Social Factors and Policies Promoting Good Health and Well-Being as a Sustainable Development Goal: Current Achievements and Future Pathways

Abstract

Promoting the Sustainable Development Goal 3 (SDG 3) of Good Health and Well-being of all people requires an approach that ensures that health systems are strengthened with comprehensive social support mechanisms. This interrelation has gained increasing recognition as a foundational pillar in realizing sustainable and equitable healthcare. Economic instabilities and social vulnerabilities have direct implications on health access and outcomes, making focused welfare and security measures important in entrenching SDG 3. This work combines interdisciplinary studies, bridging health policy and economic security, at a time when social policy decisions, more than ever, should be guided by real-world needs and evidence, dealing with key factors, interventions, and contributions from policymakers on strategies that can reinforce health systems. Thus, current achievements of SDG 3 and challenges to successfully integrate health and social support sectors are discussed. The study addresses future pathways to achieve this Goal, including greater public investment in inter-sectoral collaboration, innovative funding models, and data-driven policymaking as part of this next wave in advancing health systems resilience. Important ways to restructure public health with less inequality entail a reinforcement of social safety nets, mitigating health consequences through poverty and adverse economic conditions. Coordinated governance, cross-sectoral collaboration, and evidence-based monitoring frameworks assure policymakers of their effectiveness in achieving these policy priorities. This calls for prioritized planning that invests in scalability, sustainability, and adaptability for resilient health systems supported by inclusive welfare state policies. By aligning social policies with health priorities, this paper aims to contribute to a global agenda regarding universal, sustainable, and equitably achieved health outcomes within the framework of the Sustainable Development Goals.

1. Introduction

Sustainable Development Goals (SDGs) are strategies adopted by United Nations members to achieve global sustainability. These strategies include the elimination of poverty and starvation, better quality of education, achieving equality for marginalized groups, clean environment, water and energy, respected employment and economic development, industrial development and innovation, smart cities, climate enhancement actions, sustainability in sea and land life, global peace, and collaboration to attain these goals. Part of the SDGs also includes health and healthcare.

The global healthcare issue has troubled humanity for years. There are many problems associated with healthcare. The World Health Organization (WHO) made a first attempt to deal with this issue in 1977, when it was affirmed that every person should have the right to a minimum standard level of healthcare [1]. The global healthcare challenges are represented in Figure 1.

Maternal and child health: Global healthcare systems face numerous challenges, with maternal and child health remaining critical concerns. Despite a global reduction in maternal mortality, progress has been limited, and still, 170 deaths per 100,000 live births worldwide, along with preventable neonatal and under-five deaths, cause more than five million deaths per year globally. The vast majority is reported in low- and middle-income countries (LMICs), for instance, in Africa, which experiences high maternal mortality ratios compared to Europe and North America [2]. This is connected to poor infrastructure and limited antenatal care, which contribute to high maternal and infant mortality rates [3]. SDG 3 targets 3.1 and 3.2, therefore, call for reducing the global maternal death ratio below 70 and ending preventable newborn and child deaths under 5 years of age by 2030. All this hinges on universal access to skilled birth attendants, emergency obstetric and neonatal care, quality antenatal care, and post-natal follow-up, all of which are fundamental components of the WHO’s minimum health-service package [4]. Child health disparities are also pronounced in low- and middle-income countries. Economic-related inequalities significantly affect access to essential child health interventions, with the poorest populations often lacking improved sanitation and low indoor pollution [5]. Malnutrition, infectious diseases, and lack of immunization further exacerbate child health disparities. Improving maternal and child health requires investment in primary healthcare, education, equitable distribution of resources, and community-based interventions.

Infectious diseases have a long history, and despite technological and medical advancements, they keep spreading. Epidemics, or even pandemics, can easily emerge. Antimicrobial resistance, climate change, increased land usage, and human–animal contact are the main reasons that affect the vectors, increasing the likelihood for a new disease outbreak [6]. Particularly, antimicrobial resistance stands as a threat that could harm public health and even cause pandemics. Despite the advancements of antibiotics in the 20th century, the misuse of these drugs and the evolution of the pathogens themselves have resulted in the formation of resistance mechanisms, which have led to untreatable bacterial infections and a rise in mortality [7,8,9,10]. Historically, one of the deadliest diseases was the Spanish flu in 1918. The disease emerged at the end of World War I, when advancements in medicine were still insufficient, resulting in rapid spread across the world and leading to 50–100 million deaths worldwide [11]. During the 20th century, several significant outbreaks occurred, including the Asian flu (1957–1958), HIV/AIDS (1960), Cholera (1961), Swine flu (2009), and Ebola (2014) [12]. The most recent example of infectious disease is COVID-19, which, according to the WHO, since the beginning of the pandemic, has caused more than 7 million people to lose their lives [13]. Throughout the years and the different pandemic crises, health systems around the world became more prepared for equivalent outbreaks, to alleviate and control the severity of the situation [6]. However, the COVID-19 outbreak revealed that there are still many significant gaps in healthcare infrastructure, resulting in inadequate response to the pandemic, highlighting the need for enhancing healthcare communities with additional knowledge and sources to overcome the existing challenges and be prepared for any future equivalent problem.

Another critical challenge is non-communicable diseases (NCDs) that represent the major cause of deaths globally [14]. Most common NCDs include cardiovascular diseases (CVDs), cancer, strokes, respiratory diseases, and diabetes. According to the Pan American Health Organization, 41 million people lose their lives annually due to NCDs, a number that represents 71% of the total annual deaths worldwide, while in America, the number of deaths rises to 5.5 million each year [15]. Cardiovascular diseases are the leading cause of death [16]. WHO report in 2024 indicated that in 2021, 43 million died because of NCDs, with 18 million of them being under the age of 70. Deaths attributed to CVDs reached 19 million, followed by 10 million deaths from cancer, 4 million chronic respiratory diseases, and 2 million diabetes, which includes kidney failure caused by diabetes. And 73% of these deaths occurred in LMICs, which significantly highlights the socioeconomic impact of NCDs in less developed countries and the existing inequity of healthcare access. Despite that elevated number of deaths, NCDs can be preventable and treatable. The burden of NCDs is associated with lifestyle, globalization, urbanization and global change, and environmental crisis. Lifestyle choices include smoking, an unhealthy diet, a sedentary lifestyle, and reckless alcohol consumption [17]. Figure 2 recapitalizes statistics on NCDs.

Mental health issues can be categorized according to the National Institute of Mental Health (NIH), USA, into Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI includes mental, behavioral, or emotional disorders, whose burden to human health can be mild or more severe, while SMI includes, once again, mental, behavioral, or emotional disorders, whose effect is more serious, resulting in confining important life activities [18]. Mental health disorders are a result of genetic mechanisms and are also enhanced by environmental factors, but social factors also have a significant impact on the mental status of people, such as low income, poor education, social norms, and unfair legislation and policies [19]. From an analysis made in 2022 among adults in the US, 59.3 million people, a number that represents 23.1% of US adults, suffered from AMI, while another 15.4 million people, 6% of US adults, suffered from SMI. It was found that females are more affected by mental disorders, while it is very concerning the fact that young people (18–25 years old) are the leading affected group. The European Commission (EC) observed the elevated numbers among young people reporting mental health issues, as youngsters with depression symptoms increased during the pandemic [20]. People suffering from mental health issues and especially from SMI usually finally reach a stage of losing their freedom and independence, forcing them to become a confined group [21]. Thus, social actions and policies are necessary to overcome the challenges arising from mental health disorders.

Environmental change, especially under climate change, has played a vital role in planetary health. Air pollution enhances global health significantly, affecting the pulmonary circulation and nervous system [14]. Greenhouse gases (GHGs), chlorofluorocarbons (CFCs), and particulate matter (PM) are among the most powerful pollutants [22,23]. PM consists of acids and heavy metals, and they may be of such sizes that they can directly reach vital human organs, like the lungs. Industrial combustion, human activities, and the physical production of PM derived from emitted CFCs contribute to PM formation. GHGs include carbon monoxide, sulfur dioxide, nitrogen dioxide, carbon monoxide, volatile organic compounds, nitrous oxide, ozone, and methane [22,24,25]. Air pollution can lead to cardiovascular and pulmonary diseases, cause abnormalities in the reproduction and nervous system, harm skin, or even cause lung and skin cancer [26,27]. Particularly, the climate crisis is not just an environmental issue; it represents a serious threat to public health and societal stability. In fact, climate change affects human lives and health in numerous ways. It endangers the fundamental components of good health, e.g., clean air, safe drinking water, nutritious sources, and secure housing, and could jeopardize decades of advancements in global health. These are intricate impacts that require a shift in viewpoint, positioning health and social equity as central to climate efforts [17,28,29].

According to WHO, a health system includes all entities, individuals, and activities focused primarily on promoting, restoring, or maintaining health. Beyond being a pyramid of public resources that provide health services, it also encompasses initiatives aimed at affecting health determinants alongside more direct activities that enhance health [30]. Health systems remain under strain around the world, from a multitude of challenges, ranging from economic instability, political conflicts, environmental degradation, and pandemics like COVID-19 that revealed the vulnerabilities in global healthcare systems. The pandemic has highlighted the absolute necessity of resilient health systems, universal health access, and the incorporation of social determinants of health into policymaking. Some of these determinants include education, employment, social protection, and housing, which play an influential role in shaping health outcomes [31]. Inadequate healthcare systems create challenges for other sectors, including food, water, and sanitation services, while children face health risks, such as infections, environmental dangers, and diseases [32]. However, in 2015, the state of healthcare in LMICs was inadequate to offer proper support to patients, leading to more than 8 million fatalities [33]. Thus, implementing healthcare systems is essential for the social right of a person to health by delivering a system of suitable quality.

Health inequities are another significant challenge of healthcare systems worldwide. WHO ascribes these inequities to poor social factors, like education and income level and employment status, gender, and ethnicity, and they can be observed in both underdeveloped and more advanced countries among the people [34]. In addition, a critical role in health inequities is structural racism, which enhances racial discrimination through policies made regarding education, employment, housing, earnings, benefits, and justice, and as a result, it also affects and includes healthcare access [35].

However, disparities in health outcomes and access persisted, necessitating additional commitments such as, first, the Millennium Development Goals (MDGs) and, subsequently, the Sustainable Development Goals (SDGs) that introduced a more comprehensive and integrated approach to global health issues.

Particularly, the Sustainable Development Goal 3 (SDG 3) aims to promote healthy lives and well-being for everyone at all ages and includes some of the most important health goals, such as reducing maternal and child mortality, preventing communicable and non-communicable diseases, providing universal health coverage, and strengthening nations’ capacity for early warning, risk reduction, and management of national and international health risks [36]. SDG 3—“Ensure healthy lives and promote well-being for all at all ages”—is one of the key pillars of sustainable development, as good health is both a result and a driver of progress in other fields such as poverty reduction, quality education, gender equality, decent work, and climate action. This Goal offers 13 targets and 28 indicators covering an integrated health approach beyond the absence of disease. The objectives are to reduce the maternal mortality rate globally below 70 per 100,000 live births, avoid unnecessary deaths of children under 5 years and newborns, cope with major communicable diseases such as AIDS, tuberculosis, malaria, and other neglected tropical diseases, and prevent premature mortality from NCDs by prevention and treatment. Moreover, SDG 3 calls for universal health coverage (UHC) in the form of financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for everybody. It further emphasizes ensuring the strengthening of national and global health risk management, early warning, and risk reduction capacities—a call made even more urgent by the COVID-19 pandemic. Mental health, drug abuse, and road safety are also covered under SDG 3, emphasizing the vision of the Goal for an integrated understanding of health and well-being. The implementation of SDG 3 needs to be carried out through concerted actions at the sectoral, national, and subnational levels, with long-term investment in health systems, social protection systems, and inclusive policy designs. Its achievement is not only essential to human health, but to reaching all the other Sustainable Development Goals, thus making it one of the most interconnected and influential targets in the 2030 Agenda [30,37,38].

SDG 3 bridges health and Well-being, the latter being defined as a multidimensional state of physical well-being, mental peace, social relationships, and sense of living. For instance in Greece, recent policy documents use the term “holistic health” and track well-being through life-satisfaction and mental-health measures; across the European Union, Eurostat’s Quality-of-Life dashboard places Good health in eight dimensions of life, since being able to participate fully in society; the World Health Organization (WHO) clings to its classic 1948 definition—“a state of complete physical, mental and social well-being and not merely the absence of disease”—and measures it with tools like the WHO-5 Well-Being Index. To make these ideals a reality, the WHO requires a minimum package of care: immunization; antenatal, delivery, and neonatal care; treatment for prevalent infectious and NCDs; basic mental health care; and emergency/trauma care, all without catastrophic out-of-pocket costs [39]. Other standards are the World Bank’s High-Priority Package for low-income countries and the OECD’s Basic Benefits Basket for high-income systems. Together, these service standards and definitions give tangible flesh to SDG 3’s vow to “ensure healthy lives and promote well-being for all at all ages” [40].

In

Table 1. Actual social policies promoting good health and well-being in Greece, Europe, and globally.

Region	Key Policies	Focus Areas
Greece	National Health Action Plan, Primary Healthcare Reform, eHealth Strategy [41,42]	UHC, mental health, primary care, digital access
EU	EU4Health, Europe’s Beating Cancer Plan, Mental Health Strategy [43]	Health equity, NCDs, digitalization, pandemic response
Globally	GAP, UHC2030, Health Sector Strategies, HiAP [44]	Global coordination, health systems resilience

, actual social policies promoting good health and well-being in Greece, Europe, and globally (WHO) are comprehensively presented.

At the vital midpoint of the implementation of the 2030 Agenda, the outcomes to date have, unfortunately, not met expectations. Especially for the third Goal, it is visible that after a rather promising start, the progress has critically deteriorated, and then, the lack of sufficient data renders the development of the field rather ambiguous. Based on official UN metrics regarding progress assessment for all the SDGs from 2023 and later, specifically, the current global status of SDG 3 appears to be in a stagnation or recession phase, with about of a 10% of “target met or on track”, 65% “fair progress, but acceleration needed”, 15% “stagnation or regression”, and 10% “insufficient data” reported [45].

In this context, the current work aims to contribute by combining interdisciplinary studies, bridging health and social policy, dealing with relative key factors, interventions and contributions from policymakers on strategies that can enhance health systems, presenting the current achievements, the existing challenges and gaps, and the direction the future social policies should follow. The theoretical framework is also discussed, overviewing models and theories connected to socioeconomic determinants, how these factors combine with SDG 3, and how this connection affects health outcomes, policy, and governance. Thus, this review can contribute to awareness-raising for further development in this field, gathering sufficient data to fill the gaps, and calling for prioritized planning of resilient health systems supported by inclusive welfare policies in the global agenda of universal and equitable health outcomes within the framework of sustainable development.

2. The Role of Socioeconomic Factors in Public Health and Connection with SDG 3

Socioeconomic factors significantly determine public health outcomes that ensure well-being at the individual and community levels. A few of the main determinants of health outcomes include economic factors such as income inequalities, poverty, and healthcare affordability, as well as educational determinants such as health literacy, knowledge, and preventive interventions.

Economic factors are pivotal, and they can shape health inequities among people. The health status of people in some areas operates as an indicator for estimating the economic quality and social status of this specific region [36]. Health access should be equal and independent from individual income. Unfortunately, this theory in real life does not occur, and wealthier people have more advantages than those with lower incomes. Specifically, wealthier people have more resources to deal with health issues, like knowledge, power, and social relations, and thus, it has been observed that these people usually have more years of lifetime. On the other hand, low incomers face social pressure, as they reach a stage of feeling losing control, causing health issues. A rational policy that anyone could think of is to increase income, but a horizontal increase among all people could not have such an impact, and individuals would not feel either the elevated income or any improvement in health status [31]. As a result, a more sophisticated policy should be followed to combine both better income for individuals and further improving health status.

Poverty represents a critical factor that influences health outcomes. Due to poverty, many children are vulnerable, as they cannot access clean water and nutritious food, which can even expose them to life-threatening conditions [46]. Lack of access to adequate healthcare units for these children is crucial, due to their immature immune system and cognitive development, making them vulnerable to psychological, mental, and physical harm [47]. Moreover, the end of professional life for older citizens can increase health susceptibility. Since their immune systems are progressively weakened, they are more vulnerable to infections. In various instances, common mental health concerns, such as stress and depression, are aggravated. The worldwide trend of an aging population is growing swiftly, creating significant difficulties for healthcare systems around the world [48,49]. Also, unemployment has largely been linked to various deleterious consequences [50,51]. Furthermore, the current severe worldwide problem of climate crisis-induced catastrophes, such as hurricanes, wildfires, floods, rising sea levels, and desertification, increasingly forces people to relocate, and communities are displaced from their native areas. Climate refugees face various health problems, including mental health issues over time, like post-traumatic stress disorder [52,53]. Nevertheless, dislocation is an issue that stems not only from environmental degradation but also from social, economic, and political influences, and especially war that causes large-scale human movement [54,55]. Migrants face heightened economic instability and health risks and experience no or reduced social and medical care.

Social and cultural determinants, including gender equity, traditional practices, and community support, and the role of policy and governance, encompassing public health policies, social security, and global cooperation, play a crucial role [56]. Important models, such as the relatively new Social Ecological Model and the Health Belief Model, deliver key knowledge about how the aforementioned factors lead to discrepancies in health matters.

The Health Belief Model (HBM) describes how personal views and beliefs influence health-related behavior. Healthcare-seeking behavior is greatly influenced by several factors, including self-efficacy, perceived risk of illness, and perceived benefits of medical treatment [46,57]. Among the most productive countries in research in the field are the USA, China, the UK, Iran, and Australia, with a transition from general health themes to more focused subjects, including COVID-19, digital health, health-related habits, and behaviors [58]. Other specific interventions employing the HBM are lately suggested, e.g., studying the uptake and preference patterns among Nigerian women in academia for cervical cancer screening to lower both morbidity and mortality associated with the disease, revealing strong intent to use the services in the future, factoring in the professionals providing the service and locations where it is available [59]. Moreover, analyzing constructs of this health model type regarding skin cancer prevention among a high-risk population in Spain emphasizes the important functions of self-efficacy and perceived vulnerability and offers insights to create health prevention communication strategies, essential for improving sun-protection habits and behaviors and addressing the growing risk of skin cancer epidemics [60].

On the other hand, according to the Social Ecological (Socio-ecological) Model (SEM), interactions at multiple levels have an impact on health, more precisely in societal, community, interpersonal, and individual ways. It emphasizes working across sectors to address health issues holistically [61,62]. Studies on social–ecological systems are reported to be predominantly conducted by researchers based in North America and Europe by an international scientific network with collaborative aspects [63]. Moreover, SEM has been proposed recently for managing leprosy reactions in India and Indonesia, drawing on the experiences of those affected, their families, and healthcare providers, underlying the importance of culturally aware, timely, efficient, and integrated care strategies to tackle this issue [64]. Also, by employing the SEM, the present condition of congestive chronic heart failure services in community healthcare centers was assessed in China, and significant enablers and challenges encountered by healthcare personnel for guaranteeing prompt diagnosis and efficient treatment were underscored [65]. Moreover, this model also served as a conceptual context for analyzing the readiness of sub-Saharan African nations in combating the COVID-19 pandemic by implementing WHO guidelines, suggesting different actions such as lending options from donor organizations, transferring COVID-19 testing responsibilities to local levels, and enhancing community involvement to better risk communication and compliance with public health protocols [66]. Furthermore, illustrating a SEM in Croatia of an individual’s health within the family context can help to examine how family structure and dynamics influence personal health and practices from early childhood to adulthood and old age, particularly during major life changes, like marriage, divorce, and parenthood [67].

Particularly, a complementary relationship appears between the social–ecological system analysis and the sustainability science and goals (SDGs), indicating the synergistic possibilities of reciprocal interactions and support [68]. In a holistic approach, fostering multisector cooperation can steer future progress, offering an evidence-based foundation for promoting comprehensive and encouraging pathways for innovation in sustainability studies. There is increasing acknowledgment that tackling intricate sustainability issues requires innovative interdisciplinary and transdisciplinary methods of knowledge creation. Under the socio-ecological health model concept, achieving SDG 3 requires the integration of social determinants into health policy and programming. Education, employment, housing, and social protection directly affect health outcomes by access to healthcare, health literacy, and overall social well-being [19]. Health disparities stemming from inadequate social determinants, such as education, income, employment status, gender, and ethnicity, evident in both developing and more developed nations, and a structural racism amplifying racial discrimination, should be addressed via social policies related to education, employment, housing, income, benefits, and justice, which consequently impacts and encompasses access to healthcare [34,35].

Towards a more sustainable public health system for attaining the UN SDG 3, social policies directed at poverty alleviation, improved working conditions, and equitable access to education translate into better health outcomes. Moreover, challenges that need to be overcome encompass the creation of efficient public policies to guarantee access to adequate healthcare units for all children, sufficient access to healthcare services for the elderly, and designing healthcare and training programs to accelerate the reentry of unemployed individuals into the labor market. Nowadays, more than ever, the healthcare community is urged to consider the climate crisis as an essential social determinant that both affects health and raises the expenses of treatment in the community and worldwide. From that perspective, the immediate incorporation of climate change across all aspects of living to advance health equity and support well-being is required [19,31]. The necessity for inclusive adaptation strategies for displaced and migrant populations to enhance their social and health conditions is highlighted.

To conclude, for achieving universal health and well-being under the socio-ecological system analysis, it is essential to strengthen collaboration across sectors, improve data on the interaction of social factors affecting health, and ensure that vulnerable and marginalized persons receive the community support they need. By bringing the social determinants of health to light, public authorities and stakeholders involved can create a more stable relationship between health systems and SDG 3 targets, as outlined in the following chapters. The third Goal is important to attain sustainability among all people, but to accomplish this Goal in a global manner, people should be aware of their accomplishments so far and the gaps and challenges that are ahead in order to form the future pathways and social policies, as depicted in Figure 3.

3. Current Achievements in Promoting SDG 3

Advancing SDG 3 is essential for achieving sustainable health and well-being for all. Nevertheless, to attain this goal worldwide, it is significant to first acknowledge the progress that has been accomplished. Furthermore, current progress serves as a reservoir of insights and experiences for the systemic analysis, design, and accomplishment of future sustainable social policies for health.

A strong public healthcare system is considered a system that principally encompasses equal access to all, better health outcomes, appropriate processes of care, cost-effective, patient-friendly access to resources, and friendliness, as well as a synergistic combination of different sectors [62]. In the last few years, digitalization of healthcare, data acquisition, reporting, and analysis for research and optimization reasons, with chances to minimize errors and disparity in healthcare provision and the everyday citizen contact, and even lately utilization of robotics in healthcare digitalization, enable a strong and resilient health system [69,70,71,72]. Moreover, digitalization aids by introducing SDG 3 performance models centered on digital health services to assist public healthcare organizations in their planning, budgeting, performance evaluation, and reporting efforts, enhancing their internal and external accountability. Thus, digital transformation achievements within healthcare present exciting opportunities for improving resource efficiency and supply chain interoperability, minimizing waste, and greatly lowering the carbon footprint, towards a greener and more sustainable healthcare sector in compliance with SDG 3 [73,74].

Since the SDGs were established in 2015, noticeable advancements have taken place in global health indicators. Enhanced prenatal and postnatal care has lowered infant and maternal mortality rates in several regions of the planet. So far, universal health coverage, life expectancy at birth, and fulfilled demand for family planning are essential health-related SDGs’ indicators of developed nations. The speed of SDG advancement actually differs greatly among groups of countries. Nordic nations remain at the forefront of SDG attainment, with BRICS+ countries showing notable advancement, while poor and most vulnerable states, e.g., the Small Island Developing States, fall considerably behind, which highlights the role of economic factors [38].

On the other side, low-income countries continue to encounter major obstacles, especially in relation to enhancing maternal health, ensuring children’s well-being, and managing both communicable and chronic diseases [75]. Thus, developing nations with comparatively inefficient healthcare systems could gain insights from those that adopt policies featuring a balance between user choice and centralization options to succeed in the more efficient distribution of their healthcare resources [76]. Nevertheless, as vaccination campaigns have grown, the prevalence of infectious diseases like measles and polio has decreased. Since 1974, vaccinations have prevented 154 million deaths, with 146 million occurring in children under 5 years old, including 101 million infants under 1 year old [77]. Specifically, in the African Region, healthy life expectancy rose on average by 10 years per individual from 2000 to 2019, primarily because of enhancements in the delivery of essential health services, advancements in reproductive, maternal, newborn, and child health, along with progress in combating infectious diseases [78].

Medical technology and health facilities have improved disease diagnosis and treatment. Along with this, work on non-communicable diseases (NCDs), such as cardiovascular disease, cancer, and diabetes, has accelerated through preventive interventions and public awareness activities. Despite that relatively high death toll, NCDs can be prevented and treated [14]. Although numerous positive initiatives have emerged, however, the advancement has been gradual. Information from different nations indicated that merely two out of the ten NCD progress metrics were being achieved in 2020 by at least half of the 176 countries that endorsed the SDGs [79]. Particularly, the swift proliferation of COVID-19 has caused significant healthcare interruptions and lasting effects for individuals with NCD. While several health targets improved, as was already mentioned, overall global health progress has, however, decelerated since 2015. It is reported that the COVID-19 pandemic has undone nearly 10 years of progress on life expectancy [80]. With the immediate crisis appearing to diminish, there is increasing worry regarding the lasting health implications for survivors, often known as “long COVID” [81]. The persistent effects of COVID-19, intensified by conflicts, climate catastrophes, and economic disruption, have worsened existing inequalities. However, new insights obtained regarding the direct, indirect, and mediating effects of the application of pandemic strategies are subject to ongoing evaluation and the modification of protocols within enduring health policies to enforce actions for preventing and responding promptly. This evaluation method promotes and emphasizes the utilization of epidemic data sources and resources in sustainable health policies [82]. Furthermore, for creating more sustainable and effective strategies for preventing health science workforce burnout, e.g., in academic settings, policies including detachment, active measures, healthy habits, and professional assistance might be beneficial [81].

Particularly, universal health coverage has played a significant role so far. In fact, numerous nations have recognized Universal Health Coverage (UHC) as the objective for their healthcare systems, and reforms in health financing are central to strategies aimed at achieving this SDG 3 target. However, health financing support, both at a national and global level, has generally been limited in the last decades, in the context of economic and energy crises and austerity policies, characterized by restrictions in public health funding and oversight systems, with a turn rather to the private sector. Alternative funding methods are still needed for the improvement of the public health system and an adequate focus on primary health care. However, governments should retain and assume their crucial role in the shaping of healthcare systems. The COVID-19 outbreak revealed the lack of infrastructure and gaps in many healthcare systems across the world, gaps that have already existed, but they were not visible until the outbreak, when the systems were paralyzed [83]. The pandemic forced governments to spend more money on the healthcare sector. Average healthcare expenditures have risen by 6% and 4% for LMIC and high-income countries, respectively, but still, 100 million people each year are led to poverty, as they are forced to spend a large amount of their income just for healthcare services [84]. Until now, countries have increased financial support in healthcare systems in % of GDP, but despite this increase, health still faces crucial gaps, burdening people. Figure 4 demonstrates the annual GDP, %GDP spent in health, and the actual money spent in health for the duration of 2008–2022, for the EU, the USA, China, India, Egypt, Australia, and Brazil. The figure is created based on data from the World Bank Group [85].

In Figure 4a–c, the US dominates both in GDP and %GDP spent on health and the actual financing of health. Before 2010, the EU had a higher GDP than the US, while China was in third place, developing, until it overtook the EU in 2021. The rest of the countries remain at a low level of GDP, even until now, but they have an increasing rate. However, it seems that despite lower GDP, Australia and Brazil employ more of it in healthcare, almost reaching EU rates, especially for the period 2014–2020 for Australia and 2017–2019 for Brazil. On the other hand, China elevated the %GDP in health, reaching its maximum during COVID-19 in 2020, employing 5.59% of GDP. Nonetheless, the latter figure demonstrates the actual money spent on healthcare. The US remains dominant, followed by the EU and China in third place. Australia and Brazil also remain at a relatively low level of investment in national healthcare, compared to the US, the EU, and China, followed by India and Egypt.

The WHO has established a suggested minimum density level of 4.45 healthcare professionals, including doctors, nurses, and midwives, for every 1000 people to ensure essential health services accessibility [86]. Several high-income nations exhibit densities exceeding 8 per 1000, whereas poor countries frequently show a level under 1 per 1000, underscoring significant shortages.

4. Challenges and Gaps in Achieving SDG 3

Despite the aforementioned advancements in promoting SDGs, strengthening public health systems remains a challenge. Enforcing healthcare systems is crucial, as the social right of a human being to health has no meaning without providing a system of appropriate quality. Insufficient healthcare systems become a burden to other fields, such as food, water, and sanitation services, while children are exposed to health threats, like various inflammations, environmental hazards, and illnesses [32,87]. Nevertheless, there are still challenges remaining, regardless of these improvements. Due to a lack of funding, a shortage of medical personnel, and a shortage of medical supplies and technology, LMICs continue to face challenges in their efforts to achieve universal health coverage. Further impeding equal health care are socioeconomic disparities and growing health gaps between rural and urban areas [88].

A significant number of factors make the process of accomplishing fair and inclusive healthcare remain an important puzzle for specialists to solve. When it comes to healthcare, not everyone gets the same shot at quality treatment. People in marginalized communities often struggle because they cannot afford it, live too far from proper facilities, or face unfair treatment within the system. These economic and social gaps make it much harder for them to get the care they need. Without solid support systems in place, people who are already struggling end up even worse off. Many are unable to afford the treatment they need, and as a result, their health keeps declining with no real way to recover [22].

Besides that, pandemics, the health impacts of climate change, and new infectious diseases are just some of the major crises that keep adding immense pressure on healthcare systems worldwide. To ease the impact of these emergencies, we need to improve preparedness, invest in early detection, and work together globally. At the same time, a major challenge is the severe shortage of skilled healthcare workers, which makes it harder for many communities to get quality medical care [23].

All health system challenges mentioned warn of healthcare system strengthening, that is, however, in close relationship with sufficient funding. In fact, financial constraints are barriers to achieving the strengthening of the healthcare system. A lack of adequate financial resources remains a major obstacle to strengthening healthcare systems, especially in LMICs. Limited funding, particularly in under-resourced regions, restricts access to essential services, infrastructure, and medical innovations. Governments and international organizations should explore innovative approaches, such as alternative investment strategies and public–private collaborations, to ensure sustainable healthcare financing. However, merely increasing funding is not enough; resources must also be allocated equitably and utilized efficiently [22]. Financial constraints can be categorized into personal level and systemic level, which include interpersonal, community, and government interventions. Individually, financial constraints are pivotal for healthcare access, especially for people with lower incomes. Healthcare access, according to the definition by R. Penchansky and J.W. Thomas [89], is characterized by five situations, representing the dimensions of access, as demonstrated in

Table 2. The five dimensions of healthcare access and their description, inspired from [89].

Healthcare Access Dimension	Description
Availability	Providence and the existence of medical resources, such as healthcare centers, staff, and services.
Accessibility	Easiness of reaching the healthcare center, taking into account the location of the center, the location of the patient, and the costs of transportation, distance, and duration.
Accommodation	How well healthcare services are organized to accept patients serve them, regarding office hours, appointment systems, walk-in facilities, and waiting times.
Affordability	Relationship between the healthcare services costs.
Acceptability	Relationship between provider and patient, regarding the personal characteristics, such as age, gender, ethnicity and religion, acceptance of these characteristics, and not discouraging the patient.

. The market-structured economic model has directed health services into a profitable business, which distances itself from the actual needs of the people. Over the last years, some steps have been made forward, making the healthcare system more focused on the person’s needs, although there are still many challenges that should be faced [90]. In fact, many are unable to afford the treatment they need, and as a result, their health keeps declining with no real way to recover [91]. In addition, healthcare access includes direct and indirect costs, which include the fees in the center and costs that include transportation, medication, and absence from work, resulting in reduced salary [92]. As a result, livelihood has an impact on people living in urban areas, but also in the countryside, where people could face problems of shortages in staff and medical services in healthcare centers [93,94]. Thus, people are forced to leave their place and visit a more organized healthcare center, which, especially in the case of the countryside population, is a financial challenge, as people need to be absent from their work, must spend money on their travel, accommodation, and food [92]. As a result, healthcare access becomes cost effective, and people of lower income prefer to support household necessities [95].

In early 2000, much research reached the conclusion that gender is a social determinant of health [91]. Indeed, women and men have different access to health information and services, which endangers the health and well-being of women [96]. Moreover, the impact of other social determinants of health, such as ethnicity, race, education, and income, can make gender discrimination more acute [91]. Furthermore, transgender people’s healthcare access has many obstacles. Trans communities and healthcare providers have reached into agreement that the sum of barriers trans people face in healthcare can be categorized into four main barriers including: (a) reluctance to disclose due to stigmatization; (b) not sufficient experience by healthcare providers in the treatment of this group; (c) infrastructures that were designed to serve people that identify themselves as males or females, like restrooms, where there is no room designed for transgender, causing awkwardness; and (d) financial constraints [97].

Apart from social determinants affecting health and financial constraints, there are geopolitical factors that determine health. In this regard, healthcare systems are modified by geopolitical determinants, such as interests and relationships between countries, policies, and geography [98]. The geopolitical gaps in healthcare start with the national policies made by each country and can be distanced from the SDGs [99]. Thus, a global health governance should enhance planetary attempts to accomplish global health development [100]. The global economy and trade have a pivotal role in health inequities. Current global trade agreements contribute to unequal wealth distribution, as they enhance the private healthcare sector, where wealthy people can access, while low- and middle-income people can barely access the mediocre public healthcare sector [101,102]. Global economy and sanctions against a targeted country can result in an affected healthcare system, regarding access to healthcare services and importing medical equipment [103]. Apart from economic and governance factors, military actions, conflicts, and wars are crucial determinants of health. Military activity has resulted in the destruction of whole cities [101], degrading the quality of health. Furthermore, war activity creates a wave of migrants, who receive no or minimal health assistance [104]. Nonetheless, to face such geopolitical determinants, non-governmental organizations (NGOs) can have a significant role and promote health. Generally, NGOs are institutions and recognized by governments, employing researchers, activists, and service providers, to accomplish social and human development, without having profitable behavior [105]. Their involvement in dealing with geopolitical challenges in health can extend from financing to applying services, such as the delivery of medical equipment, health information technology, and medical staff, such as clinicians and doctors, and coordination among the state and healthcare providers to promote health development [106].

Particularly for maternal, fetal, and newborn survival and health, a holistic framework for research on health should integrate biomedical, socio-economic, health system factors, and environmental pollution as critical determinants of health outcomes [107]. Air pollution, particularly fine particulate matter, is known to affect and has been linked to adverse birth outcomes, including preterm birth and low birth weight [108]. Heavy metals in water and soil contribute to pregnancy complications and neonatal morbidity [109]. A comprehensive research approach should include epidemiological studies, biomonitoring, and mechanistic investigations to assess exposure pathways and biological impacts. Additionally, socioeconomic factors must be considered, as marginalized populations often face higher pollution levels and inadequate healthcare access [110]. Policy interventions should aim at reducing emissions, improving maternal healthcare, and enhancing environmental regulations. By bridging public health and environmental science, a holistic framework can better inform policies and interventions to improve maternal and neonatal health outcomes globally. In fact, maternal health is strongly linked to fetal and neonatal outcomes, requiring interdisciplinary approaches that address healthcare access, quality, and social determinants [3]. Effective antenatal and perinatal care can reduce complications such as preterm birth and stillbirths [111]. Community-based interventions, including skilled birth attendance and emergency obstetric care, have been shown to improve survival rates [112]. Furthermore, integrating maternal and newborn health programs strengthens healthcare delivery and enhances long-term outcomes [113].

5. Future Pathways and Social Policy Recommendations

Enforcing healthcare quality future pathways, to address the challenges and gaps mentioned before, calls for appropriate social and welfare policies to strengthen public health systems.

5.1. Strategies for Strengthening Social Policies in Health

To attain SDG 3, focused on good health and well-being for everyone, it is essential to adopt a strategy that fortifies health systems alongside robust social support structures. A focused and strategic effort is essential to narrowing health disparities, improving access to quality care, and strengthening healthcare systems.

The resilience of health systems represents an approach adopted especially to enhance health systems dealing with stricter budget limits resulting from fiscal consolidation efforts and increasing health demands [114]. The difference in various methods proposed worldwide requires teamwork to address the difficulties in execution and theoretical issues. Systems theory can provide a powerful tool for assessing the impact of socio-economic environment on sustainable health systems development by considering and examining them into sub-systems (resources, decision-making, operational processes, and services) [115]. Also, significant shortcomings in understanding how to translate global insights into local settings should be highlighted. Particularly, it appears that when reforms reflect the true needs of society, citizens’ confidence in institutions grows, which enhances the chances of effective social policy application. This highlights the importance of institutional trust in enabling major changes in healthcare policy [116].

Future research will be related to the execution of social protection initiatives, their societal mechanisms and impacts, the comparison of specific categories of social protection initiatives with other intervention types, and the effectiveness of social protection interventions for particular social groups, including the homeless as well as refugee and economic migrants [117,118]. Especially for people suffering from chronic illnesses, disabilities, injuries, or mental health issues, integrated strategies to safeguard their earnings and link them with additional social services may be vital [119,120].

Policymakers usually focus on operational issues regarding health policies, whereas researchers advocate for more comprehensive theoretical frameworks. Future endeavors might gain from ongoing efforts to engage policymakers not just in producing inquiries but rather with a more direct involvement in the concluding phases of research priority-setting activities, which is essential in assessing their importance for societal health policies. Moreover, it appears plausible for decision-makers to engage in internet ranking activities, communicating discoveries through webinars for further enlightenment in socio-economic factors for health [121]. Future investigations and policy formulation in the healthcare field should assist healthcare professionals and policymakers in generating innovative solutions to the challenges encountered by the healthcare sector [122]. For providing quality healthcare, especially, the severe shortage of skilled medical care workers must be addressed, which requires better healthcare education, incentives to retain workers, and clear career paths for medical professionals [23]. Generally, policymakers must enhance the connection between the public health system and economic and social advancement, enabling the public health policies to have a greater impact on economic growth, resilient health, and community well-being.

To enhance future pathways, it is useful to incorporate SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) social policy suggestions that can guide actionable steps toward achieving SDG 3, as follows.

Specific: Geographic and socioeconomic disparities significantly hinder access to quality healthcare services in underserved rural areas, limiting health equity and universal coverage efforts [123]. Therefore, the establishment of a National Health Equity Strategy focused on rural and marginalized populations by expanding mobile clinics, telemedicine, and transportation subsidies to remote areas.

Measurable: Community-based interventions, especially those led by community health professionals, have demonstrated strong results in improving children’s and maternal health outcomes in resource-poor settings [124]. Possible reduction in under-five mortality in high-burden districts by increasing coverage of community health workers, essential immunizations, and maternal health services could be set as a goal.

Achievable: Tackling global shortages in skilled healthcare workers requires scalable education and deployment strategies, particularly in low-income countries. The launch of a Health Workforce Expansion Program aims at training and deploying healthcare professionals, with an emphasis on nurses and midwives, could be proposed [125,126].

Relevant: Maternal and neonatal outcomes are significantly influenced by exposure to environmental pollutants such as PM2.5 and heavy metals, which are more prevalent in low-income communities [127]. Integrating environmental health monitoring into maternal health services, especially in urban and peri-urban pollution hotspots, could be a proposal.

Time-bound: COVID-19 has underscored the necessity for institutionalized emergency response capabilities to address pandemics and emerging infectious diseases [128]. A possible suggestion could be the requirement from LMICs to implement early-warning systems and epidemic preparedness plans aligned with WHO’s International Health Regulations, supported by simulations and independent audits.

5.2. Role of Technology and Innovation

Future strategies for attaining SDG 3 highlight the need for exploring increased investment in cross-sector collaboration, novel funding approaches, and data-informed policy development as integral steps in enhancing health system resilience. Integrating into social protection is a powerful method to enhance health and well-being advantages, especially for vulnerable people.

To enhance well-being, especially under the SDG 3 framework, the use of digital health tools (e.g., telemedicine, AI diagnostics, and mobile health apps) will improve access, especially in underserved areas, and innovative service delivery will make care more personalized, efficient, and preventive. To develop smarter, more effective health policies, the use of health data analytics and predictive modeling will identify priority areas and vulnerable groups, and real-time data can help adapt policies quickly to emerging health crises (e.g., pandemic response and vaccine distribution). To address the root causes of health disparities, aligned programs will provide income support, housing, education, and healthcare under a unified strategy and ensure access to basic services and reduce barriers caused by poverty, discrimination, and geographic isolation [129].

Research will also possibly focus on strategies of social protection that include conditional cash transfer programs. Clarifying the mechanisms of schemes of this category such as the “cash plus care” that incorporates cash transfers through “plus” initiatives connecting beneficiaries to complementary interventions, including availability to health and social services and/or communication and counseling for behavioral change towards hygiene, along with the cumulative impacts of these intervention bundles, may represent a focus for future investigation [118,130]. Zero out-of-pocket coverage for healthcare services and medications may also be a future option [131].

Future examinations may concentrate on how artificial intelligence (AI) can assist the healthcare sector in achieving SDG 3. Research can additionally offer insights into how the emerging AI models in the healthcare corporate sector can be utilized to improve customer satisfaction and service excellence. Optimizing public health systems necessitates investment in AI technologies, encompassing machine learning and deep learning methodologies, and artificial neural networks [132]. AI can be used to achieve SDG 3 through AI models for early disease detection, which enhance early diagnosis and treatment, reducing mortality rates and promoting better health outcomes. Moreover. AI models for predictive analytics for epidemics by analyzing environmental, social, and travel data may allow proactive health interventions and improved epidemic preparedness [133]. AI may improve customer contentment and service excellence in healthcare corporates using AI-powered virtual health assistants that reduce patient wait times, improves access to care, and enhance user satisfaction, or using personalized treatment plans that improve treatment effectiveness and patient trust in healthcare providers, or even by hospital resource management that increases operational efficiency and reduces patient frustration with system delays [134].

Crucial methods to reorganize health with reduced inequality involve strengthening social safety nets and alleviating health impacts caused by poverty and negative economic situations. Establishing upcoming worldwide health policy and research efforts suggests restructuring the dominant traditional reasoning of “the health market” to the interface of communities and health systems with complex health requirements, for enhanced and cross-sectoral efforts throughout the SDGs [135]. Despite the extent of advancement in public health systems and infrastructures, cross-country comparisons for their broader assessment in the future, while also considering the level of recovery of the public healthcare system in the aftermath of COVID-19, will remain a significant issue moving forward [136]. Moreover, specific social policy issues, including water and energy management, in the context of global social policy, are crucial for sustainable development, impacting human health, ecosystems, and financial endeavors, and thus, future research should also be directed to related innovative management policies [137,138].

5.3. Collaboration Between Sectors for Sustainable Health Improvements

The connection between the supportive mechanisms and health outcomes has received growing acknowledgment as a fundamental element in achieving sustainable and fair healthcare. Economic uncertainties and social weaknesses directly affect health access and results, highlighting the necessity of targeted welfare and security initiatives in reinforcing SDG 3. Future studies may explore elements of healthcare coordination (like a life course frame of reference) or care coordination at a defined level (for example, organizational-level cooperation for health service delivery), targeting specific populations, health conditions, or health interventions [139]. Also, collaboration among healthcare policymakers, providers, and various stakeholders is essential to develop innovative solutions that promote sustainability in the healthcare field [122].

A multi-sectoral approach is essential for sustainable progress in reducing maternal and neonatal mortality. Future research should focus on identifying disparities, improving data collection, and evaluating interventions to ensure comprehensive and smart health care [140]. Interdisciplinary research should be brought together to connect health policy and economic security studies, particularly when it is crucial for policy choices to be informed by real-world requirements and evidence, addressing significant interventions and inputs from policymakers on strategies to enhance health systems [141]. Coordinated governance, inter-sectoral collaboration, and data-driven monitoring systems ensure policymakers of their efficacy in meeting these policy objectives. This necessitates a prioritized research strategy that focuses on scalability, sustainability, and adaptability to create resilient health systems backed by inclusive welfare state policies.

6. Conclusions

SDG 3 for Good Health and Well-being highlights the contribution of social policy to reducing health inequality, particularly for the most vulnerable persons, and attaining universal health coverage. Reaching SDG 3 for everyone demands a strategy that reinforces health systems with extensive social support. The connection between supportive structures and health outcomes has received growing acknowledgment as a fundamental element in achieving sustainable and equitable healthcare. Economic fluctuations and social weaknesses directly affect healthcare access, underscoring the necessity of targeted social welfare and protection initiatives to strengthen SDG 3. An enhanced collaboration between health systems and social protection programs remains a prerequisite.

The current paper sought to introduce a new perspective to a global agenda with interconnecting social policy with health priorities, focusing on achieving universal, sustainable, and equitable health outcomes within the framework of the Sustainable Development Goals. In this context, this study gathered interdisciplinary research that relates health policy to socio-economic determinants, focusing on essential interventions and the role of policymakers in strategies that can enhance health systems. Consequently, the existing accomplishments of SDG 3 and the obstacles to effectively merging health and social support sectors were examined, and future pathways recommendations were discussed.

Key social policies to reorganize health with reduced inequality for attaining SDG 3 encompass coordinated governance, increased public investment, inter-sectoral partnership, and data-informed policy development to guarantee policymakers reach the policy goals. This necessitates a prioritized strategy that focuses on sustainability and adaptability for robust health systems backed by inclusive welfare state policies, forming part of the upcoming phase in health system resilience. The future of healthcare will be based on lasting improvements in social health policy, economics, and management.

Urgent research area in SDG 3 still lies in comprehending obstacles and solutions for implementing policies, equitable universal health coverage and access, as well as for health system resilience against crises, especially post-pandemic. Other important topics for further research in the future include social policies for health equity with reforms for mental health and vulnerable populations, climate crisis adaptation and environmental justice, health workforce policies, and digital and AI health technology.

Concluding a strategy centered on the good health and well-being of people as a basic social right to assist the founding of inclusive and resilient healthcare systems can help reach sustainable development objectives and foster a better, just, and equitable future.