Pillar 4 Health outcomes like life expectancy continue to improve post-pandemic – but cross-border assistance is falling. The health and wellness pillar looks at the impact of global cooperation on enabling people worldwide to live longer and better lives. Cooperation increased from 2012 to 2019 and spiked in 2020 as the world navigated the pandemic. There was a decline in 2021 and 2022, which was partially reversed in 2023. Almost all of the metrics in this pillar therefore remain above their pre-pandemic averages (represented by the black line in Figure 11).In 2023, metrics related to health outcomes (child mortality, maternal mortality and life expectancy) improved, but at a slower rate than before the pandemic. Disability-adjusted life years (DALYs), one of the key measures of health, stagnated after significant improvement in 2022. There is a risk that decreased cooperative actions now will eventually drag down health outcomes, as the former lags the latter. In fact, metrics related to cooperative actions, including cross-border assistance and pharmaceutical R&D, have continued to fall since 2020, although they remain above pre-pandemic levels. Health and wellness Health and wellness trends FIGURE 10 2012-20 2020-22 2022-23 ExtrapolationImprovement in: 7/8 2012-20 4/8 2020-22 3/7 2022-23-20 -15 5 15 -10 -5 0 100.600.650.700.750.800.850.900.951.00 2012 2014 2016 2018 2020 2022Health outcomes saw steady improvement in 2023, but development assistance retreated with distance from the pandemic Compound annual growth rate (CAGR) % Health and wellness index Maternal mortality*,** Disability-adjusted life year*,** Health-related goods trade International Health Regulations score Development assistance for health Cross-border pharma R&DChild mortality** Life expectancy at birth*,** *Metrics were reflected given negative connotation. **Outcome metrics. Note: Trade in health-related goods mostly based in 2023 actuals, partial extrapolation for missing data. Sources: UN, Institute for Health Metrics and Evaluation (IHME), Policy Cures Research, World Health Organization (WHO), UN Comtrade, McKinsey & Company analysis. The Global Cooperation Barometer 2025 Second Edition 18