High-level interactive dialogue on the social, economic and environmental determinants of health

In accordance with General Assembly resolution 78/280, the President of the General Assembly will convene a high-level interactive dialogue on the social, economic and environmental determinants of health. The social, economic and environmental determinants of health shape the lives and opportunities of individuals and communities, influencing how long and well people live. Enabling conditions allow people and communities to thrive, including the quality of housing, education, nutrition, employment, access to clean water, safety in public spaces, and access to financial and other resources. These conditions are often unequally distributed, leading to health inequities that disproportionately affect individuals based on their income, education, sex, race, ethnicity and geographical location. Often, populations face many overlapping challenges that not only influence individual health outcomes but also impact the performance and resilience of health systems.

The determinants of health are central to building sustainable health systems and achieving universal health coverage. Strong primary health care systems can only succeed when they are supported by enabling social, economic, and environmental conditions. However, current and emerging challenges, such as hunger, climate change, inflation, increasing urbanization, humanitarian crises and geopolitical conflict, continue to amplify pressures on these conditions.

Social determinants of health

Health outcomes are influenced by the conditions in which people are born, grow, live, work, and age. These are referred to as the social determinants of health and are shaped by national policies, societal values, different levels of development, within and among nations. According to the 2025 World Health Organization’s World report on social determinants of health equity, the differences in life expectancy both between and within countries are alarming, with gaps of up to 33 years. Health inequities are widening between social groups within countries. Women, marginalized ethnic minorities, Indigenous Peoples, people with disabilities, and migrants often experience poorer health and quality of life. Meanwhile, higher levels of education, wealth, and access to healthcare are linked with better health and longer life spans. Evidence shows a correlation between education and reduced hypertension and diabetes levels. Programs that address gender inequity, racism, and access to essential services also result in better health outcomes.

Expanding funding for social services and promoting access to sick leave has been linked to tangible improvements in health outcomes and equity. Yet, almost half of the world (3.8 billion people, including 1.4 billion children) remains uncovered by any social protection and 70% of workers globally do not have access to sick leave. Social protection is an important tool to act on social and economic determinants of health, such as poverty, inequality, social exclusion and social insecurity. It protects people and communities in need of healthcare services from hardship and from an increased risk of poverty due to the financial consequences of illness and disability. To promote the social determinants of health, governments must work to expand public services and social protection policies, and tackle structural discrimination and social isolation. Environmental determinants of health A healthy environment plays an important role in determining health outcomes. Environmental risk factors, including physical, chemical, biological that affect health, cause approximately 23% of global deaths, with two-thirds linked to noncommunicable diseases. Climate change is one of the major threats to public health. Increasingly frequent extreme weather events and conditions are taking a rising toll on people’s well-being, livelihoods and physical and mental health, as well as threatening health facilities. Changes in weather and climate are threatening biodiversity and ecosystems, food security, nutrition, air quality and safe and sufficient access to water, and increasing food-, water-, and vector-borne diseases and malnutrition. Exposures such as unclean air, unsafe water and sanitation, poor waste management, and poor housing conditions remain widespread. In addition, urban growth is pushing more people into informal settlements with limited infrastructure. Plastic pollution and endocrine disrupters are ubiquitous and are now found in most people’s bodies and threaten health in many different ways. 99% of the global population breathes air that exceeds World Health Organization’s air quality guidelines, and this air pollution is associated with nearly 7 million premature deaths annually. To build health-conducive environments promote better health outcomes, cross-sectoral approaches that integrate aspects of climate change, pollution reduction, land use planning and biodiversity conservation are essential.

Economic determinants of health 

Over the past two decades, economic inequality has worsened – the gap between average incomes of the top 10% and bottom 50% of individuals within countries has increased from 12 to 15 times. The potential health gains from reducing economic inequality are significant. The private sector plays a key role in shaping the social and physical environments that determine health outcomes. Commercial practices shape how physical, information, and socioeconomic conditions impact health outcomes. Noncommunicable diseases remain one of the greatest challenges to countries and societies globally and are most directly caused by the commercialization of their risk factors. Living conditions and behaviours are often influenced by marketing practices that entice people towards harmful products and services. Addressing economic determinants of health requires inclusive fiscal and labour policies, effective market regulation, and investment in equitable health systems, addressing imbalances of power between the public sector and private actors, and aligning business incentives to allow the private sector to fulfil its potential as a partner for health.

Conclusion

Addressing the social, economic and environmental determinants of health across all sectors and the underlying structural determinants, is essential to building resilient, inclusive, and sustainable societies. Sustained public investment is needed to ensure access to high-quality, affordable healthcare and services. An integrated approach based on strong political commitment is required to improve outcomes across sectors such as reduced greenhouse gas emissions and improved respiratory health through clean air initiatives, enhanced learning and nutrition in integrated school meal and education programmes, and greater gender equity and economic participation through investments in healthcare and social protection. Ultimately, the fulfilment of commitments to strengthen the global partnership for development remain essential. International cooperation, the exchange of best practices, as well as capacitybuilding, research and development, and the transfer of technology are necessary to address health inequities in the context of poverty eradication and sustainable development.