“There are two loaves. You eat two. I eat none. Average consumption: one loaf of bread per person.” Decades before they had even been envisaged, the poet Nicanor Parra highlighted in this short verse one of the key problems of Millennium Development Goals (MDGs): when it comes to indicators, the devil is in the detail.
While, overall, the outcome of the MDGs has been positive, a more nuanced analysis of the achievements over the last 15 years reveals considerable differences in access to health care between different countries, and indeed, within countries as well. Although progress towards reducing maternal mortality has been positive overall, the results in sub-Saharan Africa fell far short of the mark. For the poorest quintile (20%) of the population and for members of certain disadvantaged ethnic groups, the indicators of access to health care are still alarmingly low. If you are born into a household in the poorest quintile in an African country, your chances of dying before your fifth birthday are multiplied in comparison to those of a child born into the richest quintile.
Inequities of this type, which were not addressed by the MDGs, are contemplated by the new Sustainable Development Goals (SDG) that come into effect in January 2016. One of the SDGs relates specifically to equity and includes targets aimed at reducing economic differences within and between countries. However, disparities in available resources are just a part of the problem: inequity and specific inequalities between different population groups must also be taken into account in the implementation of all 17 goals in this new agenda.
In the case of the goal relating to health, the third SDG, we in ISGlobal are convinced that the only way to ensure that “no one is left behind on the road to progress” and that we can advance towards truly universal health coverage is to make certain that, from day one, the concept of equity underpins all the work on the implementation of the SDGs. This means that specific goals need to be defined for each country to ensure that the poorest groups in the population—the most disadvantaged communities—are not left behind, and that their problems are also addressed by public policy.
India, for example, is one of the countries where socioeconomic inequalities are particularly evident. Tens of millions of obese people live in a society in which four of every ten children suffer from malnutrition. Moreover, the two groups have radically disparate health needs, each requiring specific policies.
In the United States, a baby born to an African American mother is 1.5 to 3 times more likely to die in infancy than one of another race or ethnic group. And in the other countries in the OECD—the club of rich countries—growing pockets of exclusion and vulnerability endanger the “universal” character of our health system as it has been conceived of until now. For this reason, it is fortunate that the SDGs, unlike their predecessors, the MDGs, not only relate to Africa, Asia and Latin America, but are to be applied universally. The new resolution will oblige not just developing countries but also countries like Spain, the United Kingdom and the USA to provide their colleagues at the United Nations with reports on their progress. This broad application of the SDGs is the reason why it is important that each country set its own targets and define specific indicators commensurate with its level of development and index of inequality, going beyond the global targets.
If we are to do this, we must overcome one of the first, and greatest, obstacles to success: the lack of data needed to provide insights into existing inequalities. In many cases, we lack the data needed to even identify the real living conditions of certain social groups, let alone the information we would require to remedy these conditions. Gathering and correcting such data should perhaps be one of the first targets prioritised.
What is certain is that universal access to health care is impossible without first measuring equity. Once, the data is on the table, recipient and donor countries can decide on the best policies to ensure that real progress is made towards a truly sustainable agenda that leaves no one behind. To facilitate this process and to ensure that we can start work on an implementation of the SDGs that takes health equity into account, ISGlobal has organised a seminar entitled Mind the Gap, to be held in Barcelona on 13 and 14 October with the participation of an international panel of experts. During the seminar, participants will analyse the results of the New York summit and define the most urgent initial steps that donors and recipient countries must take immediately.
These new goals offer better guarantees of results than the Millennium Goals, which were largely focussed on the achievement of global targets. They place the political agenda in a framework which, as the name suggests, is more sustainable, designed to protect a greater number of rights and satisfy a greater number of needs. Broadly speaking, the MDGs fulfilled their purpose, which was to change the focus of the international community. Now that this goal has been achieved, the SDGs have to deal with a different challenge: making sure that no one is left behind.