Introduction
Millennium development goal
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Targets
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Progress on specific indicators
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Goal 4: Reduce child mortality
| Reduce by two thirds between 1990 and 2015, the under-five mortality rate | ○ Under 5 mortality decreased by 47% to date (in 2012, 6.6 million children under 5 died; majority of deaths occur in world’s poorest regions). |
○ Neonatal mortality has fallen by a third, but proportion of deaths in first 28 days of life has increased. | ||
○ Proportion of children covered by one dose of measles vaccine increased from 72% to 84% (from 2000–2009); no change past few years. Globally 21.2million infants unvaccinated in 2012. | ||
Goal 5: Improve maternal health
| Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio | ○ Maternal mortality ratio fell by 45% between 1990 (380 deaths per 100,000 live births) and 2012 (210 deaths per 100,000 LB). Proportion of deliveries attended by skilled health workers increased from 56% to 68% in developing countries. |
Achieve, by 2015, universal access to reproductive health | ○ 83% of women in developing countries who see a health worker once in pregnancy increased to 83%, but only 52% have the 4 recommended visits. | |
○ Births to adolescent girls have declined – e.g. from 88 to 50 births per 1000 girls in South Asia, but still 117 births per 1000 girls in sub-Saharan Africa, and 76 in Latin America/Caribbean. | ||
○ Unmet need for family planning declined from 17-12%. | ||
Goal 6*: Combat HIV/AIDS, malaria and other diseases
| Have halted by 2015 and begun to reverse the spread of HIV/AIDS | ○ Number of new HIV infections (adults) declined 38% between 2001 and 2013. |
Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it | ○ In sub-Saharan Africa, 39% young men and 28% young women (aged 15–24 years) have comprehensive knowledge of HIV. | |
○ 12.9 million people globally received anti-retrovirals in 2013. | ||
Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases | ○ Malaria mortality declined 42% between 2000 and 2012. | |
○ 87% of 6.1 million newly diagnosed TB patients received therapy. |
Background
Proposed goal
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Health-related targets
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2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture
| 2.1 by 2030 end hunger and ensure access by all people, in particular the poor and people in vulnerable situations including infants, to safe, nutritious and sufficient food all year round |
2.2 by 2030 end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons | |
5. Achieve gender equality and empower all women and girls
| 5.2 eliminate all forms of violence against all women and girls in public and private spheres, including trafficking and sexual and other types of exploitation |
5.6 ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences | |
6. Ensure availability and sustainable management of water and sanitation for all
| 6.1 by 2030, achieve universal and equitable access to safe and affordable drinking water for all |
6.2 by 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations | |
11. Make cities and human settlements inclusive, safe, resilient and sustainable
| 11.2 by 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons |
16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
| 16.1 significantly reduce all forms of violence and related death rates everywhere |
Means of implementation
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1 | Strengthen implementation of the Framework Convention on Tobacco Control in all countries as appropriate. |
2 | Support research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration which affirms the right of developing countries to use to the full the provisions in the Trade Related Aspects of Intellectual Property Rights agreement regarding flexibilities to protect public health and, in particular, provide access to medicines for all. |
3 | Increase substantially health financing and the recruitment, development and training and retention of the health workforce in developing countries, especially in least developed countries and Small Island Developing States. |
4 | Strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks. |
One goal; nine targets; four means of implementation
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Target 1: “by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births.” This continues the work of MDG 5; maternal mortality has decreased substantially over the past 25 years (Table 1: Progress towards the MDGs), but the current global rate (210 deaths per 100,000 live births) is still off-track for reaching the target [13], and there are significant intra- and inter-country variations [2].
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Target 2: “by 2030 end preventable deaths of newborns and under-five children.” There has been much progress towards MDG 4, reducing deaths in children under 5. While a very large burden remains, the burden of mortality and morbidity has shifted to those infants who die in the first month of life—44% of all under-5 deaths occur at this time [14] —a group that was not specifically recognized in the MDGs [15]. The concept of “ending preventable deaths” in this population has not yet been quantified, but a Lancet Commission highlighted that an under-5 mortality rate of 16/1000 live births should be achievable in most low- and middle-income countries [16] (compared to the current rate in developing countries of 99/1000 live births [2]).
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Target 3: “by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases and other communicable diseases.” This expands substantially upon MDG 6 which only targeted AIDS, tuberculosis (TB) and malaria. Commitments to tackle water-borne diseases, for example, will tackle the 3.6% of the global burden of DALYs associated with diarrhoeal diseases - infections which are particularly burdensome in children and neonates, with half a million deaths per year in this age group [17]. Tackling the neglected tropical diseases will potentially reduce an important source of disability and chronic illness in many regions [18]. From 1990–2010 the burden of most infectious diseases fell, but Years of Life Lost (YLL, a summary measure of premature mortality) due to AIDS and TB rose substantially [19], particularly in low-income countries. The ambition to end communicable diseases is not only in line with efforts to end extreme poverty, but also backed by important political blocs, not least the African Union [20].
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Target 4: “by 2030 reduce by one-third premature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing.” This new target acknowledges the fundamental shift in the global burden of disease towards the NCDs which are responsible for two of every three deaths worldwide [21]. Among the top 20 causes of YLL estimated in 2010, 7 were due to NCDs – including 2 of the top 3 (ischaemic heart disease ranks number 1 and stroke ranks third) [21]. This ambitious target also includes addressing the increasing burden of mental ill-health (depressive and anxiety disorders together account for 3.6% of the global burden of disease [18], and rates of self-harm are increasing and account for 1.5%), and the more nebulous concept of ‘well-being’ – commonly used in public discourse, but with little global agreement on its meaning, measurement or determining factors [22].
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Target 5: “strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” These conditions have a significant impact on health outcomes; particularly alcohol which accounted for 2.7 million deaths and around 4% of all disability adjusted life years lost (DALYs) in 2010 [23]. However, the target addressing “substance abuse” has been given a “poor” rating by the Copenhagen Consensus, and deemed vague and/or not cost-effective [24].
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Target 7: “by 2030 achieve universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” The burden of disease associated with unprotected, unwanted or non-autonomous sexuality is significant: an estimated 12% of couples have an unmet need for family planning; globally there are 500 million new sexually transmitted infections every year [25]; cervical cancer is the fourth most common cause of cancer death among women worldwide [26]; and an estimated 30% of women have experienced physical and/or sexual violence from an intimate partner [27].
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Target 8: “achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” This target represents an important addition to the agenda and has widespread backing from countries and global health institutions. The recent Ebola virus outbreak has highlighted the deficit in strong health systems coverage and access in many countries – systems that will be needed to achieve many of the other SDG targets. The ambition to shift inefficient and unjust out-of-pocket expenditure for health services to financial risk pooling arrangements aims to put an end to catastrophic payments to meet health needs which are estimated to push over 100 million people below the poverty line every year [28]. Vaccines have been identified by most analysts as a ‘best buy’ not only in global health but in development more broadly with benefits estimated at 5–15 times higher than costs [16].
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Target 9: “by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.” In 2010, an estimated 3.5 million deaths (4.3% of global DALYs) were attributable to household air pollution, and a further 3.1 million deaths (3.1% of global DALYs) were due to ambient particulate matter air pollution [17], both ranking in the top 10 attributable risk factors for ill-health worldwide. Less is known about the global health burden associated with water and soil pollution or hazardous chemicals – including risks and intergenerational risks from the nuclear industry.