How Income, Education and Location Shape Chronic Disease Risks, WHO Report Reveals

The report, State of inequality: noncommunicable diseases and their risk factors, provides a global assessment covering cancer, cardiovascular diseases, chronic respiratory diseases and diabetes.

A person's chances of developing a chronic disease, getting a diagnosis and receiving treatment can depend heavily on their income, education, gender and where they live. A new World Health Organization (WHO) report examines these differences within countries, showing how unequal access to prevention and care leaves some population groups facing greater health risks.

The report, State of inequality: noncommunicable diseases and their risk factors, provides a global assessment covering cancer, cardiovascular diseases, chronic respiratory diseases and diabetes. Drawing on national data collected over the past decade, it examines inequalities across age, gender, economic status, education, residence, disability, employment and migration status.

The gaps begin before a diagnosis

The report looks at tobacco and alcohol use, obesity, unhealthy diets, insufficient physical activity and air pollution, tracing differences that can affect people before they develop a disease and continue through diagnosis, treatment and ongoing care.

Evidence from low- and middle-income countries shows that people with less education tend to have higher rates of hypertension and diabetes. Across countries, poorer and less-educated women are less likely to receive cervical cancer screening, and tobacco use is more common among less-educated men than among men with more education.

Place of residence creates another divide. In many low- and middle-income countries, rural populations have less access to hypertension diagnosis and treatment and cervical cancer screening than urban populations. Rural households may face greater exposure to household air pollution, compared with the greater exposure to outdoor air pollution often experienced in urban areas.

Dr Ahmad Reza Hosseinpoor, WHO's Health Inequality Monitoring Team Lead, described the report as the first effort to systematically measure inequalities in NCDs and their risk factors globally. Its findings identify populations being left behind and expose gaps in the data needed to understand their circumstances.

Gender, age and personal circumstances affect care

Men are more likely to use tobacco and consume alcohol, but those with hypertension are less likely to be diagnosed and treated. Women are less likely to get sufficient physical activity, and obesity is more common among women, particularly in low- and middle-income countries.

Age brings different patterns of risk and access. Younger adults with hypertension are less likely to receive a diagnosis and treatment than older adults with the condition. Insufficient physical activity tends to increase with age, and obesity is more common among people aged 40–70.

The report examines circumstances that can make prevention and care harder to access. Unemployment is associated with higher levels of insufficient physical activity. People living with disabilities can encounter greater barriers to prevention, screening and treatment, and migrants may struggle with costs, administrative requirements, language differences and other obstacles to health services.

These findings show why a country's overall progress can leave important questions unanswered about who receives care and who continues to miss out.

Turning better evidence into accessible services

As countries work towards global NCD targets, WHO says inequality data can help them design programmes around the populations facing the greatest barriers, improve health outcomes and assess whether progress is reaching different groups.

An accompanying advocacy brief, The hidden inequalities behind noncommunicable diseases: from evidence to action, outlines how countries can use this evidence to strengthen prevention and control. It supports proven measures across the population, including WHO's recommended NCD "best buys", together with efforts to reach underserved groups through prevention, screening, diagnosis and treatment.

The brief calls for accessible services in rural and urban communities, action on financial and geographic barriers, and the involvement of people living with NCDs in shaping policies and programmes. Regular collection and use of inequality data would help countries identify gaps and assess whether their responses are working.

Dr Alain Labrique, Director of WHO's Data, Digital Health, Analytics and AI Department, emphasized the practical value of this information: helping countries adapt policies, find gaps in coverage and track whether improvements reach all population groups.