UN agencies emphasized the importance of improving countries’ health systems, with a view to achieving the Sustainable Development Goal on good health and well-being (SDG 3), in the lead up to the consideration of implementation of SDG 3 by the 2017 session of the High-Level Political Forum on Sustainable Development (HLPF). In preparation for the review, a UN Expert Group Meeting (EGM) convened from 15-16 June, and the UN system published a thematic review of the status of implementation. Further, the World Health Assembly considered progress on health-related targets at the seventieth World Health Assembly held in Geneva, Switzerland, from 22-31 May.
SDG 3 identifies many priorities for the international community, including action on sexual and reproductive health, maternal and child health, non-communicable diseases such as heart disease and diabetes, environmental diseases, and access to medicines and vaccines. The EGM, UN thematic review, and World Health Assembly identified similar priorities and recommendations. The EGM recommended addressing equity concerns, taking integrated approaches, promoting health in high-risk situations, and improving countries’ ability to track health-related data. The ‘2017 HLPF Thematic Review of SDG3: Ensure healthy lives and promote well-being for all at all ages’ (thematic review) highlights the rise of antimicrobial resistance (AMR) and the need to address mental health issues as emerging, global health issues.
The thematic review highlights the rise of antimicrobial resistance (AMR) and the need to address mental health issues as emerging, global health issues.
Expert Group Meeting (EGM): The World Health Organization (WHO), the UN Department of Economic and Social Affairs (DESA), the UN Children’s Fund (UNICEF), the UN Foundation, and the UN Population Fund (UNFPA) collaborated on organizing the EGM. A concept note prepared for the meeting highlighted the broad scope of SDG 3 and noted that universal health coverage will be an important driver for achieving the Goal. The note refers to the “unfinished business of the MDGs,” stating that there needs to be more progress in reducing maternal, newborn and child mortality, improving nutrition, ensuring universal access to sexual and reproductive health, and combating noncommunicable diseases (NCDs), sexually transmitted diseases (STDs) and neglected tropical diseases (NTDs).
The EGM outcome highlighted four priorities for action: the economic and social determinants of health; multi-sectorial approaches; high-risk situations, including conflicts and disasters; and data. Participants noted that the economic and social determinants of health can be influenced by addressing issues of social justice. They pointed out that health outcomes can be improved by action in sectors such as education, nutrition and ecosystem health. Changing demographics influence the health status of populations, so the situation of migrants and refugees, as well as the needs of aging populations, should be considered in health planning. Data systems should be strengthened and owned by countries.
Thematic Review: The UN system’s thematic review of SDG 3, published in the lead-up to the HLPF, recommends taking a human-rights approach to health challenges, including strengthening health systems, ending violence against women and girls, and ensuring water, sanitation and hygiene (WASH) services for all. The authors call for investing in health services personnel, and making more use of information communications technology (ICT) for patient support and communication between health personnel and patients.
They also call for adopting social protection policies that include migrants and displaced communities. They highlight that countries have benefited from capacity building under the Millennium Development Goals (MDGs) framework to strengthen data and reporting, and that continued support to improve capacity for managing health data is needed. They recommend promoting partnerships among UN and other development organizations, such as the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, and a Special Program for Research and Training in Tropical Diseases.
The thematic review also highlights the need to address emerging issues that are not fully captured in the 2030 Agenda for Sustainable Development. These include the rise of antimicrobial resistance (AMR), and the need to address mental health issues alongside physical health. Global spending on mental health is currently less than US$2 per person a year, and less than 25 cents in low-income countries.
How the World Has Fared: The UN thematic review provides an overview of health achievements to date. The world is far from ending maternal mortality, with more than 300,000 deaths in pregnancy or childbirth occurring annually. On current trends, the rate of reduction would have to improve by at least 7.3% – three times the rate of improvement between 1990-2015. Having trained midwives is shown to be an important factor in improving the survival rates of women in pregnancy and childbirth.
Some improvements to the survival rate of children under 5 have been achieved, but newborns are doing less well than others. The worst-performing countries are those in sub-Saharan Africa and South Asia. Children from poor households are twice as likely to die before their fifth birthdays.
National programmes to arrest the spread of HIV/AIDS have been successful, with the incidence of infection among children under 15 declining by 59%. However, young women are now the highest-risk group. Tuberculosis (TB) is still a major health problem, and this challenge has been exacerbated by the rise of multi-drug-resistant TB. Among the regions, Europe has the highest rate of drug-resistant TB, and is home to over 20% of the world’s cases. Malaria and hepatitis continue to be major health issues for many countries.
NCDs are also a growing problem, causing 40 million deaths in 2015. The top NCDs are heart disease, cancer, chronic respiratory disease, and diabetes, in that order. Pacific Islanders have highest risk of dying from an NCD, while Australia and New Zealand have the lowest risk.
Deaths from injury most often occurred in road accidents, and second-most often from suicide. The suicide rate is much higher among men than women. Deaths from suicide are highest in Europe, and lowest in Eastern Mediterranean countries. Road deaths are highest in sub-Saharan Africa. North America, Europe, Australia and New Zealand are far below the global average; however, no region is on track to meet the SDG target of a 50% reduction in mortality by 2020.
On sexual and reproductive health, Least Developed Countries (LDCs) made a lot of progress, improving their access to modern family planning methods from 29.3% in 2000 to 57.1% in 2017. There are fewer adolescent pregnancies than previously, with South Asian countries successfully dropping their teen pregnancy rate by 50%, against the global average of 21%. Sub-Saharan Africa is projected to be the next hotspot for adolescent pregnancies, based on current trends.
Indoor air pollution from using unclean cooking fuels accounted for 4.3 million deaths a year, by far the leading cause of death from environmental factors. Air pollution is linked with NCDs, including heart disease, stroke, respiratory ailments and lung cancer. By comparison, deaths from unsafe drinking water and lack of sanitation and hygiene facilities accounted for about 0.9 mil people in the same year (2012), and deaths from unintentional poisonings due to exposure to hazardous chemicals accounts for around 108,000 deaths a year.
The reviewers highlighted that medical research and innovation is not geared towards the health needs of people in developing countries. They estimate that as little as 1% of health research funding is directed at diseases mainly prevalent in developing countries.
Health-related impacts of migration and mobility are also hardly addressed. Population movements have implications for the spread of disease and the emergence of pandemics, and migrants and refugees often do not have access to health services. The thematic review highlighted the need to address population movements and emergency preparedness from the perspective of global health security.
World Health Assembly 2017: WHO issued a report on ‘Progress in the implementation of the 2030 Agenda for Sustainable Development’ for consideration by the World Health Assembly. The report notes that many countries are unprepared for health emergencies, and data tracking continues to be an issue. More than half of all reported deaths do not provide complete information about the cause of death, and many countries do not collect the data that is needed for monitoring progress towards SDG indicators and targets. WHO highlighted the experience of Bhutan as an example of progress in national planning for NCD interventions and primary health care.
Separately, many NGOs are taking action on specific areas. The international NGO CBM, supported by the Government of Australia, is working to prioritize and de-stigmatize mental health issues in five countries in West Africa and, through a partner organization in Tanzania, is seeking to ensure women with disabilities have access to maternal and child health services.
Interactions among SDG 3 and other SDGs: SDG 3 links with many other SDG targets, for example, on malnutrition (target 2.2), education (4.1), early childhood development (4.2), ending violence against women and girls (5.2), ending female genital mutilation (5.3), universal access to sexual and reproductive health and rights (5.6), drinking water (6.1), sanitation (6.2), clean energy (7.1), science research (9.5), air quality and municipal waste (11.6), resilience to natural disasters (13.1) and reducing violence and related death rates (16.1). The International Council for Science (ICSU) has published a guide to SDG interactions, discussing these links in detail.
The HLPF 2017 is convening under the theme ‘Eradicating poverty and promoting prosperity in a changing world.’ The other SDGs under consideration are no poverty (SDG 1), zero hunger (SDG 2), gender equality (SDG 5), industry, innovation and infrastructure (SDG 9), and life below water (SDG 14). SDG 17 on partnerships for the goals is reviewed at every HLPF session. [EGM Event Listing] [EGM Concept Note] [UN Summary of EGM Outcome] [2017 HLPF Thematic Review of SDG3: Ensure healthy lives and promote well-being for all at all ages] [WHO Press Release on World Health Statistics 2017] [Chapter on SDG 3 from ICSU publication ‘A Guide to SDG Interactions’] [Report ‘WHO Reports on Progress in Implementing 2030 Agenda’]
This brief has drawn on reporting by SDG Knowledge Hub colleagues, including Faye Leone and Leila Mead.