The State of inequality: noncommunicable diseases and their risk factors report published today by the World Health Organization (WHO) provides a global assessment of inequalities in noncommunicable diseases (NCDs) and their risk factors, examining differences between population groups within countries.
The report covers four major NCDs – cancer, cardiovascular diseases, chronic respiratory diseases and diabetes – and key risk factors including tobacco and alcohol use, obesity and unhealthy diets, insufficient physical activity and air pollution.
“We know that there are inequalities embedded in all aspects of health, but this is the first effort to systematically measure inequalities in NCDs and their risk factors on a global scale,” said Dr Ahmad Reza Hosseinpoor, Health Inequality Monitoring Team Lead at WHO. “The findings show which populations are being left behind, and also where a lack of inequality data hinders our understanding of inequalities.”
Drawing from national data collected over the past decade, the report examines differences in NCD burden, prevention and care by age, gender, economic status, education, place of residence, disability status, employment and migration status.
Inequality shapes NCDs risks and access to care
People’s income, education, gender, age and where they live can influence their exposure to NCD risk factors and access to health services. These inequalities can occur at every stage from preventing disease and reducing exposure to risk factors to being diagnosed, receiving treatment and managing a condition.
Evidence from low- and middle-income countries shows that less educated populations tend to have higher rates of hypertension and diabetes. Across countries, poorer and less-educated women are less likely to receive cervical cancer screening, while tobacco use remains higher among less educated men than among more educated men.
Where people live is an important factor. In many low- and middle-income countries, rural populations have less access than urban populations to hypertension diagnosis and treatment and cervical cancer screening. Rural households may also face greater exposure to household air pollution, while urban populations often experience greater exposure to outdoor air pollution.
Differences can be observed by gender and age. Men are more likely to use tobacco and consume alcohol and are less likely to be diagnosed and treated when they have hypertension. Women are less likely to be sufficiently physically active, while obesity is more common among women, particularly in low- and middle-income countries. Younger adults with hypertension are less likely to be diagnosed and treated than older adults with the condition, while insufficient physical activity tends to increase with age and obesity is more common in people aged 40–70 years.
The report also considers how unemployment, disability and migration status may be associated with exposure to NCDs risk factors and their ability to access health care. Unemployment is associated with higher levels of insufficient physical activity, while people living with disabilities can face greater barriers to prevention, screening and treatment. Migrants may face financial, administrative, language or other barriers to accessing health services.
Using inequality data to inform action on NCDs
As countries work towards global NCDs targets, information on inequalities can help inform the design and implementation of NCD programmes and policies. Better data offer an opportunity for countries to target NCD prevention and care more effectively, improve health outcomes and ensure that progress reaches populations that are being left behind.
An accompanying advocacy brief, The hidden inequalities behind noncommunicable diseases: from evidence to action, outlines ways countries can use inequality data to strengthen NCD prevention and control. It highlights the importance of implementing proven, population-wide interventions, including WHO-recommended NCDs best buys, while ensuring that prevention, screening, diagnosis and treatment reach populations that face the greatest barriers to care.
The brief emphasizes the importance of making services accessible to underserved rural and urban communities, addressing financial and geographic barriers, involving people living with NCDs in shaping policies and programmes and strengthening the regular collection and use of inequality data.
“Inequality data are not simply about documenting differences – they are a tool for action,” said Dr Alain Labrique, Director of WHO’s Data, Digital Health, Analytics and AI Department. “They help countries better tailor policies and programmes, identify gaps in coverage and track whether progress is reaching all population groups.”