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A participant in the “Butterfly Effect” project receives a COVID-19 vaccination on a busy avenue in Buenos Aires. Supported by the Partnership for Healthy Cities, the project uses peer-to-peer outreach to overcome vaccine hesitancy.

2021: Year in review

Public Health is for Everyone,
by Everyone .

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2021: Year in review

Public Health is for Everyone,
by Everyone .

Youth in Kumasi, Ghana show support for 30 km/h speed limits in areas where people live, work and play, as part of the city's U.N. Global Road Safety Week activities.

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2021: Year in review

Public Health is for Everyone,
by Everyone .

A community member receives a birth certificate at a mass registration event in the Lower River Region, The Gambia.

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2021: Year in review

Public Health is for Everyone,
by Everyone .

Supported by the Vital Strategies Data for Health Initiative's Global Grants Program, the Gambian Ministry of Health has built a community-based surveillance system in the Lower River Region—where community members facilitate the registration of births, deaths and other local events of public health significance.

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2021: Year in review

Public Health is for Everyone,
by Everyone .

A client plays ping pong at Casa de Todos (Everybody's House), an emergency shelter established for older unhoused men in Lima, Peru.

slide image 6

2021: Year in review

Public Health is for Everyone,
by Everyone .

A student at San Agustínschool in Bogotá, Colombia, drinking water from a Partnership for Healthy Cities-supported water fountain, part of healthy school food environments program.

Good health doesn't just happen—it is generated when societies value and support health for everyone.

In 2021, it was easy to despair as the world reeled from the effects of a pandemic that raged on. In cities and countries around the world, Vital Strategies worked with leaders who were able to see beyond the immediate crisis of COVID-19 and act to strengthen their systems for the future. We supported advances in health policy and practice in areas where progress had stalled for years. And we saw people and institutions who had not previously prioritized public health recognize that it is everyone’s mandate.

Vital’s work in more than 70 countries continued to accelerate in 2021, as we partnered with governments and civil society to strengthen their public health systems to contend with the most difficult health challenges of our time—from COVID-19 to air pollution to drug overdose to tobacco use. Working with local partners, we have touched the lives of millions of people through scalable interventions that prevent illness, injury and death. We worked in partnership to reimagine evidence-based, locally driven policies and practices to support and improve health and well-being.

Much of the tragic loss experienced in 2021 was foreseeable and preventable, and the result of years of underinvestment and inaction in public health. Too many lives were lost to COVID-19, exacerbated by underlying conditions such as heart disease, cancer and diabetes. And the COVID-19 death toll of 6 million does not take into account the needless excess mortality that resulted when fear of contagion and disruptions in essential health services kept people from seeking needed prevention and treatment services.

The pandemic showed us even more clearly that we must do better to achieve equity in health. We must continue to seek partners in governments, international governing bodies, civil society and all who recognize we have to reimagine public health. The status quo is unacceptable.

Jose Luis Castro
Read more from Vital Strategies’ President and CEO, José Luis Castro
read the letter
Luis James de Viel Castel
Read more from Vital Strategies' Chairman of the Board, Louis James de Viel Castel
read the letter

Tobacco use is one of the leading causes of premature death in our day and age. Every person is entitled to a smoke-free environment.”

Deputy Lord Mayor, Kampala, Uganda

Vital Strategies supports countries, regions and cities in their efforts to guarantee spaces where everyone can breathe smoke-free air.

In Mexico, Vital Strategies has supported tobacco control efforts for years, including 2021’s communication campaign “ ¿Cómo te lo explico?" (“How Do I Explain it to You?”). The sign in the image above says: “It’s urgent to reform the anti-tobacco law.”
In Mexico, Vital Strategies has supported tobacco control efforts for years, including 2021’s communication campaign “ ¿Cómo te lo explico?" (“How Do I Explain it to You?”). The sign in the image above says: “It’s urgent to reform the anti-tobacco law.”

1 Billion People in 9 Countries Covered by New, Stronger Tobacco Control Laws in 2021

Mexico and Ukraine passed national, comprehensive tobacco control legislation, while Indonesia raised taxes, Turkey increased the size of warnings on tobacco packaging and Brazil banned flavors and additives.

Tobacco kills half of regular users, with as many as 8 million dying each year—including 1 million nonsmokers exposed to secondhand smoke. Laws that ban smoking in public places protect nonsmokers and encourage smokers to quit. In 2021, the world saw historic progress on tobacco control in several countries, including landmark policy change in Mexico, Indonesia, and in Ukraine—whose government remained committed to its tobacco control work despite rising tensions with Russia. Mexico reformed its comprehensive national tobacco control law to ban smoking in all public places and forbid tobacco marketing. Ukraine expanded public smoke-free rules to include e-cigarette use, and Indonesia raised taxes on tobacco by up to 14% for some products.

Vital Strategies has worked on tobacco control with national and local governments in all of these countries for many years, and launched tested, strategically timed media campaigns to build support for these policies. In 2021, Vital also ran campaigns in China, India, Bangladesh, and the Philippines—all places where there were tobacco control policy victories in the midst of the pandemic.



people were covered by new, stronger tobacco control policies in 2021.

smoke image
In Bangladesh, this public service announcement ran in 2021 ahead of a call for thousands of local jurisdictions to plan, implement and enforce tobacco control policies in accordance with new national guidelines.
explore tobacco control work in 2021
  • Mexico

    After a decade-long effort to increase support among policymakers and the public to strengthen tobacco control and fend off tobacco industry opposition, the Mexican government approved amending the national tobacco control law, which now bans smoking in all public places and forbids tobacco advertising.


    of public spaces in Mexico are now smoke-free, benefiting all 128 million Mexicans.


    In 2021, despite rising tensions with Russia, Ukraine stayed committed to tobacco control. Parliament passed a national tobacco control law that bars the use of new electronic products—such as e-cigarettes—in enclosed public spaces, and further restricts these products by requiring health warnings and banning flavors, sales to minors, and advertising.


    of both sides of cigarette and e-cigarette packages must now be covered by pictorial health warnings.


    Turkey now has the world's largest cigarette pack health warnings, alongside Timor-Leste. In 2021, the country announced the new requirement that health warnings take up 92.5% of cigarette packaging.


    of cigarette packaging in Turkey must now be covered by health warnings.


    Thanks to a unanimous Federal Regional Court ruling, Brazilian regulators now have the power to ban flavored cigarettes, which are known to attract children. After years of litigation, this latest ruling sets a precedent for any additional cases in the country, finally making these bans the law of the land.

    212 MILLION

    Brazilians benefit now that regulators have the power to ban additives in cigarettes.

  • Bangladesh

    Thousands of local jurisdictions in Bangladesh have been called upon to plan, implement and enforce tobacco control policies in accordance with new national guidelines. Vital Strategies supported the government in airing the campaign “Smoke-Free Homes” on the importance of quitting smoking to protect loved ones from secondhand smoke.

    164 MILLION

    people across Bangladesh will benefit from local tobacco control measures.

  • Indonesia

    In late 2021, the Indonesian government announced tobacco tax increases of an average of 12% on tobacco products and up to 14.4% on premium brands. Vital Strategies played an important role in this win, sharing a drumbeat of social media campaigns, designed by Vital and partners, that amplified the economic cost of tobacco use.


    is the new, higher tobacco tax rate on premium brands.

  • Philippines

    Vital supported the creation of national-level warning labels for e-cigarettes and heated tobacco products in the Philippines, the first country in the world to provide pack warnings for these new products.

    109 MILLION

    people across the country protected by new national-level labeling for e-cigarettes and heated tobacco products.


    Two more cities became smoke-free, bringing the number of people covered by smoke-free policies in public spaces to over 200 million. In 2021, Vital provided technical assistance and launched citywide media campaigns in Hangzhou on enforcement of the new 100% smoke-free law and to highlight the harms of secondhand smoking. Vital also worked with China CDC and our partner, The Union, to support enforcement of a 100% smoke-free law in Xining.

    200 MILLION+

    people in cities in China are now covered by smoke-free policies.


    The state of Jharkhand amended the national tobacco control law by adding state provisions that ban smokeless tobacco and spitting. Vital provided communication support to the state government in running two campaigns— "Sunita" and "I Don't Believe"> —about the harms of smokeless tobacco.


    media mentions plus eight mass media campaigns and four social media campaigns promoted the new Jharkhand law.

We’ve seen firsthand how working with government, philanthropic and private sector partners has saved lives and been instrumental in the fight against the opioid overdose epidemic.”



Vital Strategies works with partners in Michigan and other U.S. states to offer harm reduction services that help people who use drugs to stay safe and alive.

Domenick, a person in recovery, offers one of the five testimonials in the "Essential. Effective. Human."campaign developed by New Jersey Harm Reduction Coalition and Vital Strategies.
Domenick, a person in recovery, offers one of the five testimonials in the “Essential. Effective. Human.”campaign developed by New Jersey Harm Reduction Coalition and Vital Strategies.

2021 Marks a Hopeful Change Toward a Public Health Approach to Overdose

After decades of trying to address drug use with stigma and punishment, some states are making important progress in moving to a harm reduction approach that provides lifesaving services that center on the safety and dignity of people who use drugs.

The U.S. reached a grim milestone in 2021: more than 100,000 people died of overdose . At long last, some states are shifting from a punitive approach to one that offers people who use drugs the support they need to protect and improve their health. Vital Strategies and its partners in Pennsylvania, Michigan, Connecticut and New Jersey are successfully pressing for harm reduction strategies such as access to supplies for safer drug use, naloxone and medications for opioid use disorder, and reduction of drug-related incarcerations.

For example: a partnership with the New Jersey Harm Reduction Coalition helped pass a new law that strengthens support for syringe service programs; technical assistance helped the Michigan health department establish a statewide naloxone ordering portal and in Pennsylvania, grants are helping counties revise probation systems to reduce drug related incarceration. In 2022 Vital's support will expand to Kentucky, New Mexico, North Carolina and Wisconsin.

Jenna, one of the participants in Love & Dignity, is the executive director of the New Jersey Harm Reduction Coalition. Photo credit: Graham MacIndoe

Jenna lost many people in her life to drug overdose, which inspired her to bring harm reduction to her community. She is the executive director of the New Jersey Harm Reduction Coalition. Read more of Jenna's story

The way I think of it is we wake up in the morning and say, 'Are we doing everything we can do to end preventable overdose deaths and show up for our loved ones?' And until we expand harm reduction, the answer is no. That's driving why I'm doing this work.”




Nish, one of the participants in Love & Dignity, is a harm reduction specialist with the Prevention Point Philadelphia's Syringe Services Program. Photo credit: Graham MacIndoe

After benefiting from Prevention Point Philadelphia's services, Nish was inspired to help others. He became a volunteer and now works as a Harm Reduction Specialist, connecting people with food, housing, treatment and other services. Read more of Nish's story.

They saved my life multiple times in multiple ways. They fed me when I hadn't eaten in days, they gave me water when I hadn't drank all day. They gave me a place to sit down when nobody else would even let me sit down. And then of course the Narcan that they provided saved me multiple times.”




Lilianna, one of the participants in Love & Dignity, is the director of the Ruth Ellis Drop In Center in Detroit, Michigan. Photo credit: Graham MacIndoe
Khamyia, one of the participants in Love & Dignity, is a MOMobile Rapid Engagement Program Advocate with the Maternity Care Coalition in Philadelphia. Photo credit: Graham MacIndoe

Love & Dignity: Portraits From the Front Lines of the Overdose Crisis brought photographer Graham MacIndoe and writer/interviewer Susan Stellin together with Vital Strategies partners who are working to end overdose in the United States. They captured the stories and images of dozens of people working on the front lines to reduce overdose, challenge stigma and broaden support for a humanistic, harm reduction response to people who use drugs.

To explore additional stories and to learn more about overdose prevention work, please visit


This is not a job for the health sector alone. It requires an all-of-government and all-of-society approach to improve the governance of air quality, the monitoring of air pollution risks.”



Vital Strategies collaborates with partners in countries with high levels of air pollution to encourage the adoption of solutions at all levels of society, from households to regulatory agencies.

(L) A technician from the Ministry of Environment and Forestry installs an air quality monitoring station in South Jakarta, Indonesia. (R) A family outdoors in their neighborhood in Jakarta, Indonesia.
(L) A technician from the Ministry of Environment and Forestry installs an air quality monitoring station in South Jakarta, Indonesia. (R) A family outdoors in their neighborhood in Jakarta, Indonesia.

New Research Reveals Air Pollution's Devastating Impact on Children's Growth

More than 90% of the people in the world breathe polluted air, causing an estimated 5 million premature deaths each year. Children face unique risks from breathing unhealthy air as their bodies develop—leading the World Health Organization to call air pollution “an overlooked health emergency for children around the world.

As many as 1 in 5 children under age 5 are stunted—too short for their age—a largely irreversible condition that affects cognitive, physical and social development. Vital Strategies' Environmental Health team published research in April 2021 that describes “significant and noteworthy” increases in the risk of stunting for children exposed to ambient and household air pollution. The harm begins before birth: The researchers found that higher levels of unhealthy air during pregnancy are associated with an 8% increase in the incidence of low birth weight. Children exposed to household air pollution in their first five years—usually from burning coal or wood for cooking and heating—were 19% more likely to be stunted. Vital Strategies works with India and Indonesia, which have high levels of both stunting and air pollution, to make progress toward identifying leading sources of air pollution, investing in clean fuels and emission-reduction technologies, engaging the health sector in clean air action, and implementing proven, evidence-based policies to reduce emissions.

the situation

more than

Of the world breathes polluted air.


india and indonesia are among the
top 5

countries with the highest burden of disease linked to air pollution.


Early impaired growth of children, especially from conception to age 2, which often later negatively affects cognitive functioning, school performance, adult wages and productivity. Children are defined as stunted if their height for age is more than two standard deviations below the WHO Child Growth Standards median.


children under 5 are stunted.

Baby_Orange.svg Union.svg Union.svg Union.svg Union.svg


Air pollution contributes to stunting levels in India and Indonesia, which are among the highest in the world.


OR 31%


or 32%




If Indonesia realized the air quality benefits from accelerating its climate action plan, the country would avoid:


cases of stunting, cutting its rate in half;


adverse birth outcomes;


premature deaths; and


infant deaths.


fewer children would be born small for their gestational age if India met the air quality guidelines set by the World Health Organization.

We know the solutions to reduce air pollution. The challenge is overcoming barriers, from lack of awareness about leading sources of pollution to limited data on air quality to lack of political will.







In 2021, Vital Strategies:

Partnered with the city of Jakarta to DEVELOP A CLEAN AIR ACTION PLAN

CONDUCTED RESEARCH linking air pollution and stunting

EVALUATED THE RETURN ON INVESTMENT from Indonesia's climate action plan

ASSESSED NATIONAL CLIMATE ACTION PLANS focused on air quality and health

To achieve good health for everyone, everywhere, we must recognize the gaps in our public health systems and seek to fill them. To recognize people who use tobacco, consume alcohol or take drugs for who they are: people. It's small choices and big policies that build an environment that supports and generates health.


Reimagining Public Health

In 2021, Vital Strategies refreshed and reimagined its strategic direction, identifying our five most important focus areas.

urban health

Our world has urbanized so rapidly that by 2050, 68% of the people in the world are expected to live in cities. Our city-focused work encompasses Road Safety in up to 30 cities and Air Pollution and Health, primarily in Indonesia and India. Since early 2020, the Partnership for Healthy Cities has expanded its focus areas beyond noncommunicable diseases and injuries to include COVID-19, working with local governments and partners across its network of 70 cities.

environmental health and climate change

Our health as humans is deeply connected to the health of the environments where we live. The vast majority of people in the world—90%—breathe polluted air, and in 2021 the WHO released new air quality guidelines that show no safe level of air pollution exists. Children are at particular risk from environmental hazards: In 2021, Vital's Air Pollution and Health program published new research on the impact of air pollution on children's development, and the Childhood Lead Poisoning Prevention program released clinical care guidance for childhood lead poisoning in Peru.

noncommunicable diseases

Noncommunicable diseases (NCDs) such as cancer, diabetes and heart disease are responsible for 71% of all deaths globally. Vital's Food Policy and Tobacco Control programs use policy advocacy and strategic communication to address two of the biggest drivers of NCDs. The Partnership for Healthy Cities supports a variety of NCD prevention programs across its 70-city network. Going forward, Vital is developing a new program on alcohol policy.

injury prevention

Injuries are the leading causes of death among children and young adults—and most injuries are preventable. Vital's Road Safety program, part of the Bloomberg Philanthropies Initiative for Global Road Safety, uses a comprehensive, evidence-based approach to reduce road crashes, injuries and deaths in up to 15 countries and 30 cities. Our Overdose Prevention program uses a public health approach to address rising drug overdose deaths, promoting harm reduction and emphasizing a just, non-punitive approach to treatment.

public health systems

To strengthen and embolden public health, institutions such as ministries of health and local health departments need the capacity to collect, analyze and use data. Vital's Data for Health programs—encompassing Civil Registration and Vital Statistics (CRVS), Data Impact, Cancer Registries and the Global Grants Program —support our country partners as they build robust data systems, including assisting with tools to analyze available health data, inform policy solutions and maximize resources for greatest impact. Vital's Research Division conducts clinical and operational research to guide important public health decisions—notably the USAID-funded TREAT TB project's STREAM clinical trial —as well as building institutions needed for long-term sustainability and engaging with affected communities.

Meet Our Team

We are inspired by the remarkable stories, deep talent and diverse backgrounds of our global team. Vital Strategies is a global organization of scientists, epidemiologists, designers, communicators, advocates and innovators, supported by experts in operations and finance. We profile our colleagues in an ongoing series we call Vital People. Here are a just a few of the Vital Strategies team members we profiled in 2021. Read more Vital People profiles here.

Technical Advisor, Civil Registration and Vital Statistics

Anushka Mangharam

"You see there is a huge discrepancy among women and girls in civil registration. It can be as unbalanced as nine male deaths to one female death registered in some regions. You are not even given a legal identity just because you were born female."

Read Anushka's Vital People Profile

Deputy Director, Research Grants

Purnima Jolly

"I have been in this line of work for 18 years. When I look at the cause I’m working for it really motivates me. Whatever I am doing, I am facilitating the work for those who are working in the field."

Read Purnima's Vital People Profile

IT Manager, Americas

Garland Brown

"Once I'm really passionate about something, it becomes addictive, and when I don't know something it drives me to figure it out. I apply myself to figure it out."

Read Garland's Vital People Profile

Program Officer, Environmental Health Division

Carisse Hamlet

"It is important to me that we are not taking up space that is not ours to take up in an institutional way. We are sharing the expertise we have, so partners are not reinventing the wheel, and cementing ways for them to access that expertise internally in the future."

Read Carisse's Vital People Profile

Program Associate, Partnership for Healthy Cities

Grace Pickens

“What attracts me to global health is wanting a broader perspective... The health system has historically neglected and excluded many communities—and continues to do so—and being privy to that growing up, with my parents working with communities facing language loss due to displacement, is a big motivator.”

Read Grace's Vital People Profile

Senior Technical Advisor, Brazil

Fatima Marinho

"From the data, I can sometimes easily see the problem below the tip of the iceberg… The problem is not where you see it, it’s usually behind it. If you work with information, you can show the problem and you can do something about it."

Read Fatima's Vital People Profile

Every policy win, every new hire, every resource and every training was the result of the efforts of many, many colleagues and partners working together to improve health for people around the world. In 2021, many team members had a chance to come together when COVID-19 conditions permitted. Here are a few of those moments.

New York
New York
New York

Vital Strategies’ vision for the future is a world where everyone is protected by equitable and effective public health systems. From clean air to traffic safety regulations to access to lifesaving treatment, public health must be seen as an essential common good that touches all facets of our everyday lives.

Health should be for everyone, by everyone. In 2022, Vital is working to make that a reality.

Emboldened and energized by our mission—to work in partnership to reimagine evidence-based, locally driven policies and practices to advance public health—Vital Strategies is expanding our work in 2022. The COVID-19 pandemic has stalled or reversed progress on many longstanding health challenges, but has also led to new openness, awareness and investment in others.

Since its inception in 2004, Vital Strategies’ most sustained and potent work has tackled preventable causes of ill health, such as tobacco, ultra-processed foods and air pollution, and that work continues to expand. Starting in 2022, we are expanding critical work on reducing the adverse health and social effects of alcohol, which causes more than 3 million deaths each year and a tremendous amount of collateral harm to families, communities and economies. Also in 2022, we are expanding our overdose prevention and harm reduction efforts to five more U.S. states: Kentucky, New Jersey, New Mexico, North Carolina and Wisconsin. And our Data Driven Initiative for Women’s Health is accelerating its lifesaving work in Rwanda, Uganda and Bangladesh.

Promoting better health globally is inherently a pursuit toward equity, and in 2022, we are more deeply focused on explicitly understanding and addressing health disparities. Only when everyone has equal access to the drivers of good health will we achieve our vision: A world where everyone is protected by equitable and effective public health systems.

The Partnership for Healthy Cities supported more than 180 health screening events in Lima, Peru.