World Health Statistics 2022
Foreword
Over two years since it first began, the COVID-19 pandemic continues to cause major disruptions to health systems around the world. Not only is the delivery of essential health services delayed, the pandemic has also interrupted global efforts to monitor and track health data, depriving analysts and researchers of key information at a very critical time.
Many national statistical offices and ministries of health employed new data collection methods to circumvent catastrophe. Unfortunately, not all Member States had the resources or capacity to adapt, leaving their statistical and informational systems even further behind.
At the time of writing, more than 500 million COVID-19 cases 6 million deaths have been reported to WHO.
But limitations in testing and many countries’ health information systems mean the true toll is much higher.
For this reason, WHO has also produced estimates of excess mortality associated directly or indirectly with the COVID-19 pandemic.
WHO’s World health statistics 2022 includes an analysis of the epidemiological evolution of the pandemic over the last two years, including the impact of excess mortality, along with a summary of disruptions to health services worldwide.
The report also presents the latest data for more than 50 health-related indicators for the Sustainable Development Goals and WHO’s “Triple Billion” targets, and provides comprehensive country-level statistics for both burden of disease and service delivery for the first year of the pandemic.
It shows overall increases in life expectancy and healthy life expectancy over the last 20 years, as a result of reductions in maternal and child mortality and in premature mortality due to noncommunicable diseases,which have both had a positive impact on global health.
The report also includes data on the two main indicators for universal health coverage: the extent to which people have access to essential health services; and the extent to which they face financial hardship as a result of having to pay for those services out of their own pockets. While health service coverage has improved since 2000, catastrophic health expenditure has worsened. We expect that the COVID-19 pandemic will slow the progress made in service coverage, and worsen financial protection, particularly for the most vulnerable populations.
Despite these setbacks, WHO remains committed to supporting countries to improve health data and information systems, to show who is being left behind and where countries can make the best investments for the biggest health gains.
Dr Tedros Adhanom Ghebreyesus
Director-General
World Health Organization
Key messages
Coronavirus disease (COVID-19) continues to be a global threat to health more than two years after being declared a public health emergency of international concern by WHO. As of 20 April 2022, there had been 50.4 million confirmed cases of COVID-19, including 6.2 million deaths directly attributable to COVID-19.
The WHO Region of the Americas and the European Region accounted for almost 72% of all reported cases and 75% of reported COVID-19 deaths. However, many countries have limited testing capacity and lack functioning vital statistics or registration systems to provide accurate and complete mortality data and causes of death.
Consequently, the global number of COVID-19 cases and deaths is underreported.
WHO excess mortality estimates show that the actual death toll associated directly or indirectly with the COVID-19 pandemic between 1 January 2020 and 31 December 2021 was approximately 14.9 million worldwide––or 9.5 million more deaths than the initially reported 5.4 million COVID-19 deaths during that period.
Significant inequalities underpin the distribution of COVID-19 cases and deaths, as well as access to vaccinations.
COVID-19 has disproportionately affected vulnerable populations, including those who are economically disadvantaged, the elderly and people with existing underlying health conditions, and the unvaccinated. Higherrisk populations need better protection against severe illness, more transmissible variants of coronavirus and death due to COVID-19 infection. Yet, they remain critically underserved by vaccination programmes in many countries.
In the latter part of 2021 and in early 2022, the global vaccine supply increased to such a degree that supply was no longer a constraint. In early 2022, there were enough vaccine doses to protect every adult and adolescent (12 years and older) in the world with a three-dose regimen. As of 25 April 2022, 74% of persons in highin come countries (HICs) and 74% in upper-middle-income countries (UMICs) were vaccinated (that is, they had completed their primary series of vaccination), as were 51% in lower-middle-income (LMICs) countries, compared with only 12% of persons in low-income countries (LICs). In LICs, only three in 10 health care workers had been fully accinated against COVID-19 by April 2022, compared with a global average of 80%. Only 25% of adults aged over 60 years were fully vaccinated in African countries and only 11% of people with comorbidities had completed the primary series. Research shows that vaccine hesitancy is not the main challenge holding back vaccination programmes in low- and lower-income countries.
The pandemic continues to affect health systems worldwide, in some cases severely. Conducted during the final quarter of 2021 and with inputs of 129 countries, the third round of the WHO global pulse survey on continuity
of essential health services during the COVID-19 pandemic found little to no improvement in service disruptions since early 2021 when the previous survey was conducted. In more than one half of surveyed countries, dayto-day primary and community care for the prevention and management of some of the most common health conditions were badly affected. Elective, critical and operative care was disrupted in 38% of reporting countries and close to one half of countries reported that routine immunization services were disrupted in the final quarter of 2021. Lower-income countries generally reported more disruption to services than HICs. The main reasons for disruptions were temporary closures or postponement of services (40% of countries), as well as shortages of staff, essential medicines and diagnostics, and of health facility infrastructure and space (36% of countries). Many millions of people have missed out on vital health care. If these disruptions are allowed to persist, they will have potentially major implications for morbidity and mortality and for the evolution of other communicable disease epidemics.
People continue to live longer and live more years in good health. Global life expectancy at birth increased from 66.8 years in 2000 to 73.3 years in 2019, and healthy life expectancy (HALE) increased from 58.3 years to 63.7 years. However, health inequalities continue to claim a disproportionate toll on life and health in lower-resource settings. Both life expectancy and HALE were at least 10 years lower in LICs than in HICs in 2019, despite the dramatic improvements observed since 2000, with gains of 11 and 10 years, respectively.
Both indicators were consistently higher for women than men by approximately 5 and 2.4 years, respectively.
The overall gains in life expectancy and HALE reflect profound changes in mortality and morbidity. Indeed,associated inequalities in mortality and morbidity profiles since 2000 are the main drivers for the patterns of life expectancy and HALE. In the past 20 years, gains have been made in maternal and child health, with the global maternal mortality ratio and under-five mortality rate falling by nearly 40% and 60%, respectively, since viii World Health Statistics 2022 – Monitoring health for the SDGs 2000. Additionally, major investments and improvements in communicable disease programmes, such as those dedicated to human immunodeficiency virus (HIV), tuberculosis (TB) and malaria, have led to declines in incidence and mortality for these diseases at the global level. Consequently, the global share of deaths attributable to noncommunicable diseases (NCDs) increased from almost 61% in 2000 to almost 74% in 2019. Despite this,communicable diseases were still responsible for nearly one half of all deaths in LICs. Low- and middle-income countries also continue to bear most of the burden of communicable diseases, including TB, HIV, malaria,neglected tropical diseases and hepatitis B. At the current pace of improvement, many indicators––including premature mortality due to NCDs, the incidence of TB, malaria and new HIV infections––will not meet their Sustainable Development Goal targets by 2030.
The COVID-19 pandemic is likely to have a negative effect on both life expectancy and HALE, either slowing or reversing the progress made in some aspects of population health. For example, this was evident in the rising numbers of deaths from TB and malaria between 2019 and 2020 due to disruptions to various types of services. Strengthened disease and injury prevention and control programmes, especially in low- and middle-income countries, are needed to mitigate the impact of the pandemic and to accelerate the progress for meeting various national and international health targets.
Prior to the COVID-19 pandemic, there had been encouraging trends globally in the reduction of child stunting,alcohol consumption and tobacco use, as well as in increased access to safely managed drinking water and sanitation, basic hygiene and clean fuels and technologies for cooking. However, at the same time, obesity among people of all ages, hypertension among adults, anaemia among women, outdoor air pollution and violence against women had been either increasing or remaining at high levels.
The total number of children affected by stunting was 27% lower in 2020 than in 2000 and the prevalence rate of stunting also declined. Meanwhile, obesity has increased globally across all ages since 2000.
The average level of alcohol consumption worldwide declined slightly between 2010 and 2019, with men continuing to consume about three times more alcohol than women. Tobacco use declined more steeply:about 22% of the global population aged 15 years and older were using tobacco in 2020, down from almost 33% in 2000. The number of adults aged 30–79 years with raised blood pressure (hypertension) is estimated to have almost doubled to 1.28 billion between 1990 and 2019, mainly due to population growth and ageing.
There was little change in the overall rate of hypertension globally, although the burden has shifted from high-income to low- and middle-income countries.
Safely managed drinking water services were accessible to about three quarters (74%) of the global population in 2020. Nevertheless, this translated into two billion people who still lacked access to safely managed water, while about 3.6 billion people globally had insufficient sanitation services. Achieving universal access to safely managed water, sanitation and basic hygiene services by 2030 will require a four-fold increase in the current rates of progress. Furthermore, approximately 44% of household wastewater was discharged without safe treatment in 2020.
More than two thirds (approximately 69%) of the global population were primarily using clean fuels and technologies for cooking, up from one half in 2000. However, almost the entire global population (99%) breathes unhealthy levels of fine particulate matter and nitrogen dioxide. People in low- and middle-income countries are most exposed to outdoor air pollution at levels exceeding WHO air quality limits.
Violence against women continued to be prevalent. Globally, about one in four (26%) women aged 15 years and older had been subjected to physical and/or sexual violence by an intimate male partner at least once in their lifetime. The COVID-19 pandemic is likely to have caused a major setback in efforts to reduce violence against women, with initial data indicating increases in intimate partner violence.
A more complete picture of the impact of the COVID-19 pandemic on the prevalence of these various risks awaits the collection and analysis of additional data. However, the sustained disruption of many of the relevant services point to potentially dramatic negative consequences in at least some respects. In addition, a strong body of evidence indicates that some NCD risk factors increase individuals’ risk of severe outcomes due to COVID-19.
The latest global monitoring reports on universal health coverage (UHC) and financial protection in health,published by WHO and the World Bank, identified mixed trends prior to the COVID-19 pandemic. Service coverage improved steadily from an index of 45 in 2000 to 67 in 2019, while the proportion of the population
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Key messages
with out-of-pocket health spending exceeding 10% of their household budget grew from 9.4% in 2000 to 13.2% in 2017.
COVID-19 is expected to both halt the progress made in service coverage over the past 20 years and exacerbate the financial hardship experienced by people paying out-of-pocket for health. WHO, the World Bank Group and the Organization for Economic Co-operation and Development are urging stronger progress in three priority areas to accelerate progress towards UHC: primary health care, sustainable financing, and strengthening of health system capacities, particularly the health workforce.
Primary health care is the cornerstone of an equitable and resilient health system. Insufficient attention to the central role of primary health care slowed the effectiveness of the response to the pandemic and triggered disruptions to routine care in many countries, thus threatening progress made prior to the pandemic. On average,countries reported that about 56% of 28 tracer essential services had been disrupted in the third quarter of 2020 and 41% were still being disrupted in early 2021. All health care settings and service delivery platforms were affected, particularly first-contact services.
Adequate and sustained health financing is a prerequisite for well-functioning health systems and for the achievement of UHC. Sustainable health financing entails having sufficient resources to fund the health system and to protect populations against financial hardship when they use health services. Global spending on health more than doubled in real terms between 2000 and 2019, reaching 9.8% of the global gross domestic product. Approximately 80% of that spending occurred in HICs, with the bulk of it (about 70%) coming from government budgets. In LICs, out-of-pocket spending was the main source of health expenditure (44%), followed by external aid (29%).
The COVID-19 pandemic has placed unprecedented pressure on health systems’ capacities, particularly health workforces. Even prior to the pandemic, the capacity to deliver essential health services in many countries was limited due to persistent health workforce shortages. Already, in 2016, WHO had projected a global shortfall of 18 million health care workers by 2030, especially in the WHO African and South-East Asian regions. Notably, the African Region, which bears almost one quarter (24%) of the world’s disease burden, had only 3% of the world’s health care workers.
Overall, urgent actions are needed to achieve the target of having an additional one billion people enjoying UHC by 2030. Based on current trends, approximately 730 million people will miss out on UHC; if the effects of the COVID-19 pandemic and its disruptions are taken into account, that shortfall could rise to 840 million.
• The world is off track to reach the triple billion targets from the GPW13 and most health-related Sustainable Development Goals.The triple billion targets embody WHO’s mission to promote health and well-being, keep the world safe, and serve the vulnerable.
• Health emergencies protection:One billion more people are better protected from health emergencies Although initial projections anticipated this billion could be met by 2023, COVID-19 has revealed that no country is fully prepared for a pandemic of such scale.
• Healthier populations:One billion more people are enjoying better health and well-being Although the billion target is projected to be almost reached by 2023, progress is around 1/4
of that required to reach the Sustainable Development Goals by 2030.
• Universal Health Coverage:One billion more people are benefitting from universal health coverage The billion target will not be reached by 2023, and progress is less than 1/4 of that required to reach the Sustainable Development Goals by 2030.
