Where is “Health” in the Sustainable Development Goals?
22 Jan 2016
In September 2015, the Sustainable Development Goals (SDGs) were adopted with much pomp. From world leaders through to pop stars everyone hailed the adoption as a ‘truly defining moment’ in human history. Personally, I was also thrilled because finally we had truly global goals. Unlike the MDGs, the SDGs were for everyone, no dichotomy, no distinction, goals for all humanity one might add.
I have heard arguments though that health has been “diluted or diffused” in the SDGs. This is because compared to the Millennium Development Goals (MDGs) which had 3 (MDG, 4, 5, 6) out of the 7 goals geared towards health, the SDGs have only one goal (Goal 3) out of the 17 goals that talks directly about health. I am however of this opinion: not only can we see health in almost all the 17 goals (personally I counted 12 out of the 17 goals), but also the SDGs provide us with the opportunity to work together to consolidate gains made in health over the past decade.
Consider SDG 1, to end poverty in all its forms. Poverty and health are intimately linked. For instance, a poor mother is less likely to know of and access maternal health services and thereby more likely to suffer negative birth outcomes. Poverty affects a girls’ education which ultimately affects her health outcomes. This is because educated women tend to be healthier, more economically empowered, have smaller family sizes and can generally provide better health for their children. Further, teenage pregnancies accompanied by its attendant health problems, is more pronounced in poorer communities. The nexus of child health and poverty are well documented. Children growing up in poor settings are more prone to infant mortality, developmental delays, malnutrition, etc. Spare a thought too, for the 17 Neglected tropical diseases (NTDs) such as yaws, leprosy and onchocerciasis that still plague millions because they are just that -diseases of neglect and poverty. So by addressing poverty, the cause of ill health in these situations, we would make huge inroads in improving the health of populations.
Goal 6 aimed at ensuring clean water and sanitation, is also a ‘health goal’ by all accounts. UNICEF highlights malaria, cholera and diarrhea as diseases of poor sanitation. According to WHO, in 2013, an estimated 437 000 African children died before their fifth birthday due to malaria and more than one in ten deaths of children is due to diarrhea. How many of these deaths could have been averted by clean water and sanitation, your guess is as good as mine!
Thus, it very clear that until we address the social and structural deficiencies that cause ill health, or what is often referred to as the social determinants of health we would not be able to meet the ambitious targets set out in the SDGs. This approach means that we look at the underlying causes of ill health as opposed to merely treating the presentation of ill health.
We learn to look beyond our individual mandates to see how we can work across sectors, adopting a multisectoral approach to health. An approach championed by UNDP and premised on the fact that actions outside the health sector have as much effect on improving health outcomes as the health sector itself. This thinking is what underpins UNDPs work in promoting enabling legal environments for HIV responses, improving access to medicines through the use of TRIPS flexibilities or competition law and combating Non Communicable Diseases.
Thus, instead of seeing it as a narrowing of health goals in the SDGs, we should see the so called ‘diffusion’ as a good thing. It is an opportunity for all of us to come to the table as it were, irrespective of our core mandates, to see health in all we do, to do things un-usual, because as it is often said just as health shapes development, development shapes health.