Unacceptable gaps persist in how long people can expect to live healthy lives depending on where they live, the communities they belong to, their education level, their race and ethnicity, their income and wealth, their gender and whether they have a disability. The social determinants of health equity - that is, the conditions in which people are born, grow, live, work, and age, and people’s access to power, money, and resources—have a powerful influence on these avoidable and unjust health gaps.

This comprehensive World report on social determinants of health equity, as requested by resolution WHA74.16, reviews the insufficient progress on meeting the Commission on Social Determinants of Health’s targets on achieving health equity and focuses the narrative and action agenda on what produces and reproduces health inequities and what proven policy remedies are available. The report includes 14 specific recommendations for action within four action areas. Country examples throughout the report showcase actions and diverse strategies for actioning the report’s recommendations across different contexts. The report aims to inform global, national and local policymaking, providing a foundation for coordinated action and investment in social determinants of health equity. The report was developed with input from scientific and policy advisory groups, commissioned papers and evidence reviews, extensive internal contributions across the three levels of WHO, and consultation with Member States through the Executive Board and World Health Assembly.

P.18 Health behaviours - Alcohol, Physical activity, Tobacco, Nutrition

P.40 The commercial determinants of health are the commercial dimension of the social determinants of health. These are the activities undertaken by commercial actors that affect people’s health, directly and indirectly, positively and negatively. Commercial actors not only shape health and health equity through the development, sale and marketing of their products, goods or services, but also in their impacts on the health of their workforce, on supply chains, and in shaping the norms and the regulatory and legal ecosystems that influence health (200, 201, 202). Commercial actors that produce goods and services that improve health can reduce health inequities when they support good employment conditions and have broader positive impacts on communities (203). However, health-harming sectors, such as the tobacco and alcohol industries, pose risks
to health under all circumstances.

Just four industries – health-harming food and drinks, fossil fuels, alcohol and tobacco – account for at least a third of global preventable deaths, collectively in 2021 causing 19 million deaths annually (200, 204). Experience has shown that these industries can and will prevent and undermine public-sector action to limit health-harming products, services and practices, including by seeking to shape public discourse, and to bias or undermine research. They have also established opaque front groups to pursue their interests. The health-harming segment of the food industry has been particularly effective in influencing national governments to reduce or not implement regulations, and in marketing products which misinform about their effects on health, the environment and other social determinants (205, 206).

P.61 Health taxes on health-harming products like tobacco, alcohol and sugary beverages also can play a key role (see Section 3.3 and Box 13). Raising prices on these products by 50% would raise US$ 3.7 trillion over the next five years for public spending: $2.1 trillion in low- and middle-income countries and $1.6 trillion in high-income countries (371).

P.69  Effective instruments to curb health-harming products include tax measures in relation to tobacco, alcohol, salt, trans-fatty acids and other foods (see Box 11, for example, on taxing sugar-sweetened beverages) (439, 440, 441, 442). A systematic review of health taxes in Latin America found that they reduced consumption of harmful goods (81% of studies), and had positive effects on revenue generation (71%) and health outcomes (82%) (443). Other strategies to limit exposure to unhealthier options include giving them less prominence on supermarket shelves, banning price promotions, and restricting marketing.  Across all industries and types of commercial actor, there is a need to ensure processes for transparently identifying and responding to perceived or actual conflicts of interest. Frameworks to address this problem and monitor transparency have been developed in academia, policy-making, and scientific studies (454, 455). Sector-specific tools have been created to help manage conflicts of interest in the alcohol (456) and nutrition sectors (457), including by WHO (458).

P.72 Health exceptions and provisions exist in the General Agreement on Tariffs and Trade, the Technical Barriers to Trade Agreement, and the Agreement on Trade-Related Aspects of Intellectual Property Rights (489, 490). However, effective use of these protections has been undermined by narrow interpretation and the influence of commercial actors, including through legal challenges to both climate change mitigation measures and health-promoting regulation of food, alcohol, tobacco, toxic chemicals and medical devices. Health-related labelling (for example, for alcoholic beverages) has also been contested under World Trade Organization (WTO) rules on technical barriers to trade (491, 492).

P.101 The increasing body of evidence for the harmful impact of the digital transformation on child and adolescent health has led to growing government action. Negative impacts include the significant amount of potentially harmful online content available, particularly to children and young people, such as inappropriate marketing of health-harming or dangerous products, encouragement of violence, and explicit sexual content. Digital technologies, in particular social media, can contribute to feelings of isolation and worsened mental health (746), and can place people – especially children and young people – at risk of exploitation (747). They can also be highly addictive, exacerbating previous addictions such as online gambling, or generating new addictive behaviours such as gaming (748, 749).