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SDGs on health needs to go beyond GDP

by Mit Philips | Medecins Sans Frontieres (MSF) - International
Friday, 25 September 2015 17:20 GMT

An MSF staff assists a woman in the maternity ward. South Sudan has the highest maternal mortality rate in the world, at 2,045 per 100,000 live births. Copyright Médecins Sans Frontières.

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

The health goal is buried in the 17 targets, and too vague

Today the UN General Assembly in New York adopted the Sustainable Development Goals, or SDGs, a long list of goals and targets supposed to make the world in 2030 a better place.

Every self-respecting leader was there and hundreds, if not thousands, of VIPs, lobbyists and activists attended the event. Let’s have a look at some of the statements made yesterday.

First the Pope, who reminded us that while the SDGs continue to put all hopes of eradicating the ills of the world – from poverty to violence – on economic growth, “most of us are acutely aware of the need to dethrone GDP growth as the measure of human progress”.

Economic growth is indeed playing an increasingly prominent role in discussions on development, linking a country’s GDP classification to its social and health progress.

This is despite the fact that most of the world’s poorest and sickest people live in countries classified as middle income. As a result, their health needs risk being ignored while the majority of international health aid is allocated elsewhere.

Linking economic growth to health funding will cripple the ability of global health initiatives to remain global and to fight diseases where they claim most victims.

Yes, India may have more billionaires than the UK, but it is also home to a large proportion of the world’s unimmunised children. Many serious public health crises, such as the explosion in multidrug-resistant tuberculosis, occur in countries which fall into the middle income bracket, but which are unable to cope with the financial burden imposed by these diseases.

Without international support, struggling countries are even less likely to meet international health targets and bring the diseases under control.

Yesterday, a group of economists said, ‘Our global society has a vested interest in investing in health’. It’s a welcome statement for the health sector, of course. However, the economic argument raises the question of who better health makes economic sense for, and who stands to gain?

My suspicion is that the focus will be on those with the potential to contribute to economic growth, and money will be rationed to those interventions considered cost-effective.

Is a woman in need of an emergency caesarean living in a remote village in the highlands of Lesotho a good investment opportunity? What about marginalised people, such as sex workers, prisoners or migrants – will they get the same entitlement to healthcare as other people?

Health and healthy lives should have a value in themselves, not just as an interesting economic opportunity.

After a welcome breathing space from 2000 to 2015, when health was seen not as a commodity to be bought with economic growth, but as a public good, we seem to be back at square one.

The SDGs seem to concur with the old premise that health and other sectors will have to wait for the trickle-down benefits of countries’ economic growth.

Key international donors are reverting to the paradigm of the 1980s and 90s, when the major concern about health was "how much does it cost?" and not the cost of suffering of people with little or no access to quality health services, existing medicines or diagnostics.

Buried among 17 goals, health goal number three – “to ensure healthy lives and promote wellbeing for all at all ages” – remains conveniently vague and fails to address the vast inequalities in health provision between and within countries.

The health needs of vulnerable groups, and of people who are stigmatised, discriminated against or excluded from political and health systems, remain hardly visible within the SDG framework. 

A good start for the UN meeting on the SDGs would be to go well beyond GDP classifications and economic growth aspirations. If we are serious about making progress in health, people’s needs should be central from day one.

With the SDG framework now done and dusted, our hopes must rest on what happens next, and what additional resources are mobilised to achieve these ambitious goals. Without real, concrete action to reverse the current trends, the SDGs’ rousing motto – ‘Leave no one behind’ – will pale into just another slogan.


Dr. Mit Philips is Head of Health Access Team, Advocacy and Analysis Unit for Medecins Sans Frontieres/Doctors Without Borders (MSF).