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Honorable chair, distinguished delegates,

The International Society of Nephrology (ISN) urges the WHO and member states to accelerate action to tackle the social determinants of health. Chronic kidney disease (CKD) is the highest risk comorbidity for severity of illness and death from COVID-191, and disproportionately affects the poor and disenfranchised. The social gradient impacts outcomes and increases the risk of comorbidities, such as obesity, diabetes and cardiovascular disease2.

Kidney disease is indeed a barometer for the social determinants of health as:

• Its risk begins in utero due to a lack of gender equality, poor maternal education, health and nutrition
• Infections related to lack of access to clean water, sanitation and hygiene lead to acute kidney injury in children and increase risk of later life kidney disease
• Kidney disease is more prevalent among vulnerable populations including black, immigrant and indigenous populations who have less access to care in high-income countries3, and who frequently have other comorbid NCDs
• Kidney disease is worsened by lack of access to primary care, early diagnosis and essential medicines, imposed by poverty, lack of universal health coverage and lack of education
• Kidney disease in turn exacerbates poverty through associated costs of care, the transportation costs, job losses and interruption of education

Given the undeniable impact of social determinants on kidney health, and the recognition that good health is key to maximizing each person’s individual capabilities, we call upon Member States and the WHO to:

• Strengthen efforts to fully achieve the Sustainable Development Goals through multi-sectoral policies and action, to leave no one behind
• Prioritize the elimination of health inequities, removing barriers to access health services and developing policies that include treatment and care for all people affected by kidney disease