In a comprehensive assessment of the state of global health released in December 2025, the World Health Organization (WHO) and the World Bank Group have unveiled a complex picture of progress and persistent peril. The UHC Global Monitoring Report 2025 indicates that while the world has made undeniable strides toward Universal Health Coverage (UHC) over the past two decades, the pace of improvement has plateaued, leaving a staggering portion of the human population vulnerable to disease and destitution. The report serves as a critical scorecard for the Sustainable Development Goals (SDG), specifically the target to ensure that everyone, everywhere, can access the care they need without suffering financial hardship by 2030.
Since the turn of the millennium, the global trajectory has generally been positive. The report highlights that most countries, spanning all income levels and geographic regions, have managed to expand health service coverage while simultaneously reducing the proportion of their populations facing catastrophic health expenditures. The Service Coverage Index (SCI), a key metric used to evaluate the reach of essential health services, climbed from 54 points in 2000 to 71 points in 2023. Concurrently, the percentage of people experiencing financial hardship due to impoverishing out-of-pocket health payments declined from 34% to 26% between 2000 and 2022. These figures suggest that the global health architecture has become more robust and that policy interventions aimed at protecting the vulnerable have yielded tangible results.
However, the aggregate data masks a harsh reality that the report brings into sharp focus. Despite the statistical improvements, the sheer scale of unmet needs remains overwhelming. An estimated 4.6 billion people worldwide—more than half of the global population—still lack access to essential health services. Furthermore, 2.1 billion people experience significant financial hardship when attempting to access care. Perhaps most alarming is the finding that 1.6 billion individuals are living in poverty or have been pushed deeper into it solely due to health expenses. This paradox, where coverage expands yet financial ruin persists for billions, underscores the fragility of health systems in the face of economic volatility and the rising cost of medical care.
Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, emphasized the gravity of the situation upon the report's release. He noted that while universal health coverage represents the ultimate expression of the human right to health, that right remains effectively out of reach for billions who cannot access or afford necessary services. In the context of severe cuts to international aid and shifting geopolitical priorities, Dr. Tedros urged nations to double down on domestic investment in health systems to protect both their citizens and their economies. The message is clear: reliance on external funding is becoming increasingly precarious, and sustainable health security must be built from within.
A central driver of the financial hardship identified in the report is the cost of medicines. For families living on the margins, the price of pharmaceuticals often forces a choice between health and other basic necessities like food or education. The data reveals that in three-quarters of countries where information is available, medicines account for at least 55% of people’s out-of-pocket health expenses. This burden is disproportionately shouldered by the poor. Individuals living in poverty allocate a median of 60% of their out-of-pocket health spending specifically to medicines, a statistic that highlights the inefficiencies and inequities in pharmaceutical supply chains and pricing models. When the cost of staying alive consumes the majority of a household's discretionary budget, the cycle of poverty is reinforced, not broken.
The report also identifies a worrying deceleration in progress. While the period from 2000 to 2015 saw rapid gains, the global progress rate has slowed significantly in the years since. Since 2015, only one-third of countries have managed to improve both in increasing health coverage and reducing financial hardship. While all WHO regions have seen improvements in service coverage, only half—specifically Africa, South-East Asia, and the Western Pacific—have successfully reduced financial hardship simultaneously. This divergence suggests that in many parts of the world, access to care is expanding, but the cost of that care is being transferred to patients rather than being absorbed by risk-pooling mechanisms or state subsidies.
Low-income countries present a specific area of focus within the 2025 analysis. These nations have achieved the fastest gains in both service coverage and financial protection, a testament to the effectiveness of targeted infectious disease programs and development assistance. However, they continue to face the largest absolute gaps. The global increase in health service coverage has been driven largely by successes in combating infectious diseases, such as HIV, tuberculosis, and malaria. In contrast, coverage for noncommunicable diseases (NCDs)—such as diabetes, heart disease, and cancer—has shown steady but slower improvement. Gains in reproductive, maternal, newborn, and child health have been notably modest, signaling a need to reinvigorate efforts in these foundational areas of public health.
The report also sheds light on the stark inequalities that persist beneath the surface of national averages. In 2022, three out of four people among the poorest segment of the global population faced financial hardship due to health costs, compared with fewer than one in twenty-five among the richest. This disparity illustrates that the current models of health financing are failing to protect those who need protection the most. Women, people living in rural areas, and those with lower levels of education reported significantly greater difficulty in accessing essential services. While the gap between women in the richest and poorest quintiles has narrowed slightly over the past decade, vulnerable groups, including people with disabilities, continue to report higher unmet health needs. The report authors caution that these findings likely underestimate the true extent of inequality, as data often fails to capture the most marginalized populations, such as displaced persons and those in informal settlements.
Looking ahead to the 2030 deadline for the Sustainable Development Goals, the projections are sobering. Without a dramatic acceleration in progress, full-service coverage without financial hardship will remain a distant aspiration for many. The global Service Coverage Index is projected to reach only 74 out of 100 by 2030, and nearly one in four people worldwide are expected to still face financial hardship at the end of the SDG era. This trajectory falls short of the global commitment made by world leaders, necessitating urgent and transformative action.
The WHO and World Bank report outlines six core areas for immediate action to correct this course. First, there is a critical need to ensure that essential health care is free at the point of service for people living in poverty. User fees and co-payments remain a primary barrier to access and a cause of financial ruin. Second, public investment in health systems must be expanded, prioritizing primary health care as the most efficient and equitable way to deliver services. Third, the high out-of-pocket spending on medicines must be addressed through regulatory reform and improved procurement strategies. Fourth, access to essential services for noncommunicable diseases must be accelerated, particularly as the burden of these diseases rises in low- and middle-income countries. Fifth, primary health care must be strengthened to promote equity. Finally, the report calls for multisectoral approaches, recognizing that the determinants of health extend far beyond the health sector itself, encompassing sanitation, education, and economic policy.
As the international community digests the findings of the UHC Global Monitoring Report 2025, the focus shifts to political will. The technical solutions to achieve universal health coverage are largely known; the challenge lies in their implementation and financing. With five years remaining on the SDG agenda, the window for action is narrowing. The report makes clear that health is not merely a byproduct of economic development, but a prerequisite for it. Investing in health systems is an investment in human capital, stability, and economic resilience. For the billions currently left behind, the fulfillment of the promise of universal health coverage cannot come soon enough.
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