Why does Oxfam say ‘inequality kills’? We break down the numbers

Didier Jacobs Events, Inequality, Methodology

In our latest blog for Davos week, Didier Jacobs unpacks the calculations behind our striking statistic that inequality is linked to one death every four seconds

Every year before the Davos meeting Oxfam takes the opportunity to remind the world about the chasm that exists between the Davos elite and the rest of us. A chasm that, for instance, means the wealth of the ten richest men on earth has doubled during the pandemic, while there are 163 million more people in poverty than pre-pandemic projections.

Look out for a future blog on how we did the analysis behind our striking stats on billionaires but, in this post, I’ll focus on a new big theme for our Davos report: “economic violence”. The gap between rich and poor costs lives.  The report examines four pathways between inequality and deaths:

  • Lack of access to quality healthcare,
  • Hunger,
  • Gender-based violence, and
  • Climate change.

There are of course other pathways not included in our report: crime, conflicts, accidents and more. There are also multiple kinds of inequality that could be considered: for instance, economic vs. social inequality or international vs. within-country inequality.

So instead of being comprehensive, the table below summarises what we could measure based on what we felt to be strong and available data. To avoid double counting the same deaths across the four mortality causes, we propose both lower and upper bounds and add up only the lower bounds. So all in all, “one death every four seconds” is very much an underestimate.

Inequality-related deaths per day

Here is an overview of the data and calculations behind each of the four causes of mortality. You can find more details about the methodology here.

1. Lack of access to healthcare – about 15,000 deaths a day

The correlation and causation between economic inequality and health outcomes has been well documented (eg in the research of Kate Pickett and Richard Wilkinson and their book The Spirit Level; work by health inequality expert Michael Marmot; and research by the World Health Organization (WHO). But quantifying it worldwide is challenging.

Our estimate is drawn from this Lancet study of the mortality impact of international inequality in access to healthcare services. That study examines the death rates of 61 specific medical conditions in 137 low- and middle-income countries compared to four top-performing middle-income countries (Chile, China, Costa Rica, and Cuba). Essentially, it estimates how many deaths could be avoided in the 137 countries if they had healthcare systems as good as these top performers.

All in all, the authors conclude that, in 2016, 5.6 million people died in low- and middle-income countries owing to either a lack of access to healthcare or low-quality healthcare, which is 15,342 a day.

It is important to note that this study precedes the Covid-19 pandemic, which may have killed an extra 19.5 million people worldwide and counting. While low and middle-income countries have not been more afflicted than high-income ones, vaccine apartheid is bound to increase deaths in the latter. Several studies have found a robust correlation between mortality rates and the degree of economic inequality within countries in the early days of the pandemic. Unfortunately, despite our best efforts, we were not able to get a verifiable estimate as to how many more people have died of Covid-19 due to inequality, but it is definitely a number that we intend to continue to work on.   

2. Hunger – at least 5,700 deaths a day

The world produces more than enough food to ensure no one dies of hunger. It is the unequal distribution of food that leads to deaths from hunger. Our assumption here is therefore that all hunger deaths can be attributed to inequality.

Oxfam’s estimate of hunger deaths is based on the Integrated Food Security Phase Classification (IPC) monitoring system. Based on death rates for the different IPC grades of food insecurity and the affected populations for each grade, we were able to estimate the excess deaths from hunger. This gives between 5,773 and 14,916 deaths per day.

3. Gender-based violence – at least 200 deaths a day

Almost one in three women around the world has suffered from gender-based violence. This gender-based violence results from patriarchal social norms as well as government negligence in enforcing laws that protect survivors and victims. This violence results in deaths, all of which can be attributed to social inequality.

Our estimate of deaths from gender-based violence is the addition of victims of murders by intimate partners (about 30,000 women and 6,585 men) collected by the United Nations Office on Drugs and Crime (UNODC) and an estimate of deaths resulting from female genital mutilation (37,530 women) computed by Professor James Rockey for Oxfam (available on request), giving a total of 74,115 deaths a year or 203 a day.

This is only part of the picture of the lethality of gender-based violence: because of lack of data it excludes femicides by people other than intimate partners (eg honour killings), femicides unreported due to social stigma (eg Indigenous women and girls or sex workers), or killings of transpeople, and other forms of gender-based violence. One estimate suggests there were as many as 1.7 million excess female deaths in 2020, which is 4,685 per day and which we use as our upper bound, because it probably overlaps with our health and hunger estimates.

4. Climate change – up to 600 deaths a day… but with huge future risks

Our estimate of climate deaths is drawn from a 2014 WHO study, which projected that climate change would kill about 241,227 people a year worldwide by around 2030, through increases in only five causes of death (so it is an underestimate): malnutrition, malaria, dengue, diarrheal disease, and heat waves.

Climate deaths are very much the result of international inequality. On the one hand, rich countries are responsible for an estimated 92% of historical excess carbon emissions. And the richest 10% of the world’s people are projected to emit nearly ten times more carbon in 2030 than the per-capita emissions compatible with keeping the rise in global temperature under 1.5C above pre-industrial levels. On the other hand, the WHO study shows that climate deaths are concentrated in low- and middle-income countries. We therefore count all deaths in low- and middle-income countries – 231,168 a year or 633 per day – as inequality-related climate deaths. We use that figure as an upper bound, given that it overlaps with our health and hunger estimates.

However, this estimate does not convey the full severity of climate change. There is a big time lag between emissions and deaths. Climate change could kill millions of people a year later in this century. One study estimates that the greenhouse gases emitted by just 273 Americans in 2020 could kill one person in the second half of this century through heat waves alone.

Taking the lowest estimate of all of these four factors, we can see inequality contributes to at least 21,318 deaths per day globally or one death every four seconds.

None of this is inevitable. Economic policies as well as social norms cause inequality. Governments need to act by investing in social services paid for by taxes on the rich to end the economic violence.


Didier Jacobs

Didier Jacobs is Senior Policy Advisor at Oxfam America (email Didier.Jacobs@Oxfam.org)

You can find the full report, Inequality Kills, as well as a comprehensive methodology document outlining how we did the analysis, here.

This is the third in a series of posts for this month’s online Davos gathering on Oxfam’s Views and Voices blog. Subscribe to keep up with the latest posts and also do follow us on Twitter and LinkedIn