By Mikhail Afanasyev, head of research at RT’s Social Well-Being Index project
The 2030 Agenda for Sustainable Development, approved by the UN General Assembly in 2015, includes 17 global goals (the Sustainable Development Goals, or SDGs). One of them is “universal health coverage” – that is, the idea that all people will be able to obtain the medical services they need without facing financial hardship that ruins them.
How things are progressing in that direction can be judged from the data presented in a World Health Organization publication, Tracking universal health coverage: 2025 global monitoring report.
The WHO formulated and tracks two fairly complex indicators, each made up of many smaller ones. The first, the Health Service Coverage Index (SCI), aggregates data across four areas and aspects of healthcare: maternal and child health, infectious diseases, noncommunicable diseases, and the volume and accessibility of medical services. The second, the Financial Hardship Index (FHI), shows the share of the population whose out-of-pocket household spending on healthcare (excluding insurance-based and state-funded medicine) exceeds 40% of the household budget.
The WHO report reveals the irony of “sustainable development.” If in 2000-2015 there was global progress on both indicators, then in the “era of the SDGs,” as the report calls it – that is, after 2015 – there is stagnation, and in some places even deterioration.
From 2015 to 2023, progress on both indicators was recorded in fewer than 4 out of every 10 countries (38%). In the overwhelming majority of countries, either there is no growth in access to medical services, or there is no reduction in the unaffordable cost of those services for very many people. And in 8% of countries, both indicators show negative dynamics.
It must also be borne in mind that the decline in the Financial Hardship Index shown in the report was obtained through a revision of the methodology used to calculate it. By contrast, the previous global UHC monitoring report for 2023 recorded a steady increase in the frequency of catastrophic healthcare spending by patients not covered by insurance – at that time, “catastrophic” referred to spending exceeding 25% of a household budget.
The WHO reports that as of 2023, 4.6 billion people worldwide – that is, the absolute majority (57%) of humanity – did not have access to essential health services. At the same time, 2.1 billion people experienced financial hardship because of healthcare costs.
Through revised indicators and slippery wording, the WHO is trying to demonstrate progress toward universal healthcare access. It should be understood that national statistical agencies, whose data the WHO collects, are trying to solve the same task. Yet despite the positive colors in which the charts are painted, the negative trends are clearly visible.
In Asia, the growth in the volume of medical services is purely nominal, while in Europe and in the Americas, where the greatest volume of medical services had been achieved, the last ten years have seen a decline.
We have already noted the statistical game used to show a reduction in the financial hardship patients face when paying for healthcare, but the manipulation of indicators was enough only to turn a negative trend into the absence of positive movement – that is, into “stability” in the terminology of the report’s authors. It is precisely such “stability” that is recorded in Europe, the Americas, and the Eastern Mediterranean. In Southeast Asia, which aspires to become the new core of the world-system of global capitalism, there is not even such “stability” – there, even after all the recalculations, a clear increase is visible in the financial hardship patients face when paying for medical services.
As a result, although the report’s authors do not say so directly, “universal health coverage” by 2030 looks completely unrealistic. A far more realistic scenario is, on the contrary, a decline in the accessibility of medical services.
There is one more important point. Earlier, we examined the UN’s World Cities Report 2026, devoted to the global housing affordability crisis, as well as UNESCO’s Global Education Monitoring Report 2026, devoted to trends in children’s education. Everywhere we observe a similar picture: a shift in the global trend from positive to negative in roughly 2015 – that is, just after the UN General Assembly approved the updated Sustainable Development Agenda...
So what exactly happened to humanity and its sustainable development in 2015? That is a question we still have to answer. In the meantime, we suggest reflecting on what social well-being consists of, and what conditions are necessary to achieve it.
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