an interdisciplinary perspective on global health and the sdgs - prof. sir andy haines

Global Health and the SDGs – an interdisciplinary perspective

Andy Haines

Progress on the Millennium Development Goals --% improvement in relation to targets for selected indicators (100% means target is met)

Country progress in reducing

under-five mortality (MDG4)

24

37

18

0

10

20

30

40

On Track Insufficientprogress

No progress

Nu

mb

er

of

Co

un

tdo

wn

Co

un

trie

s

(n=

74)

African Countries

Eritrea

Ethiopia

Liberia

Malawi

Tanzania

Countdown to 2015, report June 2012, Figure 3, progress updated for 2012

estimates

28 are African

countries

49% in

Africa

All are African

countries

Millennium Development Goals – despite the successes there were limitations

1. Around half of current MDG indicators not reported by many countries

2. Fragmented approach--nothing on inequalities, access, NCDs, injuries, human rights

3. Limited focus on environmental health

4. A top-down process with main focus on low income countries

17 goals and 169 targets

Synthesis report of the UN Secretary General

Indicators

Management tool for countries

‘Report card’

Invest in national statistical systems, household surveys, Big Data, remote sensing

Allow for disaggregation e.g. spatially, socioeconomically, gender, age etc.

Data for Core indicators should be widely available, reliable, good coverage etc

Development of indicators-- UN

Statistical Commission Of the 304 proposed provisional

indicators, 50 indicators (16 per cent)

were evaluated as feasible, suitable

and very relevant (rating AAA)

39 indicators (13 per cent) received

the rating BAA, meaning that those

indicators were considered only

feasible with strong effort, but suitable

and very relevant

‘Health is a precondition for and an outcome

and indicator of all three dimensions of

sustainable development.’

Global Burden of Disease 2010

12Lim et al 2012

1.1 By 2030 eradicate extreme poverty for all people

everywhere (less than $1.25 a day )

1.2 reduce at least by half the proportion or people at all ages

living in poverty according to national definitions

1.3 Implement nationally appropriate social protection systems

Childhood (<5) Stunting de Onis M, et al. (2013);

64

36

20

80

Percentage change in yields to 2050

-50 -20 0 +20 +50 +100

UN Devt Prog, 2009

Plus climate-related:

• Flood/storm/fire damage

• Droughts – range, severity

• Pests (climate-sensitive)

• Infectious diseases (ditto)

CLIMATE CHANGE: Poor Countries Projected to Fare Worst MODELLED CHANGES IN CEREAL GRAIN YIELDS, TO 2050

End Hunger, improve nutrition –potential indicators

% below minimum dietary energy (MDG)

% lacking essential micronutrients (tbd)

% Stunting in children <5

% Obesity/Overweight ( also integrates physical activity)

Household Dietary Diversity score (tbd)

A focus on Universal Health Coverage

Historical background:

Alma Ata Declaration of 1978

2005-12: all nations have

made the commitment to

achieve universal health

coverage

"everyone should have

access to the health

services they need without

risk of financial ruin or

impoverishment"

Health Care- selected targets OWG goal 3

₋ Achieve universal health coverage (UHC) including financial protection and family planning

₋ Maternal deaths: Target MMR of 70/100,000 live births (Lancet, UNICEF)

₋ Child mortality/infant mortality: End preventable deaths

₋ End epidemics of HIV/AIDS, TB, malaria, water-borne and neglected tropical diseases

₋ Non-communicable disease mortality: Reduce by one third

₋ Mental Health

Life expectancy – widely available but slow to respond and does not assess health.

Healthy Life Expectancy

– less but increasing availability.

More holistic ( indicator 32)

The Economist

Integrating health indicator

6.1 Achieve universal and equitable access to safe and affordable drinking water

6.2 Achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation (modified MDG indicators urban/rural)

6.3 Improve water quality by reducing pollution....and increasing safe reuse by x% globally

By 2030, ensure universal access to affordable, reliable and modern energy services

modern cooking indicator 55

access to reliable electricity indicator 56

deep decarbonization strategy indicator 82

Estimates of air pollution deaths ( WHO 2014, Lim et al LANCET 2012 ;380;)

Ambient particulates

~3.7 m deaths p.a.

Household from solid

fuels ~4.3 m deaths p.a.

Around 7 million in total

Tropospheric Ozone

~ 150 k deaths p.a.

Health and Environment, IGU Warsaw

2014 28

Halve deaths from road injuries /100000 pop

Mean urban fine particulate air pollution levels

Proportion of urban journeys/ km by public transport/ walking or cycling.

Urban green space per capita

Housing Goal 11.1 2030, ensure access for all to

adequate, safe and affordable housing and basic services, and upgrade slumsProportion of population in slums/informal settlements. indicator 72

http://laughingsquid.com/biolite-clean-burning-wood-fired-

stoves-that-generate-electrcity/solar-aid.org

www.gatesfoundation.org

Disasters OWG Goal 11.5

by 2030 significantly reduce the number of

deaths and the number of affected people

and decrease by y% the economic losses

relative to GDP caused by disasters,

including water-related disasters, with the

focus on protecting the poor and

vulnerable .

13.1 Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters

mobilizing $100 billion annually by 2020 to address the needs of developing countries for mitigation actions.....

Criticisms of the SDGs

ICSU/ISSC•Lack of hard quantitative language.

•Lack of integration - goals presented in ‘silos.’

Danger of trade offs e.g. between overcoming

poverty and moving towards sustainability.

•“The ‘ultimate end’ of the SDGs in combination

is not clear, nor is how the proposed goals and

targets would contribute to achieve that

ultimate end,”

Recommended meta-goal be “a prosperous,

high quality of life that is equitably shared and

sustained.”

Figure

The Lancet Global Health 2015 3, e251-e252DOI: (10.1016/S2214-109X(15)70112-9) Copyright © 2015 Waage et al. Open access article published under the terms of CC BY Terms and

Conditions

Framework for examining interactions (Waage et al Lancet Global Health 2015)

Interdisciplinary research linking health, development and sustainability should-Address policies that:

reduce environmental change and improve health

( heath co-benefits)

and/or increase resilience of populations to adverse environmental conditions

reduce inequities and address socio-economic determinants

http://www.usclimatenetwork.org/climate-change-101/Climate-Risks-and-Preparedness