The annual progress report of the Secretary-General on Progress towards the Sustainable Development Goals, prepared in accordance with General Assembly resolution 70/1, is now available. It is based on “a proposed global indicator framework developed by the Inter-Agency and Expert Group on Sustainable Development Goals Indicators.” (See: E/CN.3/2016/2/Rev.1 Annex IV). It was agreed to, “as a practical starting point” at the Statistical Commission’s 47th session. (See: E/2016/24, chap. I, sect. B, decision 47/101) The Secretary-General notes that some targets are not reflected at this time “owing to a lack of data, or because they are measured by indicators that are still undergoing methodological development.” (paras 1-3).
The report is divided into three sections: Section II summarizes the regional and global status and trends for each Goal. Following the main theme of the 2016 session of the high-level political forum, Ensure that no one is left behind, Section III highlights some of the inequalities found across Goals and targets, based on existing disaggregated data. Section IV details the availability and compilation of data used to measure the global indicators and describes the challenges faced by national statistical offices and the international statistical community in producing the indicators for the Goals and initiatives to address these challenges. (para 4)
Each of these sections includes important information for those working on health, including sexual and reproductive health and rights, with key issues being included below
II Measuring progress towards SDGs
Goal 3. Ensure healthy lives and promote well-being for all at all ages
Under Goal 3. Ensure healthy lives and promote well-being for all at all ages, the Secretary-General stresses that the goal addressed all major health priorities “including reproductive, maternal and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines.” The goal also “calls for more research and development, increased health financing, and strengthened capacity of all countries in health risk reduction and management.” (para 20)
The global maternal mortality ratio declined by 37 percent to 216 per 100,000 live births from 2000 to 2015, with nearly all maternal deaths are preventable and occurring in low-resource settings. Skilled birth health-care personnel attended three out of four births in 2015 and while maternal mortality rates declined by 44 percent globally, some 5.9 million children aged under-5 died in 2015. The report notes that the critical importance of sexual and reproductive health-care services in preventing unintended pregnancy and reducing adolescent pregnancies. In 2015 worldwide, “approximately 3 in 4 women of reproductive age (15 to 49 years of age) who were married or in union satisfied their need for family planning by using modern contraceptive methods…” The “share was less than half,” however, in sub-Saharan Africa and Oceania. There has also been a steady decline in adolescent childbearing in almost all regions, although wide disparities still persist, ranging from 7 births per 1,000 girls in Eastern Asia to 102 per 1,000 in sub-Saharan Africa. (paras 21-22)
There has been a decline globally in the incidence of major infectious diseases, including HIV, tuberculosis and malaria since 2000, with 0.3 new infections per 1,000 uninfected people in 2015. The incidence of HIV was highest in sub-Saharan Africa. Of the 9.6 million new tuberculosis cases, 58 percent were in South-Eastern Asia and the Western Pacific. Nearly half the world’s population are at risk of malaria, with 89 percent accounted for in sub-Saharan Africa. More than 1.7 billion people in 185 countries required treatment for at least one neglected tropical disease in 2014. (paras 23-24)
Some 38 million deaths each year, 68 percent of all deaths worldwide, were attributable to non-communicable diseases (NCDs) in 2012, with an estimated 52 percent of all premature deaths (deaths of persons under the age of 70). Three-quarters were due to cardiovascular disease, cancer, diabetes and chronic respiratory disease. Globally there was a decline in deaths from these four NCDs by 15 percent between 2000 and 2012. Reducing tobacco use will be critically important for reaching the proposed target for reducing premature mortality from NCDs by one third. More than 1.1 billion people, of which 945 million were male, consumed tobacco in 2015. (para 24)
Unhealthy environmental conditions increase the risk of NCDs and infection diseases and substance use and substance use disorders have contributed to a “significant public health burden,” with alcohol consumption highest in the developed regions (10.41 per person) and lowest in Northern Africa (0.51 per cent). Of the 1 in 6 people receiving treatment for drug-use disorders in 2013, 1 in 18 received treatment in Africa and 1 in 5 in Western and Central Europe. Referring to mental disorders, they occur in all regions and cultures, the most common being anxiety and depression, possibly leading to suicide, which is the second leading cause of death among those aged 15 – 29. Road traffic injuries killed 1.25 million people in 2013. (paras 24-28)
In 2014 the total official flows for medical research and basic health sectors were £8.9 billion, of which overseas development assistance from DAC donors was $4.5 billion, showing an increase of 20 percent from 2010. Some 1 billion was spent on malaria control and a further $1.2 billion on other infectious diseases, excluding AIDS. (para 29)
Other health-related targets
Under Goal 1. End poverty in all its forms everywhere, almost all countries have child or maternity benefit programmes. (para 9) Reported damaged to health-care facilities has shown “statistically significant upward trends form 1990 onwards.” (para 12)
Under Goal 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture, while the prevalence of hunger has decline from 15 percent in 2000 to 2002 to 11 per cent for 2014 to 2016, 790 million people worldwide lack regular access to adequate amounts of dietary energy. If these trends continue, the zero hunger target will largely be missed by 2030. In 2014 1 in 4 children aged under 5, totalling an estimated 159 million children had stunted growth. At the same time, in nearly every region, the percentage of overweight children increased from 5.1 percent to 6.1 percent. (paras 14-15)
Under Goal 5. Achieve gender equality and empower all women and girls, the rate of child marriage has declined, and progress has been made in sexual and reproductive health and reproductive rights, with fewer maternal deaths. (para 39) Meanwhile violence against women and girls, from surveys conducted between 2005 and 2015 in 52 countries, indicates that 21 percent of girls and women aged 15-49 “experienced physical and/or sexual violence at the hands of an intimate partner in the previous 12 months.” Nevertheless, owing to data limitations, estimates of risks of violence experienced by women with disabilities, women from ethnic minorities and among women aged over 50. At least 200 million girls and women in 30 countries have undergone female genital mutilation/cutting. (paras 39-43)
Under Goal 6. Ensure availability and sustainable management of water and sanitation, issues related to drinking water, sanitation and hygiene are addressed as well as quality and sustainability of water resources worldwide. 4.9 billion people used an improved sanitation facility while 204 billion did not, with unsafe management of faecal waste and wastewater continuing to present a major public health and environmental risk. The percentage of the global population using improved drinking water rose from 82 percent in 2000 to 91 percent in 2015. (paras 46 – 48)
Under Goal 7. Ensure access to affordable, reliable, sustainable and modern energy for all, the absolute numbers of people relying on polluting fuels and technologies for cooking, including solid fuels and kerosene, has increased to an estimated three billion people. (para 55)
Under Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable, more than half the world’s population lives in cities, rising to a projected 6 out of 10 by 2030. (para 78) Urban air pollution annually causes illnesses and premature deaths with the global population being “exposed to air pollution levels at least 2.5 times higher than maximum standards set by the World Health Organization in 2014. (para 82)
Under Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels, information is included on violence against children. (para 108) Sexual violence, moreover “is one of the most unsettling of children’s rights violations,” while from zero to 16 percent of women aged 18-29 had experienced sexual violence for the first time before the age of 18. Only five countries have comparable data for the experiences of men. (para 110)
III Ensuring that no one is left behind
In reaching first all those who are furthest behind, it is necessary to understand the population groups that are “most disadvantaged, in what way and to what extent.” Accurate information must be “broken down by age, sex, location of residence and other group characteristics” to do this. (para 127) The potential of young people, of which there are 1.8 billion aged 10 – 24, as agents of change is recognized, while noting that 168 million were engaged in child labour in 2012 with a youth unemployment rate of 15 percent globally in 2015. Young people are also overrepresented among direct and indirect victims of violence. Worldwide in 2011, they accounted for an estimated 40 percent of all new HIV infections. Births of the richest quintile were twice more likely to be attended by a skilled birth attendant than those in the poorest quintile and stunting was also twice as likely. (paras 120-130)
Health-care systems tend to be weaker in rural and remote areas with lower rates of health service coverage than in urban areas and a disproportionately higher burden of disease and death. Death among under-5s is also 1.7 times more likely to occur, in comparison with children in urban areas. There are also disparities in access to drinking water, with 79 percent of urban populations having access to piped water in their homes or premises, as opposed to 33 percent among rural populations. In 2015, the prevalence of undernourishment was 12.9 percent in all developing regions, with 22.9 percent in sub-Saharan Africa, 22.7 percent in landlocked developing countries and 26 percent in least developed countries. Less than 30 percent of those living in sub-Saharan Africa had access to an improved sanitation facility while the percentage worldwide was 68 percent. Disaggregated data remain scarce for groups such as migrants, refugees and persons with disabilities, minorities and indigenous people. (paras 132-134)
IV Note on the data and indicators
The report identifies some of the challenges being faced by national statistical offices and the international statistical community in producing indicators for monitoring progress in the implementation of the SDGs. It refers to the Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs), which will be subject to “future modifications,” as the development of a “robust and high-quality indicator framework [is] a technical process that [will] require time” with refinements and improvements being made as “knowledge improves and as new tools and data sources become available.” Indicators will also be developed at the regional and national levels as well as indicators for monitoring the commitments of the Addis Ababa Action Agenda. (paras 135 -137) The IAEG will agree on a final classification for the “tier system” and will develop a work plan for the methodology for tier III, in consultation with specialized agencies and experts. (See also: IAEG-SDGs - Day 3) They will also discuss available data sources and methodologies for improved coverage of tier II indicators, as well as regularly reviewing tier III indicators, with a plan for “refining and reviewing the indicator framework being presented to the 48th session of the Statistical Commission in March 2017. (para 142) A High-level Group for Partnership, Coordination and Capacity-building for Statistics for the 2030 Agenda has been established. (para 145) Partnerships with civil society, the private sector and academia should be explored in the context of new data sources and technologies for data collection. (para 147)