Health After the Millennium Development Goals

None of the Millennium Development Goals will be achieved exactly as planned. However, we all want to include the issues we see as essential in the new framework of the Sustainable Development Goals As we approach the target date set at the end of the last century for achieving a series of advances in global development, two things are clear. The first is that none of the Millennium Development Goals will be achieved exactly as planned. However, the second is that we all want to include the issues we see as essential in the new framework of the Sustainable Development Goals with which the next UN General Assembly will open a new fifteen year phase this autumn.

Every issue—health, education, food, human rights, climate change, good governance and democratisation, to name but a few—has its army of defenders who are working to ensure that their cause is not left out of the new action plan. It would appear, therefore, that even though we have not fulfilled many of the promises or achieved all the desired results, the development goals have worked. Even though the optimum target was not always reached, they provided the incentive needed to crank up the engine of global development.

Even though the optimum target was not always reached, the Millennium Development Goals provided the incentive needed to crank up the engine of global developmentThe advantage of having goals is that they allow us to measure our progress, and in the field of global health—and particularly that of infectious diseases—some of the achievements are by no means minor. Take the case of child mortality, for example: the number of children who die before their fifth birthday has been reduced dramatically. Mortality among the under-fives declined from around 12 million a year in the 1990s to half that number today. In 2013 the figure was 6.3 million.

Something similar could be said about the impact on the world’s three major infectious diseases. The fight against AIDS has succeeded in stabilising the upward curve of the infection rate. In 2010, the number of people living with the HIV virus was estimated at about 34 million, some 20% more than in 2000, but HIV-related mortality has declined significantly since 2000, when it peaked with more than two million deaths. This success would have been impossible without the momentum of a decade that has seen the advent of new international financing mechanisms, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, which have hugely boosted access to antiretroviral therapy worldwide.

Should the progress made in infectious diseases be followed by a strategic shift in focus towards chronic diseases? The fight against malaria has also achieved a decline of almost 30% in the number of deaths over the last decade. The progress in almost all infectious diseases, including those traditionally neglected, has been significant thanks to a variety of factors. Among the most decisive of these have been the emergence of a new kind of philanthropy spearheaded by the Bill & Melinda Gates Foundation, the creation of new financing mechanisms, and the transfer of innovation to make new interventions accessible to the most vulnerable populations. Overall, the work has been supported by political commitment and the framework of a set of global objectives. On the other hand, important as it is to recognise the progress made, it is equally important not to view the glass as half full and underestimate what still remains to be done.

In what direction should the new challenges lead us? Should the progress made in infectious diseases be followed by a strategic shift in focus towards chronic diseases? We are certainly seeing an epidemiological shift and many of the conditions once more prevalent in wealthier countries, such as heart disease and cancer, have started to have a much greater impact than before on the populations of middle- and low-income countries. Nevertheless, in the debate on global health, the problem should never be posed as a choice between two concepts reflecting a difference that is often more semantic than real. AIDS is caused by an infection, but thanks to current treatments it has become a chronic disease. The problem is not to choose between one concept or another. If we see global health as a prerequisite for the development of the most vulnerable populations—the populations least likely to have the basic resources they need to move forward—the horizon is still a long way off and our objectives for the future should be based less on past achievements and more on the challenges that lie ahead.

It is true that infant mortality has been halved. But more than half of the 6 million children who died last year before reaching their fifth birthday were cut down by infectious diseases that could have been treated. That is a clear indicator that we must continue to focus on the fight against these diseases. It is also perfectly exemplifies why we should measure impact not only in terms of lives but also by how much we have reduced the unjust inequalities that all too often determine a person’s vulnerability to disease and condemn a section of the population to an early death simply because they are born into poverty. Putting an end to this inequity must, therefore, be one of the top priorities in the new phase that is about to begin.

[ Rafael Vilasanjuan is Director of Policy and Global Development at the Barcelona Institute for Global Health (ISGlobal).]