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WHO Library Cataloguing-in-Publication Data Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. 1. Global Health. 2. Health Priorities. 3. Conservation of Natural Resources. 4.Organizational Objectives. 1. World Health Organization. SBN97892415650 (NLM classification: WA 530) o World Health Organization 2015 AllrightsreservedPublicationsoftheWorldHealthOrganizationareavailableontheWhowebsite(www.who.int)orcanbepurchasedfromWhoPress,World Health Organization, 20 Avenue Appia, IZI Geneva 27, Switzerland(tel +41227913264: fax +41227914857 email: bookorders @who. int) Requests for permission to reproduce or translate WHO publications-whether for sale or for non-commercial distribution -should be addressed to WHO Press throughtheWhowebsite(www.whoint/about/licensing/copyright_form/en/indexhtml) The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization conceming the legal status of any country, territory, city or area or of its authorities, or conceming the delimitation of its frontiers or boundaries. and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers'products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned Errors and omissions excepted, the names of proprietary products are distinguished by initial pital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use Design and layout by LTV Com Sarl, Villars-sous-Yens, Switzerland. Printed in france ACKNOWLEDGEMENTS The principal authors of this report are Ties Boerma, Colin Mathers, Carla Abou Zahr, Somnath Chatterji, Daniel Hogan and Gretchen Stevens, assisted by Wahyu Retno Mahanani, Jessica Ho, Florence Rusciano and Gary Humphreys All chapters are based on contributions from WHO departments, programmes and partnerships, as well as other United Nations agencies and academic institutions, with specific contributions from Jonathan Abrahams, Heather Adair-Rohani, Najeeb al-Shorbaji, Valentina Baltag, Shannon Barkley, John Beard, Nicole Bergen, Douglas Bettcher, Michel Beusenberg, Ann Biddlecom, Monika Blossner, Elaine borghi, Cynthia Boschi Pinto, Bela Bovy, Rick Brennan, Sylvie Briand, Alexander Butchart, James Campbell, Diarmid Campbell-Lendrum, Andrew Cassels, Jorge Castilla, Daniel Chisholm, Doris Chou, Richard Cibulskis, Giorgio Cometto, Alison Commar, Marilys Corbex, Melanie Cowan, Bernadette Daelmans, Cornelis de Joncheere, Carlos Dora, Tarun Dua, Chris Dye, Tessa Edejer, David Evans, Majid Ezzati Cristin Fergus, Jane Ferguson, Christopher Fitzpatrick, Alexandra Fleischmann, Katherine Floyd, Silvia Franceschi, Claudia Garcia-Moreno, Abdul Ghaffar, Philippe Glaziou, Andre Griekspoor, Michael Gruber, Laurence Grummer-Strawn, Michelle Hindin, Rifat Hossain, Ahmad Reza Hosseinpoor, Justine Hsu, Hamid Jafari, Rick Johnston, Sowmya Kadandale, Rania Kawar, Edward Kelley, Ron Kessler, Marie-Paule Kieny, ROdiger Krech, Joseph Kutzin, Jeremy Lauer, Katherine Lofgren, Belinda Loring, Daniel Low-Beer, Blerta Maliqi, Matthews Mathai, David Meddings, Christopher Mikton, I Jaime Miranda, Nirmala Naidoo, Lori Newman, Margaret Peden, Vladimir Poznyak, Amit Prasad, Annette Pruss-Ustun, Mario Raviglione, Dag Rekve, Leanne Riley, Gojka Roglic, Alex Ross, David Ross, Nancy Sampson, Shekhar Saxena, Lale Say, Anne Schlotheuber, Gerard Schmets, Amani Siyam, Shams Syed, Tibor Szilagyi, Tamitza Toroyan, Edouard Tursan D'Espaignet, Nicole Valentine, Meindert Onno Van Hilten, Cherian Varghese, Eugenio Villar Montesinos, Joanna Vogel, Milton Were, Teodora Wi, Stefan Wiktor
WHO Library Cataloguing-in-Publication Data Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. 1.Global Health. 2. Health Priorities. 3.Conservation of Natural Resources. 4.Organizational Objectives. I.World Health Organization. ISBN 978 92 4 156511 0 (NLM classification: WA 530) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Design and layout by L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Printed in France. ACKNOWLEDGEMENTS The principal authors of this report are Ties Boerma, Colin Mathers, Carla AbouZahr, Somnath Chatterji, Daniel Hogan and Gretchen Stevens, assisted by Wahyu Retno Mahanani, Jessica Ho, Florence Rusciano and Gary Humphreys. All chapters are based on contributions from WHO departments, programmes and partnerships, as well as other United Nations agencies and academic institutions, with specific contributions from Jonathan Abrahams, Heather Adair-Rohani, Najeeb al-Shorbaji, Valentina Baltag, Shannon Barkley, John Beard, Nicole Bergen, Douglas Bettcher, Michel Beusenberg, Ann Biddlecom, Monika Blössner, Elaine Borghi, Cynthia Boschi Pinto, Bela Bovy, Rick Brennan, Sylvie Briand, Alexander Butchart, James Campbell, Diarmid Campbell-Lendrum, Andrew Cassels, Jorge Castilla, Daniel Chisholm, Doris Chou, Richard Cibulskis, Giorgio Cometto, Alison Commar, Marilys Corbex, Melanie Cowan, Bernadette Daelmans, Cornelis de Joncheere, Carlos Dora, Tarun Dua, Chris Dye, Tessa Edejer, David Evans, Majid Ezzati, Cristin Fergus, Jane Ferguson, Christopher Fitzpatrick, Alexandra Fleischmann, Katherine Floyd, Silvia Franceschi, Claudia Garcia-Moreno, Abdul Ghaffar, Philippe Glaziou, Andre Griekspoor, Michael Gruber, Laurence Grummer-Strawn, Michelle Hindin, Rifat Hossain, Ahmad Reza Hosseinpoor, Justine Hsu, Hamid Jafari, Rick Johnston, Sowmya Kadandale, Rania Kawar, Edward Kelley, Ron Kessler, Marie-Paule Kieny, Rüdiger Krech, Joseph Kutzin, Jeremy Lauer, Katherine Lofgren, Belinda Loring, Daniel Low-Beer, Blerta Maliqi, Matthews Mathai, David Meddings, Christopher Mikton, J. Jaime Miranda, Nirmala Naidoo, Lori Newman, Margaret Peden, Vladimir Poznyak, Amit Prasad, Annette Prüss-Ustün, Mario Raviglione, Dag Rekve, Leanne Riley, Gojka Roglic, Alex Ross, David Ross, Nancy Sampson, Shekhar Saxena, Lale Say, Anne Schlotheuber, Gerard Schmets, Amani Siyam, Shams Syed, Tibor Szilagyi, Tamitza Toroyan, Edouard Tursan D’Espaignet, Nicole Valentine, Meindert Onno Van Hilten, Cherian Varghese, Eugenio Villar Montesinos, Joanna Vogel, Milton Were, Teodora Wi, Stefan Wiktor
PREFACE n 2015 the Millennium Development Goals(MDGs) come to the end of their term and a post-2015 agenda, comprising 17 Sustainable Development Goals(SDGs), takes their place. We stand on the threshold of a new era. this is an important moment to look back at the trends that have defined health-related development under the mdgs, noting achievements, highlighting lessons learned, drawing attention to unfinished business, and looking forward to the challenges we must now face While progress towards the mDgs has been impressive in many ways, much work remains to be done In health, unprecedented progress has been made in reducing maternal and child mortality and in the fight against infectious diseases, even thoug several global and many country MDG targets were not met. The unfinished agenda needs to be addressed, but more importantly the dramatic progress paves the way λL心 for more ambitious achievements by 2030. Similarly important is addressing other significant, ongoing public health challenges that were left out of the MDgs altogether, Dr Margaret Chan notable among them the challenge of acute epidemic diseases, disasters and conflict situations, the burgeoning epidemic of noncommunicable diseases and mental health World Health Organization disorders and large inequalities in all parts of the world The SD Gs address many of these issues head on, setting a new health goal ("Ensure healthy lives and promote well-being for all at all ages")with a broad set of targets. The SDgs also significantly broaden the scope of action with 17 goals, covering a wide range of human activity across the three sustainable development dimensions(economic, social and environmental): people, planet, prosperity, peace and partnership, the five Ps of the new agenda, an agenda for all countries Fundamental to achieving the SDGs will be the recognition that eradicating poverty and inequality creating inclusive economic growth, preserving the planet and improving population health are not just linked but interdependent. This has profound implications for development strategy, many of which will only be revealed as we move forward. But some seem fairly clear at the outset, including the fact that silo-based, vertical approaches to development will have to give way to broader, cross-cutting approaches coordinated around and aligned with countries' needs and priorities By taking a more integrated approach to development the SDgs present us with an opportunity to advance, seizing opportunities to collaborate and exploit synergies. However, there are clearly challenges too. For example, in order to take on cross-cutting issues, it will be necessary to achieve far greater intersectoral coherence and coordination of effort To achieve that end, a new impetus will have to be given to global and regional partnerships and collaborations, with a focus on country action A great deal has been achieved since 2000. However, progress can easily be reversed if we do not maintain our commitment to making the world a better place for all, leaving no one behind. Key to achieving that vision will be focusing our efforts intelligently, and setting clear, measurable goals that national governments and development partners can support. In health the target on universal health coverage(UHC) provides the platform for integrated action across all 13 health targets Rather than being seen as one target among many it is my belief that UHC should be seen as the linchpin of the health development agenda, not only underpinning a more sustainable approach to the achievement of the other health targets, but allowing for a balance between them relevant to all, it can now be monitored within an accepted framework which ill allow for target setting and measurement of progress. It is, I believe, our way forward. This report is a first step in a series of actions that i am taking to make Who fit to fully support the implementation of the sdg agenda HEALTH IN 2015: FROM MDGS TO SDGs
HEALTH IN 2015: FROM MDGs TO SDGs iii PREFACE I n 2015 the Millennium Development Goals (MDGs) come to the end of their term, and a post-2015 agenda, comprising 17 Sustainable Development Goals (SDGs), takes their place. We stand on the threshold of a new era. This is an important moment to look back at the trends that have defined health-related development under the MDGs, noting achievements, highlighting lessons learned, drawing attention to unfinished business, and looking forward to the challenges we must now face. While progress towards the MDGs has been impressive in many ways, much work remains to be done. In health, unprecedented progress has been made in reducing maternal and child mortality and in the fight against infectious diseases, even though several global and many country MDG targets were not met. The unfinished agenda needs to be addressed, but more importantly the dramatic progress paves the way for more ambitious achievements by 2030. Similarly important is addressing other significant, ongoing public health challenges that were left out of the MDGs altogether, notable among them the challengse of acute epidemic diseases, disasters and conflict siituations, the burgeoning epidemic of noncommunicable diseases and mental health disorders and large inequalities in all parts of the world. The SDGs address many of these issues head on, setting a new health goal (“Ensure healthy lives and promote well-being for all at all ages”) with a broad set of targets. The SDGs also significantly broaden the scope of action with 17 goals, covering a wide range of human activity across the three sustainable development dimensions (economic, social and environmental): people, planet, prosperity, peace and partnership, the five Ps of the new agenda, an agenda for all countries. Fundamental to achieving the SDGs will be the recognition that eradicating poverty and inequality, creating inclusive economic growth, preserving the planet and improving population health are not just linked but interdependent. This has profound implications for development strategy, many of which will only be revealed as we move forward. But some seem fairly clear at the outset, including the fact that silo-based, vertical approaches to development will have to give way to broader, cross-cutting approaches coordinated around and aligned with countries’ needs and priorities. By taking a more integrated approach to development the SDGs present us with an opportunity to advance, seizing opportunities to collaborate and exploit synergies. However, there are clearly challenges too. For example, in order to take on cross-cutting issues, it will be necessary to achieve far greater intersectoral coherence and coordination of effort. To achieve that end, a new impetus will have to be given to global and regional partnerships and collaborations, with a focus on country action. A great deal has been achieved since 2000. However, progress can easily be reversed if we do not maintain our commitment to making the world a better place for all, leaving no one behind. Key to achieving that vision will be focusing our efforts intelligently, and setting clear, measurable goals that national governments and development partners can support. In health the target on universal health coverage (UHC) provides the platform for integrated action across all 13 health targets. Rather than being seen as one target among many, it is my belief that UHC should be seen as the linchpin of the health development agenda, not only underpinning a more sustainable approach to the achievement of the other health targets, but allowing for a balance between them. Relevant to all, it can now be monitored within an accepted framework which will allow for target setting and measurement of progress. It is, I believe, our way forward. This report is a first step in a series of actions that I am taking to make WHO fit to fully support the implementation of the SDG agenda. Dr Margaret Chan Director-General World Health Organization
CONTENTS Abbreviations 1 From MDGs to SDGs: general introduction 4 MDGs 5 Health in the MDg: achievements Strengths and limitations of the MDgs 7 SDGs The health goal 9 Health in other goals Follow-up and review 12 Notes and references 15 Economic, social and environmental context and health implications 17 ummar 18 Population trends 18 Fertility and population growth 19 The youth bulge 21 Ageing 22 Migration 23 Urbanization 25 Economic determinants of health and financing for development 26 Poverty eradication and income inequality 28 Development assistance for health 29 Social development Gender equality and rights 60 Human righ 32 Environment and climate change Climate change 4 Pollution and contamination 34 Occupational healti Intersectoral action 36 Notes and references 39 Universal Health Coverage 41 Summary 43 Trends 44 Positive developments 47 Strategic prioritie Governance HEALTH IN 2015: FROM MDGs TO SDGs
iv HEALTH IN 2015: FROM MDGs TO SDGs 3 vii Abbreviations 1 From MDGs to SDGs: general introduction 3 Summary 4 MDGs 5 Health in the MDG: achievements 6 Strengths and limitations of the MDGs 7 SDGs 8 The health goal 9 Health in other goals 10 Follow-up and review 12 Notes and references 15 Economic, social and environmental context and health implications 17 Summary 18 Population trends 18 Fertility and population growth 19 The youth bulge 21 Ageing 22 Migration 23 Urbanization 25 Economic determinants of health and financing for development 26 Poverty eradication and income inequality 27 Globalization and trade 28 Development assistance for health 29 Social development 29 Gender equality and rights 30 Human rights 31 Education 32 Environment and climate change 32 Climate change 34 Pollution and contamination 34 Occupational health 35 Intersectoral action 36 Notes and references 39 Universal Health Coverage 41 Summary 43 Trends 44 Positive developments 45 Challenges 47 Strategic priorities Snapshots 50 Governance 52 Health financing 1 2 CONTENTS