Addressing Health Inequalities: Pandemics and the One Health Approach

Pandemics don’t affect everyone equally. From COVID-19 to Ebola, outbreaks have consistently hit the poorest, most marginalised communities the hardest. The reasons go far beyond biology – they are rooted in social determinants like poverty, lack of education, and unequal access to healthcare. Addressing health inequalities requires more than just better medicines. It demands a systemic shift – one that connects human health with animal health, the environment, sustainable finance, and global policy frameworks. That’s exactly where concepts like the One Health approach, ES ratings, and the WHO’s Global Health Security Agenda come in.

Social determinants of health inequalities 🔗

Health inequalities refer to the systematic, avoidable differences in health outcomes between different population groups. These differences aren’t random – they follow a clear social gradient. According to the WHO’s World Report on Social Determinants of Health Equity, non-medical factors like income, education, housing, and working conditions have a greater influence on health outcomes than genetics or healthcare access alone. Within countries, life expectancy can vary by decades depending on social group and geographic area.

Poverty is a major driver. People with lower incomes face greater exposure to environmental hazards, have less access to nutritious food, and are more likely to live in overcrowded conditions – all of which increase their vulnerability to infectious diseases. During the COVID-19 pandemic, people in the lowest income quintile in the Netherlands died from COVID-19 twice as often as those in the highest income quintile. This pattern repeated globally – the poorest bore a disproportionate burden of infection, economic hardship, and death.

The Netherlands’ “Health in All Policies” approach 🔗

The Netherlands offers a noteworthy case study in tackling health inequalities through intersectoral collaboration. The Dutch Ministry of Health has pursued a systematic, research-based approach to addressing socioeconomic health gaps, spanning multi-year research programmes since the late 1980s. A strategy developed through these programmes identified four main entry points: improving socioeconomic position, supporting people with health problems to participate in society, enhancing living and working conditions, and improving healthcare accessibility and quality.

Building on this foundation, the Dutch government explored a formal Health in All Policies (HiAP) strategy around 2011. This approach recognised that policies affecting health originate across multiple government sectors – housing, education, employment, and social security – not just the health ministry. The study identified 38 policy resolutions across seven ministries that could reduce health inequalities. Recommendations included strengthening links between ministries, creating shared objectives, and achieving broad political agreement on health equity goals. While challenges remain (health inequalities in the Netherlands have not narrowed significantly), this model demonstrates the value of whole-of-government thinking in addressing health disparities.

One Health: linking humans, animals, and the environment 🔗

The One Health approach recognises that human health, animal health, and environmental health are deeply interconnected. It’s not a new idea, but it has gained significant momentum in recent decades, especially as zoonotic diseases – infections transmitted between animals and humans – have caused major outbreaks worldwide.

According to the U.S. Centers for Disease Control and Prevention (CDC), One Health encourages collaborative efforts among disease experts, laboratory scientists, physicians, veterinarians, ecologists, and other professionals to improve health outcomes for people and animals alike. The approach extends beyond zoonotic diseases to cover antimicrobial resistance, food safety, vector-borne diseases, and even mental health.

Why One Health matters for pandemic prevention 🔗

Over 60% of pathogens that infect humans are of zoonotic origin. COVID-19, Ebola, avian influenza, and SARS all originated at the animal-human interface. The drivers behind this are largely human-made: deforestation, biodiversity loss, climate change, intensive farming, urbanisation, and global trade and travel. As we push deeper into wildlife habitats and alter ecosystems, the risk of new zoonotic spillover events increases.

The Quadripartite – consisting of the Food and Agriculture Organization (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO), and the World Organisation for Animal Health (WOAH) – developed the One Health Joint Plan of Action (2022-2026) to address these threats collectively. Action Track 2 of this plan specifically focuses on reducing risks from emerging and re-emerging zoonotic epidemics and pandemics.

Implementation challenges 🔗

Despite growing recognition, implementation of One Health remains uneven globally. A key barrier is the lack of communication and coordination between human health, animal health, and environmental sectors. As noted in research published in Scientific Reports, while international bodies like the Quadripartite have formalised inter-agency collaboration, translating this into effective national-level programmes – especially in resource-limited settings – is still a work in progress. Countries like Bhutan and Sri Lanka have conducted One Health zoonotic disease prioritisation workshops, but sustained funding and cross-sectoral institutional capacity remain significant hurdles.

ES ratings and sustainable recovery 🔗

The COVID-19 pandemic didn’t just expose health system weaknesses – it also reshaped the investment landscape. Environmental and Social (ES) ratings, a subset of the broader Environmental, Social, and Governance (ESG) framework, became a focal point for investors seeking to align recovery efforts with sustainability goals.

ESG ratings assess how well companies manage financially relevant sustainability risks and opportunities. Major rating agencies like MSCI assign letter ratings from AAA to CCC based on industry-specific environmental, social, and governance performance. These ratings are used by pension funds, sovereign wealth funds, and asset managers to inform investment decisions.

How ES ratings connect to pandemic recovery 🔗

During the first wave of COVID-19, research showed that funds with strong ESG performance provided some resilience against market losses. Studies found that investor preferences shifted toward low-ESG-risk funds during the pandemic, suggesting these investments offered a degree of protection during the crisis. This highlighted a practical link between sustainability credentials and financial stability.

The Environmental pillar of ES ratings pushes companies toward cleaner operations, reduced emissions, and better resource management – all factors that reduce the ecological disruption driving zoonotic disease emergence. The Social pillar evaluates labour practices, community relations, and health and safety standards – directly relevant to pandemic preparedness and equitable recovery.

However, the ES/ESG landscape is not without challenges. Globally, regulatory approaches are evolving to improve transparency and comparability of ratings. The EU adopted new regulations in 2024 to standardise ESG rating activities, aiming to reduce greenwashing risks and enhance investor trust. For ES ratings to genuinely support sustainable pandemic recovery, they must go beyond financial risk management and incorporate public health and ecological resilience metrics.

WHO’s Global Health Security Agenda 🔗

The Global Health Security Agenda (GHSA) is a partnership of over 70 countries, international organisations, and private sector entities working toward a world safe from infectious disease threats. Launched in 2014 by the CDC and 44 nations including the WHO, the GHSA aims to accelerate implementation of the International Health Regulations (IHR) and build countries’ capacities to prevent, detect, and respond to outbreaks.

The GHSA 2024 target and beyond 🔗

The GHSA set a target for more than 100 countries to achieve a level of “Demonstrated Capacity” in at least five health security technical areas as measured by the Joint External Evaluation (JEE). The agenda operates through nine Action Packages covering areas like disease surveillance, laboratory systems, workforce development, and emergency management. By 2022, 57 countries had reached the GHSA target, with 16 more nearly reaching it.

Recognising the lessons of COVID-19, the GHSA has now entered a new phase running from 2024 to 2028. The GHSA 2028 framework acknowledges the significant disparities the pandemic revealed in countries’ abilities to prevent, detect, respond to, and recover from outbreaks. It emphasises strengthened multisectoral cooperation, sustainable financing for preparedness, and enhanced monitoring using tools like the JEE and the Global Health Security Index.

From surveillance to local capacity building 🔗

A core strength of the GHSA is its focus on building local capacity rather than relying solely on international response. This includes strengthening laboratory networks, training epidemiological workforces, improving real-time disease surveillance systems, and expanding vaccination coverage. The 2024 U.S. Global Health Security Strategy, for instance, expanded formal health security partnerships from 19 countries to 50, prioritising countries’ own ownership of preparedness capacities.

SDGs and pandemic resilience 🔗

The United Nations Sustainable Development Goals (SDGs) provide a comprehensive framework for building long-term pandemic resilience. Three goals are particularly relevant.

SDG 3: Good health and well-being 🔗

SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. It directly addresses health inequalities by targeting universal health coverage, access to essential medicines and vaccines, and the reduction of preventable deaths. Pandemic resilience is impossible without strong primary healthcare systems that serve all populations, not just the wealthy. Countries that invested in robust public health infrastructure before COVID-19 – including disease surveillance, trained health workers, and accessible testing – fared better during the crisis.

SDG 15: Life on land 🔗

SDG 15 focuses on protecting, restoring, and sustainably managing terrestrial ecosystems. This is directly relevant to pandemic prevention through the One Health lens. Deforestation, habitat destruction, and biodiversity loss increase the frequency of human-wildlife contact and, consequently, the risk of zoonotic spillover. Preserving ecosystems is not just an environmental imperative – it’s a public health strategy. When forests are cleared and wildlife habitats shrink, animals carrying novel pathogens move closer to human settlements, raising the probability of the next pandemic.

SDG 16: Peace, justice, and strong institutions 🔗

SDG 16 promotes peaceful and inclusive societies, access to justice, and accountable institutions at all levels. Strong governance structures are essential for effective pandemic response. Countries with transparent, accountable institutions are better positioned to coordinate emergency responses, distribute resources equitably, and maintain public trust during health crises. Corruption, weak legal frameworks, and conflict undermine every aspect of pandemic preparedness – from vaccine distribution to enforcement of public health measures.

Together, these three SDGs create an interconnected resilience framework. Health equity (SDG 3) cannot be achieved without ecosystem stability (SDG 15) and strong institutions (SDG 16). Pandemic preparedness is, at its core, a sustainability challenge – one that requires coordinated action across health, environment, finance, and governance.

Connecting the dots: from inequality to resilience 🔗

The themes covered here – social determinants of health, One Health, ES ratings, the GHSA, and the SDGs – are not isolated concepts. They form an interconnected web. Poverty and inequality make populations vulnerable to disease. Environmental degradation creates conditions for new pathogens to emerge. Weak institutions fail to detect and respond to outbreaks in time. And financial systems that ignore sustainability perpetuate the very conditions that breed pandemics.

Addressing health inequalities is not just about fairness – it’s about survival. The WHO’s position is clear: health inequities will not be overcome unless economic inequality, structural discrimination, conflict, and climate disruption are all addressed simultaneously. Pandemic resilience demands nothing less than a transformation in how societies organise themselves – putting health equity, ecological integrity, and strong governance at the centre of development.

What do you think? Can approaches like One Health and Health in All Policies truly bridge the gap between wealthy and disadvantaged communities during health emergencies, or do deep-rooted structural inequalities make such frameworks difficult to implement in practice? How might stronger ES rating standards push both corporations and governments toward more equitable pandemic preparedness?

References

1. https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health
2. https://www.who.int/teams/social-determinants-of-health/equity-and-health/world-report-on-social-determinants-of-health-equity
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC10127107/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC529300/
5. https://pubmed.ncbi.nlm.nih.gov/22019297/
6. https://www.cdc.gov/one-health/about/index.html
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7232973/
8. https://www.woah.org/app/uploads/2024/06/oh-tackling-zoonotics-pandemics.pdf
9. https://www.nature.com/articles/s41598-022-12619-1
10. https://www.msci.com/sustainable-investing/esg-ratings/
11. https://www.consilium.europa.eu/en/press/press-releases/2024/11/19/environmental-social-and-governance-esg-ratings-council-greenlights-new-regulation/
12. https://globalhealthsecurityagenda.org/
13. https://www.hhs.gov/about/agencies/oga/global-health-security/agenda/index.html
14. https://globalhealthsecurityagenda.org/wp-content/uploads/2024/06/GHSA-2028-Framework-1.pdf
15. https://reliefweb.int/report/world/us-global-health-security-strategy-ghss-2024