Systems in depth

One section per system: its state at evidence close, its exposures and what the operational series will watch.

9 min read0 figures5 tables25 notesNR-SECTOR-HEALTH-GLOBAL-2026-BASELINE

Contents

8.1Health and water

Safe water, sanitation and hygiene protect people from diarrhoeal disease and slow the spread of resistance. Cholera shows the cost when they fail.

7 870deaths

cholera deaths reported to WHO, 2025³⁵

451 499cases

cholera cases reported by 47 countries, 2025³⁵

21 000 to 143 000deaths

annual cholera deaths estimated by researchers³⁴

Table 8.1State at baseline
Component	State	Evidence	Status
Cholera	deaths up 30% in 2025 with fewer cases reported; seven countries hold about 90% of cases and deaths	³⁵	Reported
Oral cholera vaccine	production rose from about 30 million to about 80 million doses between 2022 and 2025	³⁵	Reported
Resistance	poor water, sanitation and hygiene are named drivers of resistance	¹⁰	Reported
Facility services	water in health facilities is not consolidated here	⁴³	Expert input

Couplings

WAT → HLT cholera and hygiene
WAT → BIO catchments and pathogens
HLT → WAT effluent and residues

Evidence to bind in 2027

water and hygiene in health facilities
effluent and antimicrobial residues

Related editions

GLB Global Systems
GS-01 Water
GS-02 Energy
GS-03 Food and Agrifood Systems
GS-11 Biodiversity and Ecosystems
SR-02 Critical Infrastructure and Lifeline Systems

8.2Health and energy

Cooking fuels and household power shape health. Polluting fuels cause household air pollution, and clinics need reliable power for vaccines and surgery.

2.1billion

people cooking with polluting fuels²⁶

2.9million

household air pollution deaths, 2021²⁶

6.7million

deaths linked to ambient and household air pollution together²⁶

Table 8.2State at baseline
Component	State	Evidence	Status
Household air pollution	309 000 of the 2.9 million deaths were children under five	²⁶	Reported
Ambient air pollution	4.2 million premature deaths in 2019; 99% of people lived above guideline levels	²⁷	Reported
Clean cooking	only 78% of people expected to have access by 2030, leaving nearly 1.8 billion without	²⁶	Reported
Clinic power	power in health facilities is not consolidated here	⁴³	Expert input

Couplings

ENE → HLT cooking and air pollution
ENE → FOO cold chains
HLT → ENE facility demand

Evidence to bind in 2027

power reliability in health facilities
cold-chain failures for vaccines

Related editions

GLB Global Systems
GS-01 Water
GS-02 Energy
GS-03 Food and Agrifood Systems
GS-11 Biodiversity and Ecosystems
SR-02 Critical Infrastructure and Lifeline Systems

8.3Health and food

Food shapes health through safety, nutrition and cost. Unsafe food and hunger are two faces of the same system, and zoonoses cross between farms and clinics.

866million

people ill from unsafe food each year³²

1.52million

deaths a year from unsafe food³²

645million

people facing hunger, 2025³³

Table 8.3State at baseline
Component	State	Evidence	Status
Foodborne illness	unsafe food causes more than 200 diseases; USD 310 billion lost each year	³²	Reported
Hunger	645 million faced hunger in 2025; healthy diets are unaffordable for about 2.7 billion people	³³	Reported
Rabies	tens of thousands of deaths a year, 40% of them children; dogs cause 99% of cases	³⁶	Reported
Nutrition and care	service coverage for child and maternal health stalled at 72 index points	²	Reported

Couplings

FOO → HLT nutrition and foodborne illness
BIO → FOO animal disease
HLT → FOO labour

Evidence to bind in 2027

foodborne illness by country
animal-health losses and spillover

Related editions

GLB Global Systems
GS-01 Water
GS-02 Energy
GS-03 Food and Agrifood Systems
GS-11 Biodiversity and Ecosystems
SR-02 Critical Infrastructure and Lifeline Systems

8.4Health and nature

The health of people, animals and ecosystems is linked. More than 60% of emerging infections come from animals, and resistance moves between people, animals and the environment.

>60%

of emerging infectious diseases come from animals¹⁷

200types

known zoonoses¹⁸

1.14million

deaths attributable to bacterial resistance, 2021¹²

Table 8.4State at baseline
Component	State	Evidence	Status
Spillover	animal trade, agriculture, urbanisation, extractive industries, climate change and habitat fragmentation raise the risk	¹⁷	Reported
Zoonotic influenza	A(H5N1) spread to dairy cattle in the United States in 2024; no sustained human-to-human spread has been seen	³⁷	Reported
Dengue	about half of the world’s population is at risk, with 100 to 400 million infections a year	³⁸	Reported
Animal-side data	use of antimicrobials in animals is not consolidated here	⁴⁸	Expert input

Couplings

BIO → HLT zoonoses and vectors
HLT → BIO residues and spillback
CLI → BIO → HLT vector range

Evidence to bind in 2027

antimicrobial use in animals
drivers of spillover by region

Related editions

GLB Global Systems
GS-01 Water
GS-02 Energy
GS-03 Food and Agrifood Systems
GS-11 Biodiversity and Ecosystems
SR-02 Critical Infrastructure and Lifeline Systems

8.5Health security, climate and extremes

Health security now spans outbreaks, resistance, heat and financing. The 2025 and 2026 evidence shows detection delay, rising resistance and heat deaths near half a million a year.

3 799deaths

confirmed Bundibugyo deaths by 23 September 2026⁵⁶

546 000deaths

a year linked to heat, 2025 report⁵⁵

1 in 6infections

laboratory-confirmed and resistant, 2023¹¹

Table 8.5State at baseline
Component	State	Evidence	Status
Outbreak	no authorised vaccine or treatment; a treatment trial enrolling confirmed cases	⁵⁶²⁵	Reported
Instruments	amended IHR in force; Pandemic Agreement awaiting its annex	²¹²³	Reported
Heat	about 546 000 heat-linked deaths a year; 1.5 billion children exposed to worsening heatwaves; WHO projects about 250 000 additional deaths a year in 2030 to 2050 from undernutrition, malaria, diarrhoea and heat stress alone	⁵⁵²⁹³⁰³¹	Reported
Resistance	resistance rose in over 40% of monitored pathogen and antibiotic pairs from 2018 to 2023	¹¹	Reported

Couplings

BIO → HLT outbreaks
CLI → HLT heat
FIN → HLT service disruption

Evidence to bind in 2027

position after evidence close
heat deaths in 2024 and 2025

Related editions

GLB Global Systems
GS-01 Water
GS-02 Energy
GS-03 Food and Agrifood Systems
GS-11 Biodiversity and Ecosystems
SR-02 Critical Infrastructure and Lifeline Systems

Notes

Numbers are the edition’s reference numbers, so a note reads the same in every chapter. The full list, with every source and its licence, is in Annex C. Annex C, references

35WHO (ed.), WHO reports latest global trends in cholera, meningitis and plague, news release (29 September 2026). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
34WHO (ed.), Cholera, fact sheet (29 September 2026). World Health Organization, Geneva. Observation year 2026 (current text). Accessed 2026-11-03.back
10WHO (ed.), Antimicrobial resistance, fact sheet (16 July 2026). World Health Organization, Geneva. Observation year 2023 (resistance) and 2022 (antibiotic use). Accessed 2026-11-03.back
43WHO (ed.), Surveillance System for Attacks on Health Care, dashboard and method note (the dashboard data require an account and were not read). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
26WHO (ed.), Household air pollution and health, fact sheet (16 December 2025). World Health Organization, Geneva. Observation year 2021. Accessed 2026-11-03.back
27WHO (ed.), Ambient (outdoor) air pollution, fact sheet (24 October 2024). World Health Organization, Geneva. Observation year 2019. Accessed 2026-11-03.back
32WHO (ed.), Food safety, fact sheet (4 June 2026). World Health Organization, Geneva. Observation year 2021. Accessed 2026-11-03.back
33FAO (ed.), The State of Food Security and Nutrition in the World 2026, publication page with headline figures (hunger in 2025; cost of a healthy diet). Food and Agriculture Organization of the United Nations, Rome. Observation year 2025. Accessed 2026-11-03.back
36WHO (ed.), Rabies, fact sheet (17 September 2026). World Health Organization, Geneva. Observation year 2026 (current text). Accessed 2026-11-03.back
2WHO (ed.), Universal health coverage (UHC), fact sheet (5 December 2025). World Health Organization, Geneva. Observation year 2023 (service coverage) and 2022 (financial hardship). Accessed 2026-11-03.back
17WHO (ed.), One Health, fact sheet (8 May 2026). World Health Organization, Geneva. Observation year 2026 (current text; the share of emerging infections is undated in the sheet). Accessed 2026-11-03.back
18WHO (ed.), Zoonoses, fact sheet (29 July 2020). World Health Organization, Geneva. Observation year 2020. Accessed 2026-11-03.back
12Naghavi, M. et al. (GBD 2021 Antimicrobial Resistance Collaborators), Global burden of bacterial antimicrobial resistance 1990 to 2021: a systematic analysis with forecasts to 2050, The Lancet 404 (10459), September 2024; abstract read through Europe PMC. Institute for Health Metrics and Evaluation and partners. Observation year 2021. Accessed 2026-11-03.back
37WHO (ed.), Influenza (avian and other zoonotic), fact sheet (21 January 2026). World Health Organization, Geneva. Observation year 2024 (cattle outbreaks). Accessed 2026-11-03.back
38WHO (ed.), Dengue and severe dengue, fact sheet (21 August 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
48UNVERIFIED, not opened: WOAH (ed.), Annual report on antimicrobial agents intended for use in animals (ANIMUSE); the report page returned an access error and no figure is used. World Organisation for Animal Health, Paris. Observation year 2022. Accessed 2026-11-03.back
56WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo (25 September 2026, data to 23 September 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
55WHO (ed.), Climate inaction is claiming millions of lives every year, warns new Lancet Countdown report, news release on the 2025 Lancet Countdown on health and climate change (29 October 2025; the report itself was not opened). World Health Organization, Geneva. Observation year 2025 (average of about 546 000 heat-related deaths a year; the averaging period is not stated in the release). Accessed 2026-11-03.back
11WHO (ed.), WHO warns of widespread resistance to common antibiotics worldwide, news release on the Global antibiotic resistance surveillance report 2025 (13 October 2025). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
25WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo (28 August 2026, data to 26 August 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
21WHO (ed.), World Health Assembly adopts historic Pandemic Agreement, news release (20 May 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
23WHO (ed.), International Health Regulations: amendments, questions and answers (1 October 2024). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
29POST-CLOSE, context only: WHO (ed.), Climate change is a growing health emergency, Lancet Countdown warns, departmental update summarising the 2026 Lancet Countdown on Health and Climate Change (28 October 2026; the report itself was not opened; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
30POST-CLOSE, context only: WHO, WMO, UNICEF and UNFPA (eds.), New global framework launched to track increasing health risks of extreme heat for pregnant women, newborns and children, news release (21 October 2026; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
31WHO (ed.), Climate change and health, fact sheet (12 October 2023). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back

Cite this chapter

Valadbaygi, S. (Ed.). (2026). Chapter 8: Systems in depth. In Global Health Risk and Resilience Report 2026: Baseline Edition, The State of the World’s Health and One Health System. (Baseline Edition 2026, Report No. NR-SECTOR-HEALTH-GLOBAL-2026-BASELINE) [Draft under review]. The Global Centre for Risk and Innovation (GCRI).

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Systems in depth

8.1Health and water

Couplings

Evidence to bind in 2027

Related editions

8.2Health and energy

Couplings

Evidence to bind in 2027

Related editions

8.3Health and food

Couplings

Evidence to bind in 2027

Related editions

8.4Health and nature

Couplings

Evidence to bind in 2027

Related editions

8.5Health security, climate and extremes

Couplings

Evidence to bind in 2027

Related editions

Notes

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