As we move forward with the SDGs era, armed conflicts continue to affect various countries in various regions globally affecting health and well-being of populations involved. For instance, in 2020 there were 56 active conflicts of which eight were wars, an increase from seven wars in 2019 and six wars in 2018 (6). Conflicts also affect coverage of health interventions to vulnerable populations especially women, children and adolescents leading to health inequalities in conflict affected countries compared to countries without conflicts (7).

The current COVID-19 pandemic has worsened the health and well-being of global populations in many ways including a high mortality, in which as per the World Health Organization (WHO) COVID-19 dashboard “as of 2:24pm CEST, 13 July 2021: there have been 186,821,815 confirmed cases of COVID-19, including 4,038,342 deaths, reported to WHO” (44). The COVID-19 has been shown to exacerbate inequalities even in high income countries with racial disparities in outcomes, which calls for a more research to gain an insight on what makes such inequalities to continue so that the world can better prepare for future pandemics as well as addressing the gaps in the ongoing pandemic (8). The epidemiological role of discrimination is found to be important. Cuevas et al. show that experiences of discrimination, both acute and chronic, can dysregulate immune function, characterized by elevated levels of inflammation, i.e., worsening people's health and well-being (9). Also, the COVID-19 pandemic is likely to add more burden to countries with high burden of Human Immunodeficiency Virus (HIV) infections in terms of social and psychological factors. In this case it requires more attention employing the “syndemic approach” in order to uncover vulnerabilities and design relevant strategies to protect the affected populations (10, 11). The pandemic has also impacted on the global supply chain for health commodities in an unprecedented way. In order to support low-and middle- income countries (LMICs) especially those in the African continent in a way that will ensure availability of essential health commodities that will ensure continuity of essential services and address the needs for care of COVID-19 patients, it has been proposed that support need to be informed by data on “comparative risk assessment” (12).

Apart from great efforts in the area of research and innovation to combat the COVID-19 pandemic, global, regional and country cooperation and solidarity efforts are needed to enable deployment of discoveries to save lives of people who need them. For instance, in a recent meta-analysis of 27 trials which “assessed the efficacy of Iterleukin-6 (IL-6) antagonists in patients hospitalized for COVID-19,” it was found that “administration of IL-6 antagonists (Tocilizumab and Sarilumab), compared with usual care or placebo, was associated with lower 28-day all-cause mortality” (13). The World Health Organization (WHO) immediately (on 06^th July 2021) went on to recommend the use of the medicines for COVID-19 patients; however, the biggest challenge to health systems in low-and middle- income countries (LMICs) is a high price of the medicines (14). This means that high income countries and international organizations must find ways that will ensure the medicines are accessible to poor countries in which the number of COVID-19 cases and deaths is increasing and also, they lack access to COVID-19 vaccines. In signs of enhanced commitment to save human life, the Swiss pharmaceutical company Roche (a day after WHO recommended the use of the medicines) announced that it has suspended its patent rights on the medication tocilizumab in LMICs for the duration of the pandemic, an action that will contribute to its accessibility to people in need in LMICs (15). Therefore, other manufacturing companies and high-income countries should also do the same to support LMICs to access the live saving health commodities including the COVID-19 vaccines.

Availability of water and sanitation facilities in LMICs has increased in the past two decades, however inequalities in access still persist at subnational levels with more access in urban areas (16). Concerted efforts to address this inequality in access to water and sanitation facilities are needed given the ongoing COVID-19 pandemic (17).

Cities in LMICs are growing rapidly and due to inadequate resources, they are inadequately prepared to handle effects of climate change. Implementation of nature-based solutions have been shown to have potential for improving living conditions in cities (18); and in particular due to the fact that they are low cost and widely accessible (19). A study that assessed the effect of urban design in relation to the nature-based solutions in Dar es Salaam, Tanzania, provided some insights that can be used to improve living conditions and address effects of climate change which require city planners and architects to take them on board; an indication of how inclusive we should be in terms of expertise involvement if we are to achieve One Health and be able to tackle such global health challenges as climate change (20). In order to realize the full potential of nature-based solutions, there is a need for further research and to ensure that its implementation take into account a systems-thinking framework (21). Also, inadequate planning of cities in LMICs as manifested by people living in slum areas affects implementation of interventions to improve well-being of the people. The challenges observed in addressing the ongoing COVID-19 pandemic are further enlightening us on the need for improving planning of cities and other urban areas in order to allow implementation of public health measures necessary for combating the current and future epidemics (22).

The threat of climate change to the world we live are many, hence, threatening our health and well-being. Effects of climate change to the nutrition of children under 5 years are likely to be greater in rural areas in which income of the people and prices of food are likely to affect availability of food to children (23). Also, climate change affects food accessibility to populations and exacerbates poverty and inequality. In addressing the challenge of famine, adaptation using adjustments in international trade such as reducing tariffs and barriers at organizational level as well as infrastructural barriers have been shown to have potential for addressing food shortages (24). Along these efforts, in order to address inequalities and ensure inclusiveness, there is a need for ensuring that gender equality is part and parcel of the interventions to address effects of climate change (25). Also, small-scale farmers are affected by climate change. For example, a study by Aryal and colleagues, has reported effects of climate risks to farmers in East Africa and South Asia in which they found an inadequate capacity to deal with effects of climate change which was further compromised with inadequate governance (26). Health effects of climate change to small-scale farmers have been reported to range from “communicable diseases; non-communicable diseases; mental health; and occupational health, safety and other health issues” (27). These effects require actions to be taken at country level and global level (27). Taking into account that climate change also affects disproportionately people without housing, Bezgrebelna and colleagues have suggested for application of a “Human Rights-Based Approach” in designing of interventions to address this situation (28). We note that health impacts of climate change are enormous and may increase as global warming continues. According to Baker et al. climate change, rapid urbanization and changing land-use patterns will increase the risk of disease emergence in the coming decades. Climate change, in particular, may alter the range of global pathogens, allowing infections, particularly vector-borne infections, to expand into new locations (29). Climate change may have played a key role in the evolution or transmission of SARS-CoV-1 and SARS-CoV-2 (30). Therefore, it is important to continue researching on its dynamics so that we can understand vulnerabilities and hence address the inequalities resulting from its effects (31).

Sustainability of oceans, seas and marine resources continues to be affected by climate change, and if the global efforts to address climate change are not effectively harnessed, effects of climate change will be huge by 2050 (32). With the economic role attached to these resources by countries and populations, it is extremely important now to take collective actions that will improve conservation interventions for our current and future well-being (33). In planning process for addressing these challenges, the “Marine spatial planning” as described by Grip and Blomqvist, offers a multisectoral planning process “for coordinating different marine interests and balancing the use, protection and conservation of marine areas and space with its resources, biodiversity and ecosystem services” (34). By multisectoral planning, it will ensure that the needs of those who depend on marine resources for their livelihood are taken into account.

As part of addressing the COVID-19 pandemic, need for considering control of business of live wild animals and also eating practices in terms of regulating wildlife markets was noted (35, 36). However, researchers have suggested that wildlife trade is a source of income for the poor people therefore indiscriminate banning may exacerbate poverty and may also not be sustainable in the longer term in addressing risk of zoonotic diseases to humans. Therefore, balancing trade regulation with conservation efforts will be a better approach to allow those who depend on it to earn their living and to contribute to their economic development (37–39). In order to better address this, it has been suggested to find ways of assessing the markets for risk of transmission (37, 40). Wikramanayake and colleagues have developed a tool based on the situation in the South East Asia which can be used for this purpose and probably applicable to other global regions as well (40, 41). The need to complement such regulatory efforts with strategies to improve use of land in order to minimize spread of zoonotic diseases from animals to humans has been emphasized (42). Plowright and colleagues have called for a collaborative effort involving experts from environmental sciences, wildlife, agriculture and human health to study and develop scientific evidence on contribution of changes in land use practices to occurrence of zoonotic diseases (42). Also, the authors have pointed out that findings from such collaborative research on land use will “help to understand and show how investments in landscape conservation provide returns for human health, climate change, international trade, sustainable development, environmental justice, and other policy issues associated with human well-being” (42). The debate about the origin of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has reminded us about the health and welfare of animals. A paper by Whitfort has described the gaps in China in terms of the lack of a legislation for promoting animal welfare, which is key in protecting public health, and that moving forward “decisions about animal welfare law and policy require a global vision” (43).