Social and environmental determinants of health are conditions in which people are born, grow, live and work that affect their health outcomes and can lead to health inequities.

Addressing these health determinants requires multisectoral action and evidence-based interventions.The health issues related to both climate change and equity achieved a higher profile during the biennium, with more countries recognizing and building upon areas of action in the health sector, supported by WHO’s strong leadership.

At the 26th United Nations Climate Change Conference in Glasgow (COP26) in November 2021, more than 50 countries agreed to take concrete steps to develop climate-resilient, low-carbon health systems. The countries include some of those most vulnerable to the harm of climate change to health and also some of the largest carbon emitters. The commitments were part of the COP26 Health Programme, a flagship initiative by WHO and partners to increase the health focus of COP26 after a WHO survey showed that support in this area was necessary and a special report with recommendations for climate action that demonstrated the links between climate and health.

Air pollution, a key environmental determinant of health, is estimated to cause 7 million deaths annually, and updated guidelines were issued in 2021 calling for new limits for air quality. The number of deaths that could be averted with interventions to reduce air pollutants was estimated in a pilot project in Accra, Ghana. In response to COVID-19, WHO developed a manifesto for a healthy, green recovery from the pandemic, with more than 80 “actionables” or steps that countries can take.

Equity was a strong theme during the biennium, which was expressed in many ways, including monitoring the WHO programmatic focus on a scorecard. Stronger positioning of equity was seen in the WHO Special Initiative for Action on the Social Determinants of Health for Advancing Health Equity, launched in nine countries, which was complemented by an advocacy brief on health equity and an evidence brief on COVID-19, social determinants and health equity. In collaboration with regional and country offices, health inequities were documented and addressed in Costa Rica, Morocco and the Philippines as part of advocacy for accelerated action.

The 2025 target for reducing childhood wasting rates has been reached or approached by 57 countries. Accelerated action on malnutrition, which has been exacerbated by COVID-19 and climate change, was recognized at the Nutrition for Growth Summit, where WHO announced six new commitments to action by 2025.

Prevalence of exclusive breastfeeding increased by 50% over 40 years

The International Code of Marketing of Breast-milk Substitutes (the Code) was adopted 40 years ago to address aggressive marketing by the infant formula industry to promote formula milk, which led to a dramatic increase in infant mortality. Since then, the prevalence of exclusive breastfeeding has increased by 50%, enabling an estimated 900 million infants to benefit from breastfeeding. Today, the Code is still relevant, as aggressive marketing of breastmilk substitutes discourages women from breastfeeding. WHO calls on countries to fully abide by the Code.