Just as 2015 saw the target date set for the Millennium Development
Goals (MDGs) being reached, with a global effort to track progress
towards achieving those ambitious goals, so 2016 is the first year
for a new series of such goals, with an even more ambitious scope.
In September 2015, the United Nations General Assembly hosted
the Sustainable Development Summit in New York, which endorsed
a new set of Sustainable Development Goals (SDGs).a The range
of the SDGs has been expanded. A total of 17 SDGs have been
set, ranging from “end poverty in all its forms everywhere” (Goal
1) to “promote peaceful and inclusive societies for sustainable
development, provide access to justice for all and build effective,
accountable and inclusive institutions at all levels” (Goal 16), with
a commitment to “strengthen the means of implementation and
revitalize the global partnership for sustainable development” (Goal
17). SDG3 is specific to Health: “Ensure healthy lives and promote
well-being for all at all ages”. As with the MDGs, each SDG has
a series of targets. The targets for SDG3 are extensive, and each
represents a complex set of sub-targets:b
3.1 - By 2030, reduce the global maternal mortality ratio to less
than 70 per 100 000 live births
3.2 - By 2030, end preventable deaths of newborns and
children under 5 years of age, with all countries aiming to
reduce neonatal mortality to at least as low as 12 per 1 000
live births and under-5 mortality to at least as low as 25 per
1 000 live births
3.3 - By 2030, end the epidemics of AIDS, tuberculosis, malaria
and neglected tropical diseases and combat hepatitis, waterborne
diseases and other communicable diseases
3.4 - By 2030, reduce by one third premature mortality from
non-communicable diseases through prevention and treatment
and promote mental health and well-being
3.5 - Strengthen the prevention and treatment of substance
abuse, including narcotic drug abuse and harmful use of alcohol
3.6 - By 2020,c halve the number of global deaths and injuries
from road traffic accidents
3.7 - By 2030, ensure universal access to sexual and reproductive
health-care services, including for family planning, information
and education, and the integration of reproductive health into
national strategies and programmes
3.8 - Achieve universal health coverage, including financial
risk protection, access to quality essential health-care services
and access to safe, effective, quality and affordable essential
medicines and vaccines for all
3.9 - By 2030, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water and soil
pollution and contamination
3.a - Strengthen the implementation of the World Health
Organization Framework Convention on Tobacco Control in all
countries, as appropriate 3.b - Support the research and development of vaccines and
medicines for the communicable and non-communicable
diseases that primarily affect developing countries, provide
access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement
and Public Health, which affirms the right of developing
countries to use to the full the provisions in the Agreement on
Trade-Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide
access to medicines for all
3.c - Substantially increase health financing and the recruitment,
development, training and retention of the health workforce in
developing countries, especially in least developed countries
and small island developing states
3.d - Strengthen the capacity of all countries, in particular
developing countries, for early warning, risk reduction and
management of national and global health risks.
There has been a robust debate about how best to set measurable
indicators for the health-related SDG targets. Murray has argued
that four major design features should be considered:1 that each
indicator should not only measure the intended effect, but also be
important for population health (in order to avoid diverting scarce
resources to an outcome that is only tangentially related to the
target); that each indicator be easily interpreted and communicated;
that each indicator produce valid, timely, local and comparable
measurements in an affordable manner; and that, wherever
possible, each indicator should be disaggregated by age, gender,
and sub-national location. Meeting these standards is incredibly
difficult when a target is a composite of many sub-targets (such as
the target to “end AIDS, tuberculosis, malaria and neglected tropical
diseases” as well as “combat hepatitis, water-borne diseases and
other communicable diseases”).
If such a complex development can be reduced to one dimension, it
would be that the SDGs have focused greater attention on efforts to
tackle non-communicable diseases (NCDs), while still maintaining the
visibility of major communicable diseases (and adding the politically
charged issue of hepatitis, where new treatments for hepatitis C
have been developed but are largely unaffordable). Target 3.4
combines a focus on chronic non-communicable diseases, while
adding mental health. Target 3.a focuses on tobacco control, while
3.5 targets substance abuse and alcohol. There is also an emphasis
on tracking progress towards attaining universal health coverage
(UHC), for which the South African variant is National Health
Insurance (NHI). The Global Sustainable Development Report 2015
has drawn attention to the ‘interlinkages’ between the goals, the
targets, sectors and issues addressed.2 The Report also noted that,
as much as the MDGs had posed data and monitoring challenges
for many countries, the SGDs amplified those challenges. There
are, however, increased opportunities for engagement between
researchers and operational actors, in exactly the way that Health
Systems Trust and the Health Review were first conceptualised.3