predicted a global shortfall of 15 million health 37 workers by 2030. Some health systems are seeing productivity decline as experienced employees leave due to exhaustion, burnout and concerns about staff and patient safety. Skills and infrastructure gaps undermine capacity further as staff become overwhelmed by challenges for which they are not adequately equipped or supported to solve, leading to more strikes over pay and staf昀椀ng levels. Medical in昀氀ation is expected to continue to outstrip 38 GDP growth in many countries, and 昀椀nancial pressures on working populations will intensify as dependency ratios rise. The United States of America already spends nearly 20% of its GDP on healthcare, even before its largest population cohort (the “Baby Boomers”) has retired.39 Governments, insurers or employers may respond by limiting coverage and shifting a greater proportion of the costs to individuals, reducing access and affordability of healthcare. Two-tier health systems, already prevalent in many advanced and developing economies, may become further entrenched, with a pro昀椀table private sector catering to patients with greater ability and willingness to pay, while poorer environment, some of which could have unintended people remain reliant on increasingly threadbare compounding effects on speci昀椀c diseases. For 40 public provision. example, a lack of LGBTQ protection has been linked to poorer health outcomes relating to HIV, 43 A persistent mismatch between demand and supply due to the resulting avoidance of healthcare. gradually weakens the ability of health systems even Current crises might further derail health outcomes in richer countries to cope and adapt, eroding care and equity. Chronic 昀椀nancial stress and rationing quality and shrinking healthcare access. Fragile of essentials – such as having to choose between health systems could quickly become overwhelmed heating and eating – will have long-term physical 44 by one or more catastrophic events. A large-scale and psychological impacts even on healthy people. cyberattack, war, extreme weather event or new or Lower con昀椀dence in public institutions has already re-emergent infectious diseases could trigger health resulted in less effective pandemic responses, and system collapse within one or more regions, resulting growing misinformation and disinformation could in a sudden surge of deaths from all causes. More further increase vaccine hesitancy, which has gradual deterioration of health systems would also already led to the re-emergence of locally-eradicated 45 weaken overall health, widen health disparities, diseases such as polio. These patterns may be slow economic activity and undermine political and reinforced as there is a clear rise in the erosion societal stability as a safety net disintegrates. of social cohesion (see Chapter 1.2: Societal polarisation). Socioeconomic syndemics Geopolitical tensions could limit the co-development and sharing of new scienti昀椀c breakthroughs, limiting respective abilities to address ever-present Combined with fragile health systems, there is a risk risks such as AMR as well as new ones. Export of a rise in “syndemics”: a set of concurrent, mutually restrictions applied to medicine and medical enhancing health problems that impact the overall products could cause a humanitarian crisis and spiral health status of a population, within the context of into controls over even more existential resources – 41 political, structural or social environments. The most notably food – with compounding effects on concept has long been applied to HIV research. health. Disparities in healthcare access may also More recently, it has been considered in the context worsen across and within countries as a result of of the COVID-19 pandemic and chronic disease economic inequality. For example, while advances burdens, which have resulted in higher morbidity such as in personalized, genomic and proteomic and mortality rates among socially disadvantaged medicine can vastly improve health outcomes for 42 communities. A similar pattern could now play out chronic and degenerative conditions, they come with at a systemic level: deteriorating social, economic hefty price tags that may constrain widespread use; 46 and political contexts will contribute to endemic gene therapies can cost upwards of $2 million. A diseases and lead to poorer health outcomes for rise in state instability and con昀氀ict would further limit select communities. the delivery of aid, disrupt vaccination programmes and put health workers at risk. This was evident Inequality and con昀氀icts in societal values could in the case of polio vaccination workers killed in precipitate regulatory changes regarding education, Afghanistan last year.47 employment, housing, gender, immigration and the Global Risks Report 2023 37