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Global inequalities in recent health system capacity and projected growth in landscape fire smoke mortality

Year: 2026
Type: preprint
Abstract: Background Landscape-fire smoke mortality is projected to rise under scenarios holding vulnerability and adaptation fixed. We examined whether recent health-system capacity is lowest where projected mortality growth is greatest. Methods We constructed a health-system capacity index for 191 countries from five World Bank indicators and compared it with the WHO universal health coverage service coverage index. We mapped 165 countries to 17 populated projection regions. Published mortality ratios incorporate smoke exposure, demographic change and baseline mortality; inference was region-level. Results Lower-capacity regions faced greater projected proportional mortality growth (Spearman ρ = −0.85, n = 17; permutation p < 0.001). The association persisted across index construction, regional weighting, projection-uncertainty checks and country resolution, and when the WHO benchmark replaced the index. Capacity correlated with the WHO benchmark at ρ = 0.85. Capacity deficits concentrated among poorer populations (concentration index − 0.30). Some 0.88 billion people, one in nine of those analysed, lived where the lowest capacity tertile coincided with the highest projected-growth tertile. Adjusted estimates depended on how development and demographic structure were represented. Conclusions Recent health-system capacity and projected smoke-mortality growth were inversely co-located, with misalignment concentrated among poorer populations. The analysis is descriptive: fixed-adaptation projections cannot estimate capacity effects, and the association could not be cleanly separated from development and demographic structure. Trial registration Not applicable.
DOI: 10.21203/rs.3.rs-11273253/v1
Author: Yanrui Li
Language: English
Open Access status: green
OpenAlex ID: W7225793945
Cites: 35
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