Positioning health in the post-2015 sustainable development agenda

Based on a presentation by Professor K Srinath Reddy, President, Public Health Foundation of India & President, World Heart Foundation, at Commonwealth Health Ministers Meeting, Geneva, Switzerland, 18 May 2015

In his presentation at the Commonwealth Health Ministers Meeting, Professor K Srinath Reddy, President, Public Health Foundation of India & President, World Heart Foundation, said that, while continuing the commitment to the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) “will provide a framework for integrating actions across multiple sectors to enable human development to proceed in a manner that optimizes the equitable use of planetary resources whilst minimizing threats to sustainability.” The SDGs will be universal and will position health as a shared global commitment within the broad framework of sustainable development. This is in contrast to the MDGs, which were principally directed at low and middle-income countries.

Professor Reddy recognized that health is inherently important as a human right, and is critical to achieving all the pillars of sustainable development. Strengthening health systems is important, as has become increasingly evident: at the same time the MDGs adopted a segmented approach to health on specific periods of life (pregnancy and childhood), or on specific diseases (HIV, TB and Malaria). This approach has had the effect of fragmenting the health systems of many countries, as vertical programmes have “extracted an opportunity cost in other areas of public health.” In addition, vertical programmes, even if they were well intended, “could not be force fitted into weak and dysfunctional health systems” which would affect their expected returns on investments. The health SDG must therefore build on efficient and equitable health systems rather than fragmenting them. As such “the SDGs must follow an inclusive framework, encapsulating equity and a systems-approach for achieving new health targets by 2030… using a broad framework that is universal (i.e. relevant to both LMICs and high income countries), yet capable of being applied in an adaptive and context-specific manner as required by national priorities.”

Reddy highlighted Universal Health Coverage (UHC), as called for by the World Health Organization (WHO) and the World Bank, as the specific health goal or the stated means to achieve any health goal, although he also addressed Maximizing Healthy Life Expectancy, as proposed by the Sustainable Development Solutions Network (SDSN).

In conclusion he said that the health SDG should extend action on MDGs; expand the agenda to non-communicable diseases and other major disorders; adopt a life course approach; call for UHC; and enable strengthening of health systems. Since the determinants of health extend across multiple sectors, the post-2015 development agenda must also promote synergies and partnerships that align actions for better health and link several stakeholders. Improved health of individuals and populations will also help in achieving other development goals such as poverty reduction, gender empowerment, universal education and conflict resolution.

In general, Professor Reddy highlighted the ‘disconnect’ between the discussions in the Open Working Group (OWG) and in the other parts of the UN system. It remains to be seen as to how close the discussions in the World Health Assembly (WHA) on health in the post-2015 development agenda will be to those in the OWG. The WHA provides as important opportunity for those who are policy makers and experts in public health to consider the health goal and suggested targets, which will then hopefully be reflected in the work of the OWG going forward.

The full text of Dr Reddy’s presentation is available for download here.