Where We Stand on Health Inclusivity
The Health Inclusivity Index (HII) evaluates how effectively countries are progressing toward inclusive healthcare for all citizens. It is meant to measure gains in mental, physical, and social health; assess the state of health inclusivity; and inspire policy dialogue and action to making health systems more inclusive. The HII was first published in October 2022 by Economist Impact. It includes 40 countries, and the reports have been released in three stages, with the latest launched in May 2025.
Health inclusivity is defined as: “The process of removing the personal, social, cultural, and political barriers that prevent individuals and communities from experiencing good physical and mental health, and a life fully realized.”1 Based on the second stage report, the United States ranks fourth out of 40 countries, with Australia, Sweden, and the United Kingdom in the top three.
Evaluations are based on a set of indicators across three main domains:
Health in Society. This assesses how highly a nation values the health of its people and whether it considers health across all government policies. This accounts for the social determinants of health (SDOH) such as education, housing, and income. See the article in this issue of Dimensions regarding SDOH factors in oral and overall health (page 32).
Inclusive Health Systems. This measures the strength and scope of a nation’s healthcare system, including its accessibility, responsiveness, and whether cost is a barrier to accessing services.
People and Community Empowerment. This evaluates efforts to ensure that healthcare services are designed to be inclusive, accessible, and tailored to individuals and their preferences, including vulnerable groups. This domain often focuses on factors such as health literacy and community members’ ability to engage with their own health (self-care).
Here is what the HII’s assessment of the US system implies about oral health issues:
- Cost is a major barrier to accessing health services in the US. This is acutely visible in oral health. Because dental care is separate from medical care, a significant portion of the population has no or inadequate dental coverage. Furthermore, preventive care is delayed or avoided, turning easily treatable conditions into severe, expensive, and debilitating ones.
- The US has wide health disparities. The data show that caries and periodontal diseases disproportionately affect specific groups such as low-income adults and racial and ethnic minorities (Black, Hispanic, and Native American). These individuals have greater difficulty accessing care.
- The US system, by separating medical and dental care, lacks integration of services. This impacts overall health as we know that untreated periodontal diseases are linked to serious systemic conditions like diabetes and heart disease.
In short, while the HII doesn’t isolate dental statistics, its assessment of the US system’s affordability and equity issues provides a clear explanation for why conditions, such as tooth decay and periodontal diseases, remain major, inequitable public health crises in this country. Even in 2026, we have far to go.
Reference
- Health drives wealth: the economic impact of health inclusivity. Economist Impact. Available at https://impact.economist.com/ projects/ health-inclusivity-index/documents/health_inclusivity_index_phase3_report.pdf?v=2025. Accessed December 15, 2025.
From Dimensions of Dental Hygiene. January/February 2026; 24(1):6
