A Healthy Mind in a Healthy Body: Towards universal healthcare

Written By Arvind Ravikumar

The third Sustainable Development Goal (SDG3), as adopted in the 2015 UN General Assembly meeting, strives to “ensure healthy lives and promote well-being for all at all ages” by 2030. There are nine targets specified under this goal that can be broadly classified into four categories: (1) decreasing maternal and child mortality, (2) reducing the incidence of diseases, (3) reducing human-caused mortality including substance abuse and road-traffic incidents, and (4) expanding access to affordable health care. Compared to prior efforts, SDG3 provides renewed focus on issues like substance abuse, mental health and affordable health-care for all – issues that affect the developed world as much as the developing world. The SDG3 builds on and expands the health-focused millennium development goals that were adopted in 2000. Indeed, the world community has made significant progress in reducing child mortality, maternal mortality, access to reproductive health, and reducing the incidence of HIV/AIDS and tuberculosis. However, many of these reductions are far from the targets established in the MDGs – for example, maternal mortality has reduced from 386 deaths per 100,000 live births in 1990 to about 216 in 2015, significant but far short of the target of 70 maternal deaths per 100,000 live births. More importantly, progress has been uneven, especially across the poorest and the most disadvantages populations in the world.

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Worldwide maternal mortality rate: Number of maternal deaths per 100,000 live births (Source: Wikipedia)

Progress toward any of these goals is only as good as the monitoring mechanisms in place. In this context, the SDGs differ markedly from the last decade’s MDGs because of the development of sustainable development goal indicators – these ‘indicators’ refer to various statistical health data that track progress and keep various countries accountable. A thorough global database on these specific indicators and other metrics is already available. And that highlights one of the major problems in all global development goals – the lack of institutional support and robust data collection from many regions (especially in parts of Oceania, and sub-Saharan Africa) hinders any attempt to track progress. Lessons from other global governing bodies like the World Trade Organization (WTO) could help – one way would be to develop regional expertise within the UN to help developing countries better monitor their efforts.

This goal to improve health outcomes through specific and measurable targets might make the issue seem tractable. However there are important challenges in the years ahead that are exacerbated by globalization and improved mobility. For example, road-accident related fatalities have been increasing in the developing world because of economic development. Record numbers in global mobility will simultaneously increase the risk of spawning epidemics like Ebola or Zika, which would demand a robust and rapid global response to contain its spread. The rapid urbanization in developing countries like China and India will further strain urban infrastructure – without massive investments, urban pockets are in danger of becoming hot beds for water-borne and other communicable diseases. And finally, the recent uptick in global conflicts has resulted in over 60 million people being displaced – a number not last seen since World War II. Any global effort to improve health-care will need to be coordinated with other goals that directly affect health outcomes.

While there are many targeted policies that will directly influence healthcare and wellbeing, it would be naïve to assume that improving global health standards is not dependent on progress across many of the other SDGs. For example, access to clean water and improved sanitation (SDG #6), especially in rapidly developing urban areas in Asia and Africa, can significantly reduce the incidence of many communicable diseases. A growing body of research also show that the physical and social environment (SDG #11) can influence the life expectancy at birth – such stark differences can even be seen in the developed world. Recent experiences in reducing the prevalence of AIDS or improving access to reproductive health-care have shown how unequal progress has been – big gaps exist between the poorest and the richest households, between men and women, and between rural and urban regions. Progress even in regional health outcomes would be strongly tied to success in reducing inequalities (SDG #5, #10) and increasing girls’ educational attainment (SDG #4).

Ultimately, the biggest test for the success of any of these programs comes in the form of investments required – capital to the tune of trillions of dollars will have to be mobilized over the next 15 years, largely through public finance and aid. Recent rounds of talks have ended without any concrete commitments in the part of the developed nations. It is not yet clear if equitable mechanisms to fund massive improvements in infrastructure and health-care initiatives across large parts of sub-Saharan Africa and Asia will be available.

 


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Arvind graduated with a PhD in Electrical Engineering from Princeton University in 2015 and is currently a postdoctoral researcher in Energy Resources Engineering at Stanford University. His professional interests currently lie at the intersection of energy, climate change and policy. Arvind is an Associate Editor at Highwire Earth. Follow him on Twitter @arvindpawan1.

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