Austin Barclay McCullough
The United Nations recently released the Sustainable Development Goals to guide the world’s global development agenda for the next ten years. This successor programme to the old Millennium Development Goals puts much less of an emphasis on public health measures than its predecessor. This is a big mistake, but it also represents the shifting focus of the international development community. The industry is in a state of flux, and the diluted focus of the SDGs reflects the splintering of purposes for development by private corporations, military interests, shifting donor foci, and more.
The Sustainable Development Goals came into effect in September 2015 as a replacement to the MDGs, and constitute the United Nations’ development goals for the next decade. Its 169 targets, divided into 17 broader goals represent a hugely expanded focus from the 21 targets and 8 goals of the MDGs. Some may see this broadened scope as a good thing, but public health initiatives have become much less prominent. Only one goal and 13 sub-targets are health-related. That is, 8% of the SDGs are health-oriented, versus 22% of the old MDGs. The SDG targets are also much less specific in their language, and leave more room for a lax attitude toward attaining these goals.
There is no doubt that we need to keep focusing on public health. According to the US Centers for Disease Control and Prevention (CDC), between 20 and 40 percent of deaths are preventable. Hundreds of thousands of people die every year in the developing world because of treatable causes. We must work to remove the threat of illness and death from people’s lives in the developing world, as it has largely been in the developed world. That will free them up to be able to make long-term plans and work toward a higher quality of life.
There are a number of explanations for the waning support for health goals, including the troubled role of the World Health Organisation in recent years. This once-powerful entity has suffered from a series of critiques about its scope and purpose, misuse of resources, and more. In general, the health-oriented NGOs are in a state of uncertainty. Everyone from the ICRC and MSF to Catholic Relief Services are re-evaluating their purpose and activities as the parameters of development shift. This shifting landscape leaves the field of global public health open for other actors to shape the agenda. Global corporations, private foundations, and vertical health intervention programmes like PEPFAR have all had an undermining effect upon the cohesion of the global health system. Corporations in particular have used this destabilisation to their advantage, promoting programmes under the label of corporate social responsibility that serve to add more consumers to the global market.
This is not to say the United Nations has been bought out by corporate interests in the creation of the SDGs. However, the current ascendence of corporate and private interests in international development has subtly shifted the debate toward micro-enterprise, competition, and ‘innovation’ — to the exclusion of cohesive, concerted goals. Traditional health NGOs cannot assert their vision of a global health regime until they once again establish their sphere.
Overall, the SDGs are a failure. They leave out many of the principles that made the MDGs so great — specific, attainable goals that involved all stakeholders. Increasing the health of the populace is still paramount to development aims. We need global health actors to clearly define their sphere, so we can enact clearer and more attainable goals than what are represented in the SDGs.