Chapter 04 · People & supply chainsHuman Rights & Social Sustainability
Antimicrobial resistance (AMR)
Definition
The process by which bacteria, viruses, fungi and parasites stop responding to antimicrobial medicines, making infections difficult or impossible to treat. Bacterial AMR was directly responsible for an estimated 1.27 million deaths in 2019 and associated with nearly 5 million; WHO ranks AMR among the top ten global public health threats.
References
Definition; >4.7 million associated deaths (2021); 1-in-6 resistant infections (2023); drivers and regional patterns.
4.95 million associated and 1.27 million attributable deaths (2019); WHO top-ten ranking; LMIC burden.
Pollution drivers (pharmaceutical, agriculture, healthcare); One Health framing; USD 3.4 trillion GDP and 24 million extreme-poverty estimates.
Overview
What it means
AMR is a sustainability issue because its drivers span the whole human-animal-environment system: overuse and misuse of antibiotics in healthcare and livestock production, pharmaceutical and agricultural pollution of waterways, and weak sanitation.
WHO estimates one in six laboratory-confirmed bacterial infections worldwide was antibiotic-resistant in 2023, with resistance highest where health systems are least equipped.
How it is used
Responses are organised through the "One Health" approach linking human, animal and environmental health: antimicrobial stewardship, infection prevention, surveillance, regulation of agricultural antibiotic use, and incentives for new drug development. UNEP estimates unaddressed AMR could cut USD 3. 4 trillion from GDP annually and push 24 million people into extreme poverty within a decade.
Why it matters
AMR threatens the foundation of modern medicine — surgery, cancer care and safe childbirth all depend on effective antimicrobials — and its burden falls hardest on low-income countries, making it an equity as well as a health issue. It links farm practice, pollution and public health in a single policy problem.