Pillar 4 Health and wellness Overall cooperation remained steady, as health outcomes held, but flows of global aid eroded sharply, signalling potential challenges ahead. The barometer shows that topline cooperation in the health and wellness pillar held steady, supported by resilient health outcomes, which may reflect a gradual “normalization” after having dropped during the pandemic. This stability, however, masks a growing fragility. Pressures on multilateral organizations have eroded aid support, and development assistance for health (DAH) has contracted sharply. The result is that costs are shifting to lower-income countries, potentially endangering health outcomes in the future. 0.600.650.700.750.800.850.900.951.001.051.10 2012 2014 2016 2018 2020 2022 2024Compound annual growth rate (CAGR), % Health and wellness index Health-related goods trade Maternal mortality1* Child mortality1* Disability-adjusted life years (DALYs)1* Life expectancy at birth* International Health Regulations (IHR) score Cross-border pharma R&D DAH -20 -5 0 5 -10 10 -15 15 2012–20 2020–23 2023–24Health outcomes continued to improve, but development assistance for health declined FIGURE 10 1. Metrics were inverted given negative connotation; *outcome metrics. Note: Partial extrapolation of 2024 data from 2023 data for the following metrics: health-related goods trade, cross-border pharma R&D. Sources: UN; Institute for Health Metrics and Evaluation (IHME); Policy Cures Research; World Health Organization (WHO); UN Comtrade; McKinsey & Company analysis. The heaviest pressure on this pillar was the drop in DAH, which fell 6% to $50 billion in 2024, continuing its erosion since 2021. Key donors, including Germany, the United Kingdom and the US, cut funding. Donations through multilateral channels pulled back more than those in bilateral channels; their funding fell by about 20%, while country-to- country funding contracted by 3%.51 This may suggest that the aid landscape is increasingly tilting towards bilateral arrangements, which can prioritize medicines, diagnostics and front- line delivery. While helpful at the point of care, these arrangements could impose more pressure on recipient governments, as they typically leave system costs uncovered, shifting those on to domestic budgets. For example, the new US guidance for its HIV programme aims for services to be managed by domestic actors The Global Cooperation Barometer 2026 21