On 20 October 2026 the World Health Organization (WHO) published State of inequality: noncommunicable diseases and their risk factors, which it describes as the first comprehensive global assessment of inequalities in noncommunicable diseases (NCDs) within countries.
The report does not add a new headline death toll. Instead, it asks a different question: when a country reports progress on NCDs, which groups of people does that progress actually reach? Its answer is that national averages often conceal large gaps, and that in many places the data needed to see those gaps do not yet exist.
Why NCD inequality matters
NCDs are now the world’s main cause of death. According to WHO’s NCD fact sheet, they killed at least 43 million people in 2021, and 18 million of those deaths occurred before the age of 70. Of these premature deaths, 82% were in low- and middle-income countries.
Newer WHO figures point the same way. Its Global Health Estimates released in October 2026 attribute 74% of global deaths in 2023 to NCDs, a shift Praxis examined in an earlier analysis of what those estimates ask of health data.
Comparisons between countries are well established. Comparisons within countries, between richer and poorer households, men and women, or rural and urban areas, are far less common. That is the gap the new report sets out to fill.
What the report covers
According to the report’s abstract, it examines four major NCDs (cancer, cardiovascular diseases, diabetes and chronic respiratory diseases) and five major risk factors (alcohol use, obesity and unhealthy diet, insufficient physical activity, tobacco use and air pollution).
It draws on nine multicountry data sources and analyses 35 indicators. Each is disaggregated by up to eight dimensions of inequality. WHO’s announcement lists these as age, gender, economic status, education, place of residence, disability status, employment and migration status. The data were collected nationally over the past decade.
“We know that there are inequalities embedded in all aspects of health, but this is the first effort to systematically measure inequalities in NCDs and their risk factors on a global scale,” said Dr Ahmad Reza Hosseinpoor, who leads WHO’s Health Inequality Monitoring team.
What the findings show
The report’s abstract summarises the overall picture as “substantial inequalities” in disease prevalence, exposure to risk factors and access to prevention and treatment, with patterns that vary across countries and population groups. Several findings stand out.
Education and economic status
In low- and middle-income countries, less educated populations tend to have higher rates of hypertension and diabetes. Across countries, poorer and less educated women are less likely to receive cervical cancer screening. Tobacco use remains higher among less educated men than among more educated men.
Place of residence
In many low- and middle-income countries, rural populations have less access than urban populations to hypertension diagnosis and treatment, and to cervical cancer screening. Exposure to air pollution differs by setting: rural households may face more household air pollution, while urban populations often face more outdoor air pollution.
Gender and age
The patterns do not all run in one direction. Men are more likely to use tobacco and alcohol and are less likely to be diagnosed and treated for hypertension. Women are less likely to be sufficiently physically active, and obesity is more common among women, particularly in low- and middle-income countries.
Younger adults with hypertension are less likely to be diagnosed and treated than older adults. Obesity is more common among people aged 40 to 70.
Disability, employment and migration
WHO reports that people living with disabilities can face greater barriers to prevention, screening and treatment, and that migrants may face financial, administrative, language or other barriers to services. Unemployment is associated with higher levels of insufficient physical activity.
The data gap is a finding in itself
The report is candid about its limits. Its abstract notes “significant gaps in comparable, disaggregated data”, and Dr Hosseinpoor said the findings also show “where a lack of inequality data hinders our understanding of inequalities”.
Several caveats follow for readers. The evidence spans a decade of national surveys, so some estimates describe conditions several years old. Coverage is uneven, since not every indicator can be broken down by all eight dimensions in every country; the report analyses each indicator by “up to” eight. And the presence of a gap shows where to look, not why it exists; explaining a difference in screening coverage, for example, requires local analysis of services, costs and behaviour.
These limits do not weaken the case for the report. They strengthen it. A health system cannot close a gap it cannot measure, and the groups most likely to be missed by services are often the same groups missing from the data.
From evidence to action
A companion advocacy brief, The hidden inequalities behind noncommunicable diseases: from evidence to action, sets out three priorities. Countries are asked to scale up proven interventions that address NCD inequalities, use disaggregated data to target policies and resources at the populations with the greatest needs, and measure inequalities routinely to monitor progress.
WHO’s announcement adds that this means implementing its recommended NCD “best buys” while making sure prevention, screening, diagnosis and treatment reach those facing the greatest barriers. It also stresses involving people living with NCDs in shaping policies and programmes.
“Inequality data are not simply about documenting differences – they are a tool for action,” said Dr Alain Labrique, Director of WHO’s Department of Data, Digital Health, Analytics and AI.
Practical steps for health institutions
For ministries, public health institutes and programme teams, the report points to a set of concrete tasks:
- Audit what is already collected. Many routine and survey datasets record sex, age, residence or education but are reported only as national totals.
- Build disaggregation into data systems by design. Adding variables later is slower and costlier than planning for them, and it requires clear rules on privacy and small-group confidentiality.
- Use existing tools. WHO’s Health Inequality Monitor hosts the Health Inequality Data Repository and the Health Equity Assessment Toolkit (HEAT), and HEAT Plus lets users analyse their own inequality data.
- Report gaps alongside averages. Programme reviews that show progress for the lowest-coverage group, not only the national mean, make inequality visible to decision-makers.
- Invest in skills. Disaggregated analysis depends on staff who can manage survey weights, small samples and uncertainty, and who can explain results to policymakers.
Praxis has argued before that data only matter when they reach decisions. The WHO report applies that principle to equity: an indicator that improves on average may still leave some groups behind.
Conclusion
The new report gives countries a baseline for asking who benefits from NCD prevention and care, and an honest map of where evidence is missing. Its usefulness will depend on whether health institutions build inequality monitoring into routine work rather than treating it as a one-off exercise.
Praxis supports institutions to strengthen this kind of evidence through its Research & Data work, training for health and public sector professionals and advisory partnerships; to discuss inequality monitoring in your institution, contact the Praxis team.
Praxis Editorial Team
The Praxis Editorial Team publishes Praxis Global Institute’s explainers, practical guides and analysis of new evidence and policy in global health, education and professional capability, ethical AI and technology, research and data, and institutional strengthening. Every article is researched from primary sources, cites its evidence and is published under the editorial direction of its editors.
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