September 2015 is the deadline for the eight Millennium Development Goals (MDGs) the world agreed on in 2000.
MDGs and SDGs
Based on the 2014 report, it seems several MDG targets will be met. These includereduction of extreme poverty, the fight against malaria and tuberculosis, access to improved drinking water, and the reduction of disparities in primary school enrolment between girls and boys. However, for others targets it seems unlikely that they will be met despite the progress that has been made. These targets include to reduce hunger, chronic under nutrition in infants, child mortality, maternal mortality, antiretroviral therapy access, access to improved sanitation, enrolment of children in primary school, and progress in environmental sustainability.
Although not all goals and targets have been reached, the MDGs have been exceptionally successful in uniting the world in a set of priorities and actions. As the MDGs are nearing their deadline, the “Post-2015 Development Agenda” is currently being prepared. The Sustainable Development Goals (SDGs) will be at the core, and a proposal for 17 SDGs from the Open Working Group was published in July 2014.
Process of the SDGs
The process to develop the SDGs was more inclusive than that of the MDGs. The MDG process was critiqued for not involving all stakeholders sufficiently, especially from low- and middle income countries. More voices were heard this time and not only of governments and civil society. Also people living in this world could have their voices heard for example through the “The World We Want” platform. The SDGs should therefore represent a set of (development) priorities, which includes health.
Interviews with Global Health experts
With Ding-Cheng (Derrick) Chan, fellow “Young Global Health Forum Working Group member” (as the group of Young Gasteiners and Young Taiwanese were called at the Taiwan Global Health Forum) I interviewed three (global) health experts who attended the TWGHF. Our interviews started with the same question: “If you had to choose three Global Health priorities, what would they be?”
And guess what? We got very different priorities.
Prof. Ilona Kickbusch, Director of the Global Health Program at the Graduate Institute of International and Development Studies in Geneva, listed global health governance, global inequity, and commercialization of health. Mr. Michael Moore, Vice President/President Elect of the World Federation of Public Health Associations and CEO of the Public Health Association in Australia, prioritizednon-communicable diseases, social determinants of health and health advocacy.Dr Margaret Mungherera, psychiatrist in Mulago National Referral Hospital in Kampala, Uganda and the immediate past-president of the World Medical Association, selectedmental health, sexual and reproductive health and primary health care.
“Crazy quilt” of priorities?
In one of the TWGHF talks the term “crazy quilt” was used to describe the US health care system. After having read and heard much about the post-2015 Development Agenda process and having conducted these three interviews, I wonder if we do not face a similar “crazy quilt” of the outcomes of the Post-2015 Development Agenda and the SDGs. The current draft proposes 17 SDGs and 169 targets. Yes, you read it well: 17 SGDs, 169 targets proposed, and actually even more indicators. This is many more than the comprehensive 8 goals and 18 targets of the MDGs. Although the SDGs ambition is different from the MDGs in that it 1) is applicable to both developed and developing countries and 2) it tries to incorporate the climate change and sustainability agendas, it is a much more difficult message to communicate.
How is health faring in the SDGs?
Quite a few of the health experts we talk to during the conference were worried that health was not sufficiently addressed in the SDGs. Where in the MDGs three out of eight goals were clearly health related (MDG4 to reduce child mortality, MDG5 to improve maternal health, and MDG6 to combat HIV/AIDS, malaria and other diseases), the SDGs only have one health goal (SDG3 Ensure healthy lives and promote well-being for all). Personally, I am not so worried about “only having one goal”. If we assess the SDGs on how they link to health, “we” do not have one goal – as nearly all goals will improve the health and wellbeing of people. Poverty, hunger, (women’s) education, gender equality, water and sanitation, economic growth and employment, infrastructure, inequities within countries, climate change, peaceful societies with accountable and inclusive institutions, better land/ocean/forest/etc conservation management, and others, all have an impact on health and wellbeing. In fact, many of these are part of the social determinants of health, or the “causes of the causes” and it seems a great opportunity for health advocates to reach out, and find the connections with other sectors relevant for health and wellbeing.
I am worried, however, about the complexity of the message that needs to be communicated with the proposed SDG framework. This month the UN Secretary General’s Synthesis Report is expected in which he synthesizes all the various activities of the Post-2015 process. I hope he, and the intergovernmental negotiations that will commence after, will be able to present an ordered crazy quilt of priorities that will help the world to unite and work on the future we want.
Joyce Browne (Young Forum Gastein scholar) is a medical doctor (2013) and studied Epidemiology at University College London (2009), with a focus on social determinants and international health. She is currently a PhD student in Global Health at the University Medical Center Utrecht, the Netherlands.