sometimes reaching almost three times the world average. This marker of poverty and deficient public health services is still more pronounced in conflict zones.

While the Millennium Development Goals (MDGs) called for a 75 % reduction in maternal mortality in the years 1990–2015, the real reduction was only 44 % (216 deaths per 100,000 naissances). Maternal mortality remains the prime cause of female death in the countries of the South, where it primarily affects the poor, rural women and adolescent girls. The reduction itself can be explained by the retreat of Aids, programs encouraging women to give birth with specialist help, the monitoring of pregnancy and its outcomes and better information, all of which remain inaccessible to large numbers of women. In 2015, the lifetime risk of maternal death stood at 1 in 36 women in sub-Saharan Africa as opposed to one in 4,900 women in high-income countries, and in over half of cases its causes were avoidable (hemorrhage, infection, blood pressure). The family planning needs of 225 million women in the world are not met, with an annual 89 million unplanned pregnancies, 48 million abortions and 10 million miscarriages in developing countries. In addition to destabilizing family units, the mother’s death often results in the children leaving school, particularly girls, who are required to take on domestic duties. To break this cycle, the UN advocates the development of universal health care coverage, including sexual and reproductive health, prioritizing the poorest women who do not enjoy their fundamental right (recognized by 179 countries at the Cairo Conference in 1994) to the knowledge, capacity and means necessary to enable them to decide when and how often to have children.

Access to healthcare, 2014

Source: World Health Organization (WHO),

Comment: The striking gap between the lowest and highest rates of public and private health spending per inhabitant in the different countries of the world (700 times more in Switzerland than in Madagascar) is evidence of the unequal access to health care: Insufficient public investment and the impossibility for families to pay for private health care both combine to create this situation for most of the inhabitants of Africa and Western and South East Asia.

Threats to World Public Health

In addition to insufficient progress on water (at least 1.8 billion people are drinking water contaminated by fecal matter) and sanitation (2.4 billion have no access to toilets or latrines), health risks linked to the environment are rising considerably and currently cause 12.6 million deaths a year. These include river basins with a deficient water balance (over 40 % of the global population do not have an adequate water supply), and pollution of the water (80 % of used water goes untreated into the rivers and seas), air (92 % of the planet’s inhabitants breathe air containing too many fine particles, responsible for 7 million deaths annually) and soil.

Although progress has been made, many are still threatened by lack of access to proper health care, although the right to social security has been recognized as a fundamental human right since 1948. In 2017, 400 million people did not have access to basic health services, while the extension of universal health coverage, which has been on the global agenda since 2000, has been slow in reaching many countries.

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