Pakistan has emerged as a central diplomatic broker in the conflict between the US and Iran. When announcing a pause to the US operation to guide stranded vessels through the Strait of Hormuz on May 6, Donald Trump said he had made the decision “based on the request of Pakistan”.

The Pakistani prime minister, Shehbaz Sharif, subsequently expressed hope “that the current momentum will lead to a lasting agreement that secures durable peace and stability for the region and beyond”. This latest intervention comes a month after Pakistan secured its biggest diplomatic win in years by brokering a ceasefire in Iran.

But how did Pakistan emerge as the most trustworthy mediator in this conflict, and what drove Islamabad to involve itself? Pakistan’s biggest advantage is that it enjoys relationships with both the US and Iran, which has helped it be seen as a neutral party by each side.

Pakistan has worked with the US in dealing with Iran for decades. Since 1981, two years after the US and Iran severed diplomatic ties following the Islamic revolution, a dedicated section of the Pakistani embassy in Washington has handled Iranian diplomatic affairs in the US.

Pakistan has also worked with the US in mediation efforts elsewhere. Most notably, it facilitated former US secretary of state Henry Kissinger’s secret visit to China in 1971. This paved the way for the normalisation of relations between the US and China later that decade.

Relations between the US and Pakistan have not always been smooth. In 2011, a decade after the 9/11 terrorist attacks, the Atlantic magazine in the US referred to Pakistan as the “ally from hell”. Whether or not it did so knowingly, Pakistan hosted al-Qaeda mastermind Osama bin Laden following the attack.

Trump himself also denied Pakistan military aid during his first term as president, saying it was not doing enough to combat terrorism. And Pakistan’s human rights record, particularly concerning democratic backsliding and restrictions on civil liberties, have at times led to tension with the US government.

However, Pakistan’s relationship with the US has improved markedly in Trump’s second term. Trump, who often uses personal ties to guide US foreign policy, has developed a strong relationship with Sharif and the chief of Pakistan’s army, Asim Munir. In June 2025, Munir was even invited to the White House for a private lunch. This was the first time a US president had hosted a non-head of state military leader at this level.

Pakistan’s recent efforts to court Trump have played a key role in building these ties. Over the past year Pakistan has nominated Trump for the Nobel Peace Prize, joined his Board of Peace and launched a collaboration with his World Liberty Financial crypto platform.

And in July, Islamabad signed a deal with the US to allow Washington to help develop Pakistan’s largely untapped oil reserves. “We read him [Trump] right,” said the former chairman of the Pakistani Senate’s Defense Committee, Mushahid Hussain Syed, in an interview with the Washington Post on April 20.

The relationship between Pakistan and Iran has also been characterised by ups and downs. While Iran was the first country to recognise Pakistan’s independence in 1947, their relationship has often been fraught with tension. This largely stems from Iran’s territorial claim to the Balochistan province of Pakistan, as well as from Pakistan’s ties with Iranian rivals.

As recently as January 2024, tensions between the two countries appeared to be escalating again over Balochistan. However, hostilities soon receded and both countries formally resumed their bilateral ties. They subsequently expanded their security cooperation and invited each other’s ambassadors and foreign ministers for a formal reconciliation ceremony.

Strategic necessity

Some commentators argue that Pakistan’s decision to step in as the primary mediator in Iran has been driven by strategic necessity. Its Balochistan province is currently grappling with an insurgency. Islamabad will thus want to avoid a situation where the Iran war spills into Pakistan, as this could destabilise its border regions even further.

There are also economic reasons explaining Pakistan’s involvement. Pakistan has been severely affected by the disruption to Gulf shipping. It imports between 85% and 90% of its crude oil from Saudi Arabia and the United Arab Emirates (UAE) and almost 99% of its liquified gas from the UAE and Qatar.

Before the war broke out, Pakistan’s economy had been starting to gain momentum. But higher oil prices are now affecting government revenues, increasing its fuel import bill from US$300 million (£220 million) before the conflict to US$800 million now. Pakistan’s authorities have been forced to raise consumer fuel prices by more than 50%.

Pakistan’s agricultural sector, which employs around 40% of the country’s population, is also vulnerable to the conflict due to its reliance on fertiliser imported through the Strait of Hormuz. Prices of urea fertiliser have surged by 50% since the war broke out. Prolonged disruption to the agriculture sector risks plunging some of the most vulnerable people in Pakistan further into poverty.

Remittances are another area that could be affected by a protracted conflict, with as many as five million Pakistani people living in the Gulf region. Pakistan received roughly US$30 billion in remittances between 2025 and 2026, 54% of which came from the Gulf.

If the war continues to affect Gulf economies, many Pakistani workers may be forced to return home. This will cause remittance revenues to fall, depriving Pakistan of a vital source of foreign exchange, while simultaneously pushing up domestic unemployment.

Pakistan’s relationships with the US and Iran put it in a strong position to intervene in the conflict diplomatically. But its mediation has also been a calculated effort to stabilise its borders and protect its economy.

Natasha Lindstaedt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

People in the UK are now spending fewer years in good health than they did a decade ago, according to a new analysis by the Health Foundation. The UK now sits near the bottom of a 21-country comparison, ahead only of the US.

A drop in healthy life expectancy is explained through many causes: obesity, alcohol, drugs, suicide, chronic disease, poverty and widening inequality. But one of the most powerful causes sits atop them all: housing. Where and how people live is one of the main factors explaining how health risks are created and distributed across society.

The UK Housing Review is an annual independent review of housing policy and evidence, written by housing experts and published by the Chartered Institute of Housing. Its latest edition, which we contributed to, identifies several interrelated ways that housing affects health.

A key one is affordability – housing costs shape where people can live, whether they can heat their homes, whether they can afford food and transport, whether they can move for work, whether they can leave unsafe or unsuitable housing and whether they live with chronic financial stress.

In the UK, housing costs are high by historical standards and poor housing remains widespread. The review notes that private rents are now at their highest recorded share of earnings, while millions of homes in England still contain serious health and safety hazards.

When housing is unaffordable, people are forced to make tradeoffs. For example, trading affordability for damp or overcrowded homes. They cut back on heating, food, medication, transport and social participation. They move further from public services, work and support networks. Affordability problems also force many people into cheaper, less secure, tenancies.

Poor housing quality directly shapes health. Cold, damp, mould, disrepair, poor ventilation and unsafe homes are directly linked to respiratory illness, cardiovascular risk, mental health problems and reduced wellbeing.

Read more: Cold homes increase the risk of severe mental health problems – new study

The Building Research Establishment, an independent research organisation, has estimated that poor housing costs the NHS in England £1.4 billion each year. More than half of this is attributed to cold homes, which increase the risk of respiratory illness, cardiovascular problems and poor mental health. They are especially dangerous for older people, babies and people with existing health conditions.

But the wider costs are even greater. Poor sleep, stress, disrupted schooling, insecure work, social isolation and caring strain all affect mental and physical health. They increase pressure on families and, over time, on health, education and social care systems.

Historically in the UK, social housing has provided some protection to people unable to access good quality affordable housing in the open market. But the stock of social rented housing in the UK has declined. This means that people are increasingly dependent on (often expensive) market rental, where the quality, size and location of housing depend much more directly on income.

The rise of the private rented sector this century has meant that more households are exposed, not just to higher housing costs, but also to shorter tenancies and fewer protections than social housing traditionally provided.

The Renters’ Rights Act increases security, but does not remove “no fault” evictions altogether and does little to protect tenants from economic pressures that can result in eviction. The cognitive burden of worrying about eviction, arrears, repairs or the next rent increase is a direct health risk.

Recent evidence also suggests that insecure housing can result in measurably faster biological ageing, equivalent to the effects of more traditional health concerns like smoking.

Additional weeks of biological ageing per year from different factors

The number of people living in temporary accommodation has risen dramatically, reaching over 130,000 households at the beginning of 2025. This is a 156% increase compared with 2010, largely driven by the poor affordability and insecurity of the private rented sector and lack of social housing. Temporary accommodation is inadequate housing, particularly for children. Living in temporary accommodation was a contributing factor in the deaths of at least 104 children in England between 2019 and 2025, 76 of whom were under one year of age.

This is not about housing quality alone. Temporary accommodation reflects multiple risks brought together: poverty, overcrowding, poor conditions, instability, lack of space for safe infant sleep, poor access to services and wider racial and social inequality. The National Child Mortality Database identifies temporary accommodation as a contributing factor to vulnerability, ill health or death, not necessarily as the sole cause. Emerging evidence also links temporary accommodation with stillbirth and neonatal death.

Read more: Insecure renting ages you faster than owning a home, unemployment or obesity. Better housing policy can change this

Housing health inequality

ONS data shows a very large difference in healthy life expectancy between the most and least deprived areas. In 2022-24, healthy life expectancy in the most deprived areas of England was just 49.8 years for men and 48.2 years for women, compared with 69.2 and 68.5 years in the least deprived areas.

Housing contributes to this difference, determining whether people live in homes that support recovery or deepen stress, whether children grow up in stable and safe environments, and whether older people can remain warm and independent.

If the government is serious about its stated aim to “halve the gap in healthy life expectancy between the richest and poorest regions”, housing policy must become health policy.

That means investing in social housing, enforcing decent standards in the private rented sector, making homes warmer, safer and more accessible, and recognising temporary accommodation, overcrowding and insecurity as public health failures, not just housing management problems.

It also means changing the way that success is measured. Housing policy is too often judged by supply numbers, prices or tenure outcomes. These matter, but they are incomplete. A healthy housing system should also be judged by whether people can live in homes that are affordable, secure, decent, suitable and resilient to climate change.

The decline in healthy life expectancy is a warning light. It tells us that the UK is not only failing to keep people well for longer, it is failing to provide the foundations of health.

Emma Baker receives funding from the Economic and Social Research Council, the Australian Research Council, The National Health and Medical Research Council, and the Australian Housing and Urban Research Institute.

Amy Clair receives funding from the Australian Research Council and the Australian Housing and Urban Research Institute.

Mark Stephens receives funding from ESRC, the EU/Innovate UK and the Australian Housing and Urban Research Institute (AHURI).