The background note for the 2017 HLPF Thematic Review of SDG3: Ensure healthy lives and promote well-being for all at all ages, which was developed by members of the ECESA Plus group, with WHO and UNFPA as co-leads is now available.
State of progress
The note addresses all major health priorities, including “sexual, reproductive, maternal, newborn, child and adolescent health, communicable, non-communicable and environmental diseases, universal health coverage and access for all to safe, effective, quality and affordable medicines and vaccines.” It recognises the need for “more research and development, increased and diversified health financing, enhanced health workforce and strengthened capacity of all countries in health reduction and management,” with universal health coverage (UHC) acting as the key driver for achieving all the targets. Investment is a pre-requisite given the double burden of communicable diseases, the unfinished MDG agenda together with non-communicable diseases (NCDs) and injuries.
Implementation
In this section, each target under SDG3 is examined in more details. A “huge acceleration in the annual rate of reduction of at least 7.3% [of maternal mortality]” will be needed to achieve the target, which will require increasing the access of women and girls “to quality care before, during and after childbirth is critical…” The leading cause of death among adolescent girls in developing countries (and second cause globally), is complications in pregnancy. (SDG 3.1) While there have reductions in child mortality, neonatal mortality is highest in Southern Asia and sub-Saharan Africa. Meanwhile social determinants can have a significant impact on child survival, with death rates of children under-five from poorest households nearly twice as high as those from the richest households. (SDG 3.2)
In 2015, 2.1 million people became newly infected with HIV. Meanwhile the incidence among children under 15 declined by 59%. Young women, 15-24 years of age, are at a particularly high risk of infection and for women, 15-49 years of age, AIDS is the leading cause of death. Tuberculosis (TB) remains a major global health problems, with the European region having the highest rates of drug resistant TB. In the case of malaria, between 2000 and 2015 there has been a 41% decrease globally in the incidence rate, but it remains a major cause of death for children aged under-5. 1.3 million people died of hepatitis in 2015, while 583 million people still require treatment for neglected tropical diseases (NTDs). (SDG 3.3)
NCDs, namely cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, accounted for 40 million deaths in 2015, with men at higher risks than women. In addition, there were 800,000 suicides, again with men nearly twice as likely to die, but also being a major cause of deaths among adolescents. While mental health requires a multi-sectoral approach, depression “accounts for 4.3% of the global burden of disease. (SDG 3.4) With alcohol consumption increasing in the Western Pacific and South East Asia regions, consumption worldwide was projected in 2016 to be 6.4 litres of pure alcohol per person aged 15 and older. (SDG 3.5) The main cause of death among young people aged 15-19 is road traffic injuries. Furthermore, it is unlikely that any region will meet the 50% mortality reduction target by 2020. (SDG 3.6)
Access to family planning methods has only increased slightly for married or in-union women of reproductive age, although progress in demand satisfied by these methods has been substantial in least developed countries. Although teenage childbearing has declined by 21% (2000 – 2017), it is projected that births to girls aged under 15 will nearly double in the next decade. (SDG 3.7)
The two UHC indicators have been agreed by the Statistical Commission and will measure health service coverage and the proportion of the population with large household expenditure on health as a share of the total household expenditure or income. (SDG 3.8) While household (indoor) air pollution led to 4.3 million deaths globally in 2012, it “is estimated to cause half of all pneumonia deaths in children under 5 years of age.” (SDG 3.9)
1.1 billion people, far more men than women, smoked in 2015, with 6 million deaths annually. (SDG 3.a) Access to medicines for chronic conditions and NCDs is worse than access for acute conditions. In addition, health research and development is not sufficiently aligned to global health demands and needs. (SDG 3.b) The distribution of health workers across the globe is uneven. The joint ITU/WHO “Be Healthy Be Mobile” initiative is highlighted. (SDG 3.c) Migration and cross border movement remain only marginally addressed in early warning and risk reduction/management systems despite the evidence of their links with the spread of diseases. (SDG 3.d)
Recommendations include the following:
Principles, enablers and multi-sectoral action
The note recognises first and foremost, that a human rights-based approach to health is a key requirement and that a sustained emphasis is necessary to “improve multi-sectoral action, strengthen health systems, realize equity and fulfil, protect and promote human rights, promote gender equality and the empowerment of all women and girls, and to secure adequate and sustained financing and investment in scientific research and innovation.”
Health targets, such as the elimination of HIV/AIDS, or universal access to sexual and reproductive health and rights cannot be achieved without addressing violence against women and girls. There is also an urgent need to improve coverage of drinking water supply and adequate sanitation in households, schools, health facilities etc, as well as hygiene practices, taking into account the needs of women and girls.
Human resources for health
Health sector employment and health protection should be expanded, while managing migration of health workers and promoting implementation of the code of conducts of recruitment of health personnel. Meanwhile, the potential role of information and communication technologies is recognized, including mobile phones for both community health workers and patients alike.
Equitable access
Inclusive and resilient health protection schemes should be developed and implemented to ensure that there is “equitable access to quality health services for all,” while recognizing that the “right to health extends to all societies, including migrants and displaced persons.”
Enhancing data
Monitoring and evaluation should be scaled up and the availability and quality of data improved. The note recognizes that there are significant gaps in some of the data disaggregation for monitoring SDG3. These are particularly “relevant to linkages with SDGs 1, 4, 5, 10, 16 and 17 from the perspective of addressing the highest needs of vulnerable populations and leaving no-one behind.”
Growing challenges
Anti-microbial resistance, which the note recognizes is not fully captured in the 2030 Agenda, is one of the emerging threats. It could “result in a cumulative global cost of $100 trillion by 2050”, if not addressed. Mental health is also highlighted as a growing challenge, with insufficient funding being made available.
What is missing…
While the report provides an important overall picture, and includes important information in many areas, there is no reference, for example, to the health of older persons, or to persons with disabilities.
The note demonstrates the links between targets in other goals (targets: 2.2, 4.1, 4.2, 4.7, 5,2, 5,3, 5.6, 6.1, 7.1, 9.5, 11.6, 13.1, and 16.1) stating that the “interlinkages confirm that progress in health outcomes will only be achieved with progress in other related sectors, including fiscal and finance policy (e.g. taxing schemes to discourage unhealthy behaviors), nutrition, water and sanitation, air quality, road safety, education, gender equality and the empowerment of all women and girls, migration and peace and security.” It does not, however, address to the same extent how the targets in SDG 3 will contribute to the full implementation of the other SDGs.
Although there are strong references to partnerships including the Global Strategy for Women’s, Children’s and Adolescents’ Health and the Partnership for Maternal, Newborn, Child and Adolescent Health, the Special Programme for Human Reproduction (HRP) and the Special Programme for Research and Training in Tropical Diseases, collaboration with, and the role of, civil society organizations is absent.