The United Nations is developing a list of Sustainable Development Goals (SDGs), which are intended to guide efforts to reduce poverty and improve health and well-being in all countries by 2030 while protecting the planet. One of the 17 goals – goal number 3 – relates to health: “ensure healthy lives and promote well-being for all at all ages” (1). The SDGs will replace the current Millennium Development Goals (MDGs), which end in 2015.
The International Epidemiological Association (IEA) and the World Federation of Public Health Associations (WFPHA) sponsored joint sessions on the SDGs, both at the IEA World Congress of Epidemiology in Anchorage, USA, in August 2014 and at the WFPHA World Congress of Public Health in Kolkata, India, in February 2015. Both sessions focused on the need for measurable, reliable health indicators for the single health-related SDG.
The current draft of SDG3 (for health) includes 13 sub-goals and many health indicators. In 2012 the IEA spearheaded discussion of the issues by posting a position paper suggesting life expectancy as an appropriate indicator (2). It argued “how long people live for is an easily understood concept, which accounts for the multiple determinants of health and disease”. The WFPHA endorsed the IEA position paper in 2013.
In September 2014, the IEA/WFPHA position was elaborated upon by a group of scientists who proposed “avoiding 40% of the premature deaths in each country” as an overarching target for the SDG3 on health. The report of an expert consultation at the World Health Organization in December 2014 reached similar conclusions:
“In order to permit monitoring of progress, an overarching summary health indicator is required as well as indicators for the sub-goals. The overarching health indicator is also a measure of progress in other SDGs as health is influenced by economic, social and environmental determinants, and should contain an equity dimension. Even though healthy life expectancy would be the preferred measure, globally comparable data can currently only be generated for a summary measure of mortality, such as life expectancy or number of deaths before age 70.”(4)
One of main strengths of the MDGs, which greatly contributed to their success, was that there were only eight goals, each one with a clear overarching indicator. The current draft for the SDGs is confusing, with too many sub-goals and poorly defined targets and indicators (5). The importance of specific exposures, such as childhood immunization, HIV infection or smoking, each of which can have a major effect on health, varies from one population to another. It will be impossible to hold countries and the international community accountable for progress in health, or lack thereof, without an overarching goal that is sustainably measurable and relevant in all countries.
Both the IEA and the WFPHA strongly support the position of the World Health Organization consultation, which is in line with our earlier statements and the consensus from our joint meetings. We need an overarching health goal that is reliably measured in all countries and that includes all-causes of death at every age, i.e. how long people live and the number of premature deaths avoided. Within such a goal greater gains are needed among the most disadvantaged populations, both between and within countries, to reduce the inequality gap.
References
- https://sustainabledevelopment.un.org/sdgsproposal
- Victora CG, Buffl er P, Ebrahim S, et al. A position paper by the International Epidemiological Association. http://www.worldwewant2015.org/node/292903
- Norheim OF, Jha P, Admasu K, Godal T, Hum RJ, Kruk ME, et al. Avoiding 40% of the premature deaths in each country, 2010-30: review of national mortality trends to help quantify the UN Sustainable Development Goal for health. Lancet. 2014.pii: S0140-6736(14)61591-9. doi: 10.1016/S0140-6736(14)61591-9.
- World Health Organization: Monitoring framework for the post-2015 health goals of SDGs: Targets and Indicators. Geneva: WHO, February 09, 2015.
- Stokstad E. Sustainable goals from UN under fire. Science 2015: 247,702-3