Understanding Health and Well-being
Health is most comprehensively defined by the World Health Organization (WHO) as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". This perspective emphasizes that being healthy entails more than not being sick; it requires a positive state wherein an individual can realize their abilities, respond to life’s stresses, work productively, and contribute to their community. Well-being, in turn, is a multi-dimensional concept encompassing not just physical health, but also mental and emotional stability, social engagement, fulfillment, and quality of life. Well-being signifies a positive, dynamic state that allows individuals and societies to pursue their full potential, experience life satisfaction, feel safe, and make meaningful contributions to their environments. These concepts are both subjective, relying on self-perception and reported quality of life, and objective, relying on measurable health and social indicators.
Countries with the Poorest Health and Well-being Outcomes
Globally, the worst levels of health and well-being are typically found in countries affected by persistent conflict, deep poverty, and fragile or under-resourced health systems. Among these, Afghanistan, the Central African Republic (CAR), and the Democratic Republic of the Congo (DRC) are consistently recognized as having the largest populations living under the most challenging circumstances in terms of health outcomes and well-being. Afghanistan, for instance, ranks the lowest out of 188 countries in achieving the targets for Sustainable Development Goal 3 (SDG 3), which pertains to good health and well-being. Similarly, CAR and DRC are both frequently classified at the bottom of global health and well-being indices and experience severe humanitarian crises.
Most Concerning Health and Well-being Issues in Severely Affected Countries
The most pressing health and well-being concerns in these countries include:
Extremely High Maternal and Child Mortality: Afghanistan, CAR, and DRC all report high rates of maternal deaths due to complications in pregnancy and childbirth, and many children die before reaching their fifth birthday because of preventable causes.
Widespread Infectious Diseases: The burden from infectious diseases such as tuberculosis, malaria, HIV/AIDS, cholera, and polio remains unacceptably high, with vaccination and treatment coverage often insufficient due to conflict, logistical barriers, and damaged health infrastructure.
Malnutrition and Food Insecurity: These countries are characterized by chronic and sometimes acute malnutrition, especially among children and pregnant women, impairing life expectancy and cognitive development.
Mental Health Crisis: Prolonged exposure to conflict, displacement, poverty, and loss has given rise to wide-scale mental stress, trauma, depression, and anxiety, yet mental health services are largely unavailable or inaccessible.
Poor Access to and Quality of Healthcare: Health systems are either severely under-resourced or have partially collapsed, resulting in shortages of skilled personnel, supply interruptions, inadequate facilities, and barriers to care for women and the displaced.
Compounding these challenges are devastating social determinants such as lack of clean water and sanitation, limited access to education, electricity, and transportation, political instability, and widespread poverty. Discrimination and restrictions, especially on women and minority groups, further erode community health and individual well-being.
Survival and Coping Under the Worst Health and Well-being Circumstances
In countries like Afghanistan, CAR, and DRC, millions experience ongoing humanitarian emergencies, and daily survival is fraught with uncertainty and hardship. Coping mechanisms include:
Dependence on Humanitarian Aid: Many rely on external food assistance, nutrition supplements, and sporadic healthcare missions for survival.
Negative Coping Strategies: Households may reduce meal intake, sell essential assets, or withdraw children from school to meet immediate survival needs.
Community Support: Informal networks and community-based support can provide psychosocial care, shelter, and shared resources during acute crises.
Migration and Displacement: A significant portion of the population becomes internally displaced or refugees in an effort to escape violence and deprivation, often resettling in camps with precarious living conditions.
High Mortality Rates: Despite coping strategies, many do not survive under these conditions, particularly the most vulnerable—infants, young children, pregnant women, the elderly, and those with disabilities. Mortality from preventable diseases, complications in pregnancy, malnutrition, and lack of access to emergency care remains alarmingly high.
Mental Health Resilience and Trauma: While some individuals exhibit remarkable psychological resilience, the prevalence of untreated trauma, PTSD, and depression is extensive, further impacting survival and community well-being.
United Nations Institutions Active in Crisis-Affected Countries
A coordinated United Nations system is central to the international response in these countries, working to protect lives, restore dignity, and promote the targets of SDG 3: Good Health and Well-being:
World Health Organization (WHO)
Role: Provides technical support for health system strengthening, disease outbreak detection and control, emergency trauma care, primary health coverage, and essential medicines.
Focus: Strengthening health system governance, developing health policy, supporting vaccination and disease prevention, and leading inter-agency health emergency responses.
United Nations Children’s Fund (UNICEF)
Role: Delivers maternal and child health services, vaccines, nutrition support, emergency water and sanitation, safe childbirth practices, and child protection.
Focus: Reaching remote and displaced populations, supporting skilled birth attendance, immunization campaigns, and therapeutic feeding for malnourished children.
United Nations Development Programme (UNDP)
Role: Strengthens health system resilience, supports universal health coverage initiatives, addresses the social determinants of health, and empowers women and marginalized groups.
Focus: Implementing community-based health interventions, supporting national health policies and capacity development, and working towards inclusive social protection.
World Food Programme (WFP)
Role: Provides life-saving food aid, nutrition programs, and logistical support for food security.
Focus: Targeting malnourished children, pregnant women, and displaced families with food assistance and school feeding programs.
United Nations High Commissioner for Refugees (UNHCR)
Role: Safeguards the rights and welfare of refugees and displaced populations, ensuring access to shelter, basic services, and protection.
Focus: Strengthening multi-sectoral approaches to meet the humanitarian needs of those in camps and informal settlements, including health and education.
Additional institutions—such as the Food and Agriculture Organization (FAO), United Nations Population Fund (UNFPA), and the International Organization for Migration (IOM)—contribute to nutrition, reproductive health, and support for migrants and disaster risk reduction.
How UN Institutions Improve Health and Well-being: SDG 3 Targets and Approaches
The United Nations, working across its specialized agencies, targets a comprehensive approach to achieve SDG 3: Good Health and Well-being in these severely affected countries:
Reducing Maternal and Child Mortality: Expanding access to skilled birth attendants, emergency obstetric care, and newborn resuscitation.
Combating Communicable and Non-Communicable Diseases: Supporting vaccination campaigns (e.g., polio, measles), expanding access to HIV/TB/malaria treatment, and working against neglected tropical diseases.
Advancing Universal Health Coverage (UHC): Supporting the development of affordable and equitable health systems, reducing financial risk for households, and promoting access to essential medicines and vaccines.
Strengthening Nutrition Programs: Integrating food security and nutrition surveillance, providing therapeutic foods for children, and supporting breastfeeding and supplementary feeding.
Supporting Mental Health and Psychosocial Well-being: Increasing access to psychosocial support, trauma care, and community-based mental health services, particularly for children and war-affected populations.
Improving Water, Sanitation, and Hygiene (WASH): Ensuring access to clean water, sanitation facilities, and hygiene promotion as essential components of health and disease prevention.
Empowering Women and Girls: Promoting access to reproductive health, supporting women’s employment and economic opportunities, and countering gender-based violence.
Enhancing Emergency Preparedness and Response: Coordinating rapid disaster response, supporting disease outbreak containment, and rebuilding critical health infrastructure.
Conclusion
Health and well-being—encompassing both objective health indicators and subjective assessments of quality of life—are at their most fragile in countries like Afghanistan, CAR, and DRC, where conflict, displacement, disease, and poverty converge to create ongoing humanitarian and public health emergencies. The challenges are complex and multi-faceted, with high mortality rates, malnutrition, widespread illness, poor healthcare access, and significant psychosocial distress. Many people survive through humanitarian aid, communal support, and resilience in adversity; many others, however, do not survive preventable diseases and deprivation.
The active response of the United Nations, through agencies such as WHO, UNICEF, UNDP, and WFP, is indispensable in alleviating suffering, strengthening health systems, restoring dignity, and working toward the targets of SDG 3: Good Health and Well-being. These institutions pursue integrated strategies—combining health, nutrition, education, and protection—to help lift populations out of crisis, build resilience, and lay foundations for sustainable progress in the world’s most challenging settings.
