The countdown has begun for a set of Sustainable Development Goals (SDGs), to be adopted by the United Nations in 2015. These will replace the Millennium Development Goals (MDGs) adopted in 2000, with the expectation of achievement in 15 years. While the MDGs focused on progress in health, education and poverty alleviation to be achieved by the low and middle income countries, the new goals are expected to be universal, calling for action by all countries to integrate actions in multiple sectors within the framework of sustainable development.
Several global consultations held over the last year and the report of a high level panel of eminent persons will inform the UN secretary general’s report, to be submitted to the member states of the UN by September 2013. An inter-governmental negotiation process will then debate the proposals to evolve consensus on the goals to be adopted a year later.
Health accounted for a majority of the MDGs, with targets set for reducing child mortality and the disease burdens of HIV-AIDS, malaria and tuberculosis. This resulted in accelerated global action to improve maternal and child health and led to the launch of the Global Fund for AIDS, tuberculosis and malaria. International financial assistance from high to low income countries was principally guided by these priorities.
Much has changed in the past 15 years, calling for a new set of goals. The global economic downturn that commenced in 2008 has dimmed the prospect of large-scale financial aid as an instrument of international assistance for social development. At the same time, non-communicable diseases (such as heart disease, diabetes and cancer) have come to the fore as a major threat to global health, with a special “high level” meeting of the UN in 2011 calling for an urgent response.
Population ageing and urbanization will further raise the risk of these diseases post 2015. Mental illness, too, will impose a high burden of disability.
Even though some progress has been achieved, several countries will fall short of the MDGs in 2015. Even where national aggregate health indicators have improved, there is evidence of considerable inequity with the poor still very vulnerable to high disease burdens. There is, therefore, understandable advocacy for continuing action on the MDGs even after 2015.
At the same time, concerns related to climate change and the recognition that global food, water and energy systems have to be balanced against the needs of a growing global population without violating planetary boundaries, and endangering our common future, culminate in the call for sustainability as the overarching frame for the post-2015 goals. Health is integrally related to the goals being set for other development sectors and forms the fulcrum of the SDGs.
Since there is likely to be only one goal specifically for health among the SDGs, the two leading candidates at present are Maximizing Health and Well Being At All Ages and Universal Health Coverage (UHC). The former provides the advantage of preserving and accelerating progress on the existing MDGs, while adding non-communicable diseases, mental illness and other disabilities to the actionable areas. The latter will emphasize equity in health services, with financial protection for healthcare as a principal aim. While the call for UHC resonates well with many other global resolutions of recent years, it may exclude action on the social determinants.
The author is president of the Public Health Foundation of India.