The thematic think pieces that have produced by the UN System Task Force on key issues for the post-2015 development agenda can be found on the official website for the MDGs. In addition to addressing the thematic areas there are others that look at issues such as countries with special needs; culture, a driver and enabler of sustainable development; and social protection: A development priority in the post-2015 UN development agenda.
The think piece on Health in the post-2015 UN development agenda recognizes the centrality of health in development. It recognizes that “the process leading to 2015 will be highly competitive, not only to include a wider range of topics, but also to influence the discourse on the approach to development”, eg to increase the focus on human rights, on gender, on equity versus aggregate achievement, and on ways of measuring growth beyond GDP. The post-2015 agenda must also be relevant to all societies. Meanwhile the “debate on the future development agenda has become intricately intertwined with the debate of the future of sustainable development” although there is a risk that a new set of sustainable development goals might over-emphasize environmental over other development issues.
Maternal mortality and sexual and reproductive health
It is recognized that child and maternal mortality have declined at unprecedented rates in many countries, however, many will not meet the MDG targets and much remains to be done beyond 2015, particularly in the lowest income countries in sub-Saharan Africa and South Asia, and in countries affected by conflict. The gaps within and between countries demand a much sharper focus on inequities and their consequences for health, and on health inequities themselves.
Furthermore, current investment levels in health, including sexual and reproductive health, are neither sufficient, efficient, nor equitable in many countries “challenging the belief that health has benefitted disproportionately in terms of the level of resources received over the last ten- years”.
Human rights approach
A human rights-based approach to health is essential insofar as it underpins action and provides part of the rationale for including health in the post-2015 development agenda. The think-piece recognizes that “the progressive realization of civil, cultural and political as well as economic and social rights is a prerequisite for sustainable growth and human development.” It also points out that with about three- fourths of the world’s poorest people now living in middle income countries, the issue is no longer purely a debate about development aid (although aid will remain important for some countries). It is instead about social justice and its realization in all countries rich and poor.
Health in the post-2015 development and post-Rio agendas
The development agenda post-2015 is being debated at the same time as the outcome of the UN Conference on Sustainable Development (post Rio+20). It is important therefore to bear in mind the relationship between health and sustainable development. The demographic dividend, by which a country moves from high to low birth and death rates, opens a window to accelerate economic growth that can greatly enhance countries productivity and prospects for development.
Investment in women’s health and sexual and reproductive health
Investing in women’s health and rights is equally critical and sexual and reproductive health and rights are crucial to individual, family and community health and well-being, as well as to civic participation and empowerment of women and girls.
Population dynamics, thematic think piece from UNDESA and UNFPA
The global population has increased by two billion over the last 25 years, surpassing the 7 billion mark in late 2011. It is likely to increase by at least another two billion by 2050. As such “population dynamics, particularly in the context of persistent inequalities, will have major influence on development processes and on the inclusive and balanced growth and outcomes in the coming decades.”
Why should population issues be part of the post-2015 development agenda?
Demographic changes in the past decades have led to the largest generation of youth in the world today, particularly in developing countries. At the same time the youth population in the more developed countries has been declining in both absolute numbers and in proportion to older adults, with implications for labour supply and old-age support ratios. Ageing is another major outcome of demographic change as a result of fertility decline and increased longevity and the “number and proportion of older persons aged 60 years or over are rising in all countries.” Older persons are the world’s fastest growing population group and this “global trend of ageing populations has major implications for social security, health care systems, protecting older people’s rights and interests and associated development strategies.” More than half of the world population already lives in urban areas and nearly all of the world’s population growth in the coming decades is projected to occur in the cities and towns of developing countries. At the same time migration flows and patterns are primarily driven by economic disparities, facilitated by low-cost transportation, improved communication and migrant networks.
Possible ways to bring population issues into the post-2015 development agenda
Population issues should be an integral part of the post-2015 development agenda through (a) evolving population dynamics, and (b) access to reproductive health and protection of reproductive rights.
It is suggested that a post-2015 development agenda should consider adopting measurable targets regarding achieving better education, sustainable job creation and the removal of barriers to accessing reproductive health services for improving young people’s opportunities and their wellbeing, and for maximizing their contributions to society. In addition it should include the progressively and rapidly ageing world “by promoting healthy ageing and economic well-being in old age, and by providing enabling and supportive environments where older persons”. Specific goals on social security coverage and fiscal and generational sustainability of pension and health care systems, as well as measurable targets for improvements in health status among older people should also be included. Planning for future urban growth should also be included as well as addressing the needs of those are at risk of displacement or whose livelihoods are threatened due to climatic changes in environmentally fragile areas.
Migration between sending and receiving countries, to ensure that migration occurs in safe and legal conditions, with full respect for human rights, should be addresses, taking into account the economic contributions of migrants to origin countries, including remittances.
Access to reproductive health and protection of reproductive rights
Reproductive health is “influenced by the capacity of the health system to provide access to comprehensive, quality reproductive health information and services, as a basic human right to all.”
Access to quality reproductive health information and services for many poor and less-educated women, especially adolescents and young girls in developing countries, continues to lag behind. Moreover, “an estimated 226 million women in developing countries lack access to modern contraceptive methods, and worldwide approximately 40 per cent of pregnancies are unintended.”
Access to quality reproductive health information and services in many countries is hindered by “prevailing adverse attitudes and practices such as honor crimes, sexual coercion and violence, female genital mutilation/cutting, pre-birth sex selection, rape, restrictions on women’s mobility in seeking health services, seclusion, and forced/child marriages among others”. Domestic and gender-based violence continues, being tolerated or unreported and largely unchecked, thereby compromising women’s ability to seek and obtain reproductive health information and services. In addition, some countries lack adequate policies and institutions capable of addressing gender-related barriers to reproductive health, including violence against women.
Intensified efforts will be required to ensure equal and sustained access to quality reproductive health services and “to equip women, men and young people with timely information and with the appropriate individual and institutional capacity to exercise their right to reproductive health.” It will also be important to reduce structural and system inequalities in accessing quality reproductive health and other social services.
Context in which relevant issues should be highlighted
The global development agenda should recognize the diversity of demographic situations and its varied implications for human wellbeing and sustainable development. Changes in “fertility patterns are associated with girls’ and women’s education, availability of reproductive health information and services, upholding and protecting reproductive rights, opportunities for integration into the labour market and equal opportunity social and economic development.” Investing in data and research is critical for improving understanding of factors influencing demographic dynamics and reproductive health processes. Disaggregated population data is also needed. While Governments have the primary responsibility for addressing population challenges, a joint effort of all stakeholders, including in the UN system is important. In addition, partnership-based development assistance, is also required.