The Sustainable Development Goals (SDGs) were formally adopted in September 2015 and came into effect on 1st of January 2016. The goals are part of a wider agenda for sustainable development: Transforming Our World – the 2030 Agenda for Sustainable Development.
The overall framework for the agenda is based on equity, poverty reduction, human rights, gender equality and empowerment of women and girls. It promotes a people-centered, context-specific, rights-focused approach which is grounded in implementation effectiveness and accountability (Maternal Health Task Force: Post-2015: What’s next for maternal health?). The goals are intended to be relevant for all countries regardless of their ‘income’ status; with an expectation that countries will tailor the targets to the specific health needs of their populations. For example in the USA relevant targets include preventing and treating non-communicable diseases such as heart disease and cancer, promoting mental health and well-being and reducing deaths and injuries from traffic accidents (Columbia University, 2015).
Unlike the previous 2000-2015 Millennium Development Goals (MDG), the development of the Agenda and SDGs was underpinned by high levels of consultation across a wide range of stakeholders. The SDGs have a total of 17 goals and 169 targets(United Nations, website). At the time of adoption a number of targets were yet to be finalised and some lack quantification; only 13 of the 23 health related targets had quantitative thresholds(Murray, C., 2015).
Progression from the MDGs:
Some observers refer to the MDGs in very positive terms, for example as having “brought remarkable success for global collective action (Murray, C., 2015), as having stimulated an investment in improved data collection and use (Lawn et al, 2016) and as having “galvanized attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results” (Buse, K and Hawkes, S., 2015). They are also recognised as “the first set of time-bound global development targets focused on global partnership and human development” and therefore are a platform from which the SDGs can build (Galati, A. J., 2015). However the MDGs are generally recognised as having had mixed success and as being less successful in the area of SRHR. Maternal and child health in particular have been referred to as “unfinished business” carried forward to the SDGs.
The MDGs failed to include mental health despite the overall high rates of prevalence and impact across the globe. Mental health disorders amongst pregnant and post-natal women is a significant challenge which contributes to maternal mortality and morbidity and is strongly associated with other consequences such as poor care giving to infants and children which can lead to them failing to thrive and socio-economic consequences such as the breakdown of relationships and and inability to contribute to household activities, both social and economic. Recent systematic reviews (Rahman, A., 2012) and (Fisher, J., 2011) have identified that the prevalence of perinatal mental disorders is higher in LMICs than in high income countries.
The development and adoption of the SDGs is commonly referred to as a paradigm shift. Key observations include that “the discourse has shifted from health being essential for development, to development being necessary to improve health” and that the transition from MDGs to SDGs will result in the global architecture for accountability for health outcomes becoming more complex (Lawn et al, 2016).
Some key differences between the MDGs and the SDGs include:
- The MDGs focused on improving health in lower-income countries, with the expectation that higher-income countries would help foot the bill (Columbia University, 2015).
- The SDGs are meant to be equally relevant to countries at all different income levels Bennett, S. and Sheikh, K., 2015).
- The MDGs focused on mortality (Lawn et al, 2016) and percentage-decline targets where the SDGs show a shift to absolute thresholds, with a resulting greater focus on cross-country inequalities (Murray, C., 2015).
- The SDGs are recognised as having been the result of transparent and consultative processes which, included public consultation.
- The SDGs emphasise the urgent need for increased equality everywhere (Chou, D. et al, 2015) and acknowledge the importance of sustainability and “expansive approach involves all sectors of society and a host of topics, including ending hunger, promoting access to efficient energy sources, enhancing economic growth and employment, promoting health and well-being, and achieving gender equality” (Galati, A. J., 2015).
- The SDG framework explicitly recognises how integrally important enhancing SRHR is to achieving the larger goals (Galati, A. J., 2015).
- The SDGs include mental health which was not included in the MDGs despite the overall high rates of prevalence and impact across the globe. Mental health disorders amongst pregnant and post-natal women is a significant challenge which contributes to maternal mortality and morbidity and is strongly associated with other consequences such as poor care giving to infants and children which can lead to them failing to thrive and socio-economic consequences such as the breakdown of relationships and and inability to contribute to household activities, both social and economic.A 2012 systematic review (Rahman, A., 2012) showed the prevalence of these disorders in women from LMICs to be 15.6% in pregnant women and 19.8% in women who had recently given birth. In comparison, a 2011 systematic review (Fisher, J., 2011) showed that approximately 10% of pregnant women and 13% of those who have given birth in high income countries were affected by a mental disorder.
The SDGs and health:
While there is only one goal for health, the longer list of health-related targets is seen as reflecting a broader health agenda than the previous MDGs (Murray, C., 2015). Targets exist for a range of infectious-diseases, non-communicable diseases including mental health and substance abuse, road traffic accidents, disasters, and universal health coverage (UHC).
The health goal is within the context of UHC which is seen by the UN as having the potential to be transformative in increasing equity (Barredo, L. et al, 2014). The SDGs “provide a framework for universal health coverage described by three, interlinked objectives—enhancing the quality and availability of essential health services; achieving equitable and optimal uptake of services in relation to need; and improving cost efficiencies and financial protection” (Chou, D. et al, 2015).
- Maternal Health Task Force, Post-2015: What’s next for maternal health? (website)
- Columbia University, (2015) A Critical Thinker’s Guide to the UN’s Sustainable Development Goals
- United Nations, (2015) Sustainable Development Goals (SDGs) (website)
- Murray, C., (2015) Shifting to Sustainable Development Goals — Implications for Global Health
- Lawn, J. E. et al, (2016) Stillbirths: rates, risk factors, and acceleration towards 2030
- Buse, K. and Hawkes, S., (2015) Health in the sustainable development goals: ready for a paradigm shift?
- Galati, A. J., (2015) Onward to 2030: Sexual and Reproductive Health and Rights in the Context of the Sustainable Development Goals
- Bennett, S. and Sheikh, K., (2015) How the new global goals can help drive systems to address health challenges better
- Chou, D. et al, (2015) Ending preventable maternal and newborn mortality and stillbirths.
- Barredo, L. et al, (2014) Goal 3—The SDGs and a Healthier 2030
- Fisher, J. et al, (2011) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review
- Rahman, A. et al, (2012) Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis