Antimicrobial resistance and social inequity: Why the one health approach must centre poverty

Antimicrobial resistance (AMR) is one of the most consequential threats to global public health. In 2021, bacterial AMR was associated with an estimated 4.71 million deaths globally, including 1.14 million directly attributable to resistance. Yet, despite its designation as a global emergency, policy responses remain heavily focused on surveillance, antimicrobial stewardship, diagnostics, and pharmaceutical innovation. These interventions are necessary but insufficient without sustained action on the social and structural conditions shaping infection exposure, access to care, and antibiotic use. This commentary argues that the One Health framework, as currently operationalised, does not sufficiently centre poverty and structural inequality as core determinants of AMR. AMR is shaped by overcrowded living conditions, inadequate water and sanitation, disrupted health systems, weak diagnostic infrastructure, gender inequities, and unreliable access to quality-assured medicines, disproportionately affecting low- and middle-income countries (LMICs). We propose four linked policy directions: aligning national AMR action plans with the Sustainable Development Goals; integrating socioeconomic disaggregation into AMR surveillance; reforming international financing to expand fiscal space for health, WASH, and diagnostics; and embedding communities as co-designers of stewardship and governance. A justice-oriented One Health approach is essential to translate global AMR commitments into equitable and durable action.