Sustainable Development Goals: Challenges and Opportunities : Indian Journal of Public Health (2024)

Health has been recognized as central to international development for more than 20 years, and major efforts have been made to reduce morbidity and mortality either universally or through a focus on specific population subgroups such as “the poor, woman, and children.”¹ Health is a right, as well as a means of measuring success across the whole development agenda.² Achieving health and well-being at all ages requires new perspectives: An emphasis on health rather than disease and effectively defining “well-being.”³ Post-2015 sustainable development framework can bring together the full range of human aspirations and needs to ensure a life of dignity for all.

What is Sustainable Development?

The sustainable development encompasses the achievement of three interconnected objectives, i.e., economic development, social inclusion, and environmental sustainability which are necessary for the well-being of individuals and societies.⁴

Why Sustainable Development Goals?

The adoption of Millennium Development Goals (MDGs) in 2000 represented a major shift in galvanizing global political will for poverty eradication and improvement of health and well-being of populations. The job started with MDGs, therefore, needs to be finished.⁴

Since the MDGs were devised, many new challenges have emerged while the existing ones have been exacerbated. Inequality has deepened, environmental degradation has increased, migration challenges and unemployment for youth have grown, conflicts and political instability have halted or reversed progress in many countries, organized crime including trafficking in people, and drugs violates human rights and undermines development. People across the world are demanding more responsive governments, better governance, and rights at all levels.⁴

At the same time, the world has changed radically since the turn of the millennium. New economic powers have emerged, new technologies are shaping our societies, and new patterns of human settlement and activity are heightening the pressures on our planet. A new era demands a new vision and a responsive framework. Sustainable development, enabled by the integration of economic growth, social justice, and environmental stewardship, has become our global guiding principles and operational standards.⁴

The deepening ways, in which the lives of people and countries are linked, demand a universal agenda addressing the world's most pressing challenges and seizing the opportunities. In view of these dire and unprecedented challenges, there is a need for change producing global goals.⁴

Transition from Millennium Development Goals to Sustainable Development Goals

In 2000, the member states of the United Nations agreed on a bold vision for the future enshrined in the MDGs that recognized the need to pool efforts to advance on three fronts simultaneously: Development, peace and security, and human rights. The MDGs expressed widespread public concern about poverty hunger, unmet schooling, gender inequality, and environmental degradation. By packaging these priorities into an easily understandable set of eight goals, and by establishing measurable and time-bound objectives, the MDGs helped promote global awareness, political accountability, improved metrics, social feedback, and public pressures.⁴

There has been substantial progress in achieving the MDGs and several successes in reaching specific targets globally and in individual countries. 17,000 fewer children die each day than in 1990. Since 2000, measles vaccines have averted nearly 125.6 million deaths. Maternal mortality has fallen by almost 50% since 1990. Antenatal care increased from 65% in 1990 to 83% in 2012. New HIV infections in 2013 were established at 2.1 million, which was 38% lower than in 2001. New HIV infection among children has declined 58% since 2001. Tuberculosis (TB)-related deaths in people living with HIV have fallen by 36% since 2004. Over 6.2 million deaths have been averted between 2000 and 2015. The global malaria incidence rate has fallen by an estimated 37% and the mortality rates by 58%. Between 2000 and 2013, TB prevention, diagnosis and treatment intervention saved an estimated 37 million lives. The TB mortality rate fell by 45% and the prevalence rate by 41% between 1990 and 2013. However, more than a billion people still live in extreme poverty; large populations face income disparity and gender inequality.⁵

The transition from MDGs to sustainable development goals (SDGs) has undergone massive consultations led by the United Nations since 2012. In a series of global, regional, and national consultations in nearly 100 countries and through a social media platform, more than a million people have shared their views on the post-2015 development agenda. A notable set of illuminating reports on the subject includes a report of High-level Panel of Eminent Persons on the post-2015 Development Agenda cochaired by Presidents of Indonesia, Liberia, and Prime Minister of UK, reports by the Sustainable Development Solutions Network, the Global Compact Office, the United Nations System Task Team on the post-2015 United Nations Development Agenda, the regional commissions, civil society organizations, and academic institutions, who have provided important inputs and recommendations for the formulation and content of the sustainable development agenda.⁴

Sustainable Development Goals

Countries adopted on September 25, 2015, a set of 17 goals and 169 targets to end poverty and hunger, ensure healthy lives, promotion of well-being, inclusive and quality education for all, achievement of gender equality by empowering all women and girls, ensuring access to safe water and sanitation, energy, information and technology, reduce inequality within and among countries, make cities safe and sustainable, ensure sustainable consumption and production patterns, take urgent action to combat climate change, conserve and sustainably use the oceans and seas, manage forests to protect biodiversity, promote just, peaceful and inclusive societies, and revitalize the global partnership for sustainable development.⁶

Every country will promote the well-being and capabilities of all their citizens, enabling all citizens to reach their potential irrespective of class, gender, ethnic origin, religion, or race. Every country will monitor the well-being of its citizenry with improved measurements and reporting of life satisfaction. Special attention will be given to early childhood, youth, and elderly people, addressing the vulnerabilities and needs of each age cohort. A particular focus should be on early childhood development, especially girls. In a world, where 12% of the population, and 22% of that of more developed regions, will be older than 65 years by 2030, new targeted programs and social protections will be needed for elderly people in many countries.⁷

Health Goal (Sustainable Development Goal-3) Targets

The health goal to ensure healthy lives and promote well-being for all at all ages after 2015 has 13 targets,⁸⁹ such as reduction of global maternal mortality ratio to <70/100,000 live births, end preventable deaths of newborns and under-five children, epidemics of AIDS, TB, malaria and neglected tropical diseases, and combat hepatitis, waterborne diseases, and other communicable diseases, reduce by one-third premature mortality from noncommunicable diseases through prevention, treatment, and promotion of mental health and well-being prevention and treatment of substance abuse, to achieve universal access to sexual and reproductive health-care services, information and education, and the integration of reproductive health into national strategies and programs, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water soil population, and contamination, to end open defecation by providing access to safe drinking water and sanitation for all, substantially increase health financing and workforce, strengthen and implement tobacco control, achieve universal health coverage (UHC), including financial risk protection, access to safe, effective, quality, and affordable essential medicines and vaccines for all by 2030; end all forms of malnutrition to reduce stunting and wasting in children under 5 years of age by 2025; halve deaths and injuries from road traffic accidents by 2020.

Modalities of Implementation of Sustainable Development Goals

The SDGs need the identification of new critical pathways to sustainability. The SDGs will need the unprecedented mobilization of global knowledge operating across many sectors and regions. Governments, international institutions, private business academia, and civil society will need to work together to identify the critical pathways to success. All nations must agree to four building blocks for implementing the SDGs, i.e., far-reaching vision for the future anchored in human rights, a set of concise goals and targets aimed at realizing priorities of the agenda, a global partnership for development to mobilize means of implementation, a participatory monitoring framework for tracking progress and mutual accountability mechanisms for all stakeholders.¹⁰

Challenges

There are a number of challenges for achieving SDGs such as lack of effective leadership, coordinated partnerships, investments, implementation, and indicators with effective data collection. Leadership is essential for progress in relation to policy change, legislation, investment, implementation, advocacy, and popular representation.¹¹¹² SDGs demand an increasing interface with global governance for health among those institutions and processes that directly and indirectly impact on health in the context of globalized trade, security, migration, and environment.¹³

To adopt a universal post-2015 development agenda with sustainable development at its core, all countries need to recognize the profound transformation required to address the emerging challenges of sustainable development. These include economic shifts to sustainable patterns of production and consumption, effective governance and renewed global partnership and means of implementation Another set of challenges is lack of social inclusion, widespread regional disparities and urban-rural gaps, gender inequality between men and women.¹⁰

A key challenge is to adopt a meaningful standard of basic needs worldwide, i.e., access to safe and sustainable water and sanitation, adequate nutrition, primary health services, and basic infrastructure including electricity, roads, and connectivity to the global information network. The global economic downturn, violent conflicts in some countries, biodiversity loss, degradation of water, drylands, forests, and climate change are the challenges to the peace and prosperity as they threaten to reverse the achievements to date and undermine any future gain.³

Although the SDGs have been accepted in principle, they have also been criticized for being too large in number and too wide in their scope. It is a challenge to create and maintain public awareness, mobilization, advocacy, and continuity for 17 goals and 169 targets enshrined in SDGs as compared to only 8 goals and 18 targets of MDGs which were easy to state, simple to understand, and practical for adoption by the governments, business, and civil societies worldwide.

Several targets are aspirational and unachievable, for example, target 3.2 to “end preventable deaths of newborns and under-five children” or target 3.3 to end the epidemics of AIDS, TB, and malaria. It is a challenge to end these health crises within just 15 years. Another challenge is that too many of the goals and targets are vague and immeasurable, for example, SDG3 - how will the progress toward “well-being for all” be measured. Similarly, target 3.8 “to achieve UHC” is a challenge unless the package of services and the metric for measuring its coverage are clearly articulated and specified.¹⁴

Opportunities

There is an opportunity to achieve the sustainable development collectively by the committed leadership, conviction and courage, hard work and devotion to the common progress assisted by improved science and technology. It is an opportunity for the health champions to highlight the interdependence of health and the themes of education, growth, population, energy and governance, and present health as a precondition for social sustainability and progress to prosperity.

The interconnected nature of the SDGs makes them complex but also demonstrates complementary benefits from specific goals and targets. For instance, clean drinking water and sanitation would enhance health, leading to improved nutrition and well-being.¹⁰ For health to remain central in post-2015 SDGs, it will need to be pervasive in each of the dimensions of sustainable development economic, social, environmental, and not quarantined from them. Emergence of this new sustainability paradigm offers an unprecedented opportunity.³

The transformative actions of the post-2015 development agenda provide an opportunity to be supported by multistakeholder partnerships which include not only governments but also private organizations, international organizations, parliaments, civil society, local authorities, trade unions, research and educational institutions. The success of such partnerships depends on assigning specific roles and responsibilities to ensure accountability.

Conclusion

Acting on the common challenges in post-2015 development agenda demands a renewed commitment to international cooperation. Strong national ownership, well-managed policies that foster robust and inclusive growth, decent employment and social protection, allocation of more resources for essential services, supported coherently by partners at all levels can help in achieving the SDGs.

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