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Social protection in global crises: a gap between evidence and action
  1. Elisa Landin Basterra1,
  2. Megan Naidoo1,
  3. Daniella Calvacanti2,
  4. Natanael J Silva1,
  5. Sarah Williams3,
  6. Simon J Lloyd3,
  7. Clara Marín4,
  8. Sofia Ardiles Ruesjas3,
  9. Felipe A Rubio1,
  10. Davide Rasella1
  1. 1Health Impact Assessment Group, ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
  2. 2Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
  3. 3Climate, Air Polllution, Nature, and Urban Health Group, Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
  4. 4Policy Department, Barcelona Institute for Global Health, (ISGlobal), Madrid, Spain
  1. Correspondence to Dr Davide Rasella; davide.rasella{at}

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Summary box

  • The polycrisis era has resulted in global food price surges, shortages and worsened health outcomes, disproportionately affecting vulnerable populations. Addressing structural inequalities and prioritising social protection expansion can help reduce poverty, promote resilience and is essential for sustainable progress towards achieving the United Nations’ Sustainable Development Goals (SDGs).

  • The COVID-19 pandemic has disrupted progress towards achieving the SDGs and pushed more people into extreme poverty. Prioritising social protection interventions can mitigate the impact of health crises on vulnerable households.

  • Conflicts and forced displacement have hindered agricultural production and led to increased commodity prices, exacerbating poverty and malnutrition in already fragile areas. Social protection initiatives and food subsidies are crucial for breaking the cycle of poverty.

  • Climate change poses severe risks to human health, with vulnerable populations suffering the most. Natural disasters and resource insecurity increase stress within communities and can lead to a rise in gender-based violence. Climate change strategies must prioritise social protection with a gender perspective to promote health equity.


In 2022, the world faced multiple, complex global shocks: the ongoing COVID-19 pandemic, different conflicts such as the Russian invasion of Ukraine, and various severe weather events. These challenges worsened social and health outcomes, for example, through a rapid surge in food prices and shortages worldwide. While the effects of these crises were far-reaching, vulnerable populations were the most profoundly affected.1

The current compounding crises have become known as the polycrisis or ‘three Cs’—representing COVID-19, conflict and climate change.1 The three Cs pose a series of new challenges that extend beyond the notion of borders and countries, and have knock-on effects that may not be known for years to come. However, some familiar consequences will likely be exacerbated: social instability, and health and income inequalities. In fact, austerity measures are expected to affect 85% of the global population in 2023, a rise from 80% in 2021.2

To mitigate the impact on population health, especially among the most vulnerable, social protection is essential. Social protection provides both income support and advances well-being. It encompasses cash transfers, housing assistance, healthcare services and school-feeding programmes, among others.3 The United Nations’ 2030 Sustainable Development Goal (SDG) Agenda has underscored social protection (SDG target 1.3) as key to eradicating poverty by 2030.4

In an interconnected era, addressing issues of health, conflict and poverty is crucial to support global well-being.

The first C: the COVID-19 pandemic

The magnitude of the COVID-19 pandemic is unprecedented. Within 18 months of the WHO declaring a pandemic, 195 countries were affected. By September 2023, there were 770 confirmed cases and about 7 million deaths.5 Additionally, the lockdowns and subsequent economic stagnation pushed 70 million people into extreme poverty. The progress made in many countries to achieve the SDGs was disrupted, affecting both the short-term and long-term prospects of their populations.6

What lessons could be learnt? During a health crisis, decision-makers tend to prioritise short-term gains, overlooking the underlying social vulnerabilities. Nevertheless, some countries prioritised social protection interventions as part of their COVID-19 response strategy.6 For example, Liberia built on lessons from the Ebola epidemic and provided cash transfers to thousands of poor households affected by COVID-19.7 This buffered the impact of the pandemic and beyond by addressing a foundational vulnerability.

The second C: conflicts and the rise in forced displacement

During the past decade, there have been multiple and overlapping conflicts across the globe: Yemen, Syria, Afghanistan, South Sudan, Haiti and Venezuela, among others, with far-reaching consequences.8 For example, the Russian invasion of Ukraine in February 2022 hindered Ukraine in producing and trading many agricultural products such as fertiliser and fuel, and essential food commodities like sunflower oil and wheat.9 As a result, global production of these goods dropped leading to a surge in their prices. This could potentially cause a rise in wheat prices by up to 34% during 2023.8 This hampers the progress made in reducing poverty while further stressing malnutrition in already fragile areas such as Yemen and the Sahel.1 8

Conflict disproportionately affects the poor.8 10 In 2019, people living in fragile and conflict-affected situations represented 10% of the global population but accounted for 48% of the total poor, which is predicted to increase to 60% by 2030.10 As of May 2023, a total of 110 million people worldwide have been forcibly displaced; the largest forced displacement since World War II.10

Prioritising social protection initiatives and food subsidies to vulnerable households are crucial steps to break the cycle of poverty.3 6 8 For example, despite facing border conflicts, persistent droughts and other weather-related shocks, 62% of participants enrolled in Ethiopia’s Productive Safety Net Programme avoided having to sell their assets for food, thereby increasing their living standards.8

The third C: an escalating climate change crisis

We have long been warned of the severe risks to human health that climate change poses. Those least responsible for the acceleration of climate change suffer the brunt of its hardship.1 There are about 3.5 billion people living in contexts highly vulnerable to climate change.11 Notably, the direct risk of disease and death from extreme weather events are not the only consequences. Natural disasters and resource insecurity caused by climate change increase stress within local communities, which can contribute to son preference, differential feeding, child marriage and gender-based violence.12 Research shows that women are up to 14 times more likely to suffer gender-based violence during a natural disaster.12

A vivid example of the interwoven consequences of climate change can be found in the Lake Chad Basin region in Africa. Lake Chad has shrunk by 90% since the 1960s due to reduced rainfall and higher temperatures, intensifying competition for resources and leading to greater risks of malnutrition and violent conflict.13 Additionally, women suffer increased risk of gender-based violence as they travel long distances to find essential resources.12 This scenario emphasises the urgent need for climate change strategies that strengthen social protection and prioritise social and gender issues, not only to mitigate the environmental instability but also to promote health equity.


Economic prosperity is not just about wealth. True growth ensures individuals can be self-sufficient and access services that promote their well-being, such as food, healthcare and education. Notably, a 1% yearly reduction in each nation’s income inequality (Gini) index can have a more profound effect on global poverty than just a boost in economic growth rates.14

The COVID-19 pandemic brought the crucial role of social protection to the forefront.3 6 These social strategies not only reduced the repercussions of the pandemic but also helped address other interconnected crises such as poverty, and climate change. For instance, social protection initiatives facilitated the inclusion of marginalised individuals in the formal sector and encouraged businesses to shift into greener economies during the pandemic.6 Yet, as of 2020, 53% of the global population lacked social protection. Even with abundant scientific evidence and the SDGs highlighting its significance, we have witnessed only a 2% increase in global coverage since 2015.3 15 Although funding is a continuous challenge, social protection expansion needs to be prioritised. Reallocating budget expenditures and upskilling programme personnel to make initiatives more efficient can help improve and expand programmes.3

For sustainable progress, it is imperative to address structural inequalities and foster pro-poor growth strategies based on lessons learnt from previous crises. Addressing inequality is not just an ethical imperative but is essential for collective resilience and progress towards achieving the SDGs.

Data availability statement

No data are available.

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Patient consent for publication


We acknowledge support from the grant CEX2018-000806-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Programme.



  • Contributors EL-B, MN and DR contributed to conceptualisation. All authors contributed to writing—the original draft. All authors contributed to writing—reviewing and editing. All authors approved the final version.

  • Funding Authors thank the CEX2018-000806-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Programme, for providing open access fees associated with the publication of this commentary.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.