This impact indicator was central to the vision of the PAHO Strategic Plan 2020–2025. By quantifying social inequalities in health and tracking changes over time, it provides evidence and supports accountability in relation to progress toward national, regional, and global health goals. The indicator is composed of four core tracer indicators, which correspond to selected indicators that span the life course: neonatal mortality, adolescent birth rate, tuberculosis incidence, and premature mortality due to one of the four priority noncommunicable diseases. 

The Pan American Health Organization (PAHO) monitors all data available from administrative and survey sources that are disaggregated by standard dimensions of inequality, such as income, education, sex, area of residence, racial or ethnic identity, and other social stratifiers. It then calculates a standard summary measure of health inequality: the absolute gap, defined as the arithmetic difference in a core tracer indicator between two socially defined population groups, such as the highest and lowest income quintiles, rural and urban populations, or women and men. Progress was assessed based on evidence of a meaningful reduction in the absolute gap for a core tracer indicator between the baseline year (2019) and the most recent available data. According to the indicator’s technical specifications, within-country health inequalities are considered to have decreased when a country achieves a reduction in the absolute gap for at least two of the four core tracers. 

By the end of 2025, a total of 8 countries had demonstrated reductions in within-country health inequalities in 1 tracer indicator; 10 countries had achieved reduction in 2 tracers; and 8 countries had achieved reductions in 3 tracers. No country achieved reductions in all 4 tracers. Therefore, with 18 countries reducing inequalities in 2 or more tracers, the target of reaching 17 countries was achieved. This result reflects the strong commitment of Member States to reducing health gaps, even in the context of major disruptions such as the COVID-19 pandemic. 

It is worth noting, however, that this indicator reflects only a limited part of the regional health landscape. Reductions in inequalities are urgently needed in other critical areas such as access to health services, mental health, road traffic crashes, and disability. Even for the tracer indicators, the availability of timely, quality data disaggregated by relevant social stratifiers is scarce, meaning that much of the potential evidence on reductions in health inequalities cannot yet be captured. It should also be noted that, in a few cases, reductions in the absolute gap were driven by the undesirable situation in which one social group experienced improvements in health while the other experienced no change, or even a deterioration. 

Despite these caveats, the results under this indicator show that the Region of the Americas took important steps toward embedding the monitoring of health disparities, with some evidence of narrowing gaps despite the disruption caused by the COVID-19 pandemic. This work can be further strengthened under the PAHO Strategic Plan 2026–2031, in which the indicator will continue to be monitored.