WHO report on Progress in the implementation of the 2030 Agenda for Sustainable Development now available

The World Health Organization has posted its report on Progress in the implementation of the 2030 Agenda for Sustainable Development (A70_35-en.pdf). It will be considered during the discussion on provisional agenda item 16, Promoting health through the life course, tentatively on Monday 29 May and will be the first follow up by the World Health Assembly to its resolution of 2016, WHA69.11.

The report has changed considerably from that presented to the Executive Board (EB) in January 2017 and generally takes into account comments made by Board members and observers. Part I reports on global and regional progress made by Member States in the implementation of SDG3 and other health-related targets and Part II describes the progress made in implementing progress made in implementing resolution WHA69.11.

Part I: Progress by Member States towards the health-related SDGs and targets

In compiling the report, WHO drew on information from the World Health Statistics 2016 (accessed 21 April 2017) and updated information from the World Health Statistics 2017, which also reviews the six lines of action, proposed by the Secretariat, namely

• intersectoral action by multiple stakeholders
• health systems strengthening for universal health coverage (UHC)
• respect for equity and human rights
• sustainable financing
• scientific research and innovation
• monitoring and evaluation

As demonstrated by available data, “major challenges remain in terms of reducing maternal and child mortality, improving nutrition, and achieving further progress in the battle against infectious diseases such as HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and hepatitis.” The importance is also emphasized of addressing noncommunicable diseases (NCDs) and their risk factors, including tobacco use; mental health problems; road traffic injuries; and environmental health issues. Obstacles include weak health systems, which lead to “deficiencies in coverage for even the most basic health services and inadequate preparedness for health emergencies.” While sexual and reproductive health services are expanded to some extent in the priority areas following strong statements in the EB in the context of target 3.7, there remains no linkage or reference to reproductive rights as included in target 5.6.

Maternal and child health (SDG targets 3.1 and 3.2) and nutrition (SDG target 2.2)

The global maternal mortality ratio in 2015 was 216 per 100,000 live births, requiring a global annual rate of reduction of at least 7.3 percent and more than three times the rate of reduction between 1990 and 2015 to achieve target 3.1. In 2016, moreover, only 78 percent of births were in the presence of a skilled birth attendant. Meanwhile the annual rate of reduction in under-5 mortality was 3.9 percent between 2000 and 2005, which means that the target of 25 per 1000 live births by 2030 can be met at the global level if this momentum is maintained. Meanwhile, the annual rate of 3.1 percent for neonatal mortality between 2000 and 2015 must be maintained to meet the target of 25 per 1,000 live births by 2030. In 2016 globally, 155 million children under-5 were stunted (too short for their age); 52 million were wasted (too light for their height); and 41 million were overweight (too heavy for their height). The number of overweight children increased globally by 33 percent between 2000 and 2016. (paras 4-7)

Infectious diseases (SDG target 3.3)

In 2015, some 2.1 million people were newly infected with HIV, a rate of 0.3 new infections per 1,000 uninfected people. In the African Region, the most severely affected, 4.4 percent of adults 15-49 are living with HIV. There is, however, an increasing number of new infections in the European Region. The malaria incidence rate in 2015 was 94 per 1,000 persons at risk, demonstrating a global decrease (greatest in Europe) of 41 percent between 2000 and 2015, with 212 million cases and 429,000 malaria deaths globally in 2015. There were an estimated 10.4 million new cases of tuberculosis (TB) in 2015 with 1.4 million deaths and 0.4 million more deaths among HIV-positive people. The highest rates of drug-resistant TB are in the European Region. In 2015, there were some 1.3 million deaths attributable to hepatitis, while global coverage of three doses of hepatitis B vaccine reached 84 percent of infants. In the same year, a reduction was reported from 2 billion in 2010 to 1.59 billion people, mainly poor and marginalized, requiring mass or individual treatment and care for neglected tropical diseases. (paras 8-13)

Noncommunicable diseases, tobacco control, mental health and substance abuse (SDG targets 3.4, 3.5 and 3.a)

There were 40 million deaths globally due to NCDs in 2015, 70 percent of all deaths worldwide. The main causes were: cardiovascular diseases (45 percent); cancers (22 percent); chronic respiratory diseases (10 percent); and diabetes (4 percent). Overall there was a decrease in the risk of dying from these four diseases between ages 30 and 70 from 23 percent in 2000 to 19 percent in 2015. The risk was higher in all WHO regions for men than for women. Meanwhile, available data indicates that treatment coverage for alcohol and drug use disorders is inadequate. More than 1.1billion people, many more males than females, smoked tobacco in 2015. The WHO Framework Convention on Tobacco Control has been ratified by 180 States Parties, representing 90 percent of the global population. Globally there were nearly 800,000 suicide deaths in 2015, with twice as many men as women dying this way. The highest suicide rates are in the European Region (14.1 per 100,000) and lowest in the Eastern Mediterranean Region (3.8 per 100,000). (paras 14-18)

Injuries and violence (SDG targets 3.6, 5.2, 13.1, 16.1 and 16.2)

In 2013, some 1.25 million people died from road traffic injuries, the main cause of death among people aged 15 to 29 years. Between 2011 and 2015, an average 0.3 deaths per 100,000 were due to natural disasters. There was a decline in homicide rates of 19 percent globally, with some 468,000 murders in 2015, of which four-fifths of the victims were men. According to the latest estimates 23 percent of adults suffered physical abuse as a child and 35 percent of women at some time in their lives have experienced either physical or sexual intimate partner violence or non-partner sexual violence. (paras 19-23)

Sexual and reproductive health services (SDG target 3.7)

In 2016, 77 percent of women of reproductive age who were married or in a union had their need met for family planning with a modern method of family planning worldwide and the global adolescent birth rate was 44.1 per 1,000 women aged 15-19, with the rate five times higher in low-income as opposed to high-income countries. (paras 24-25)

Universal health coverage and health systems (SDG targets 3.8, 3.b, 3.c and 17.19)

Consultations began in February 2017 with Member States on estimates for the UHC indicators (3.8.1 coverage of essential services and 3.8.2 proportion of the population with large household expenditure on health as a share of total household expenditure of income). The process will provide the first comparable set of monitoring figures. Countries, on average, have data for around 70 percent of tracer interventions for indicator 3.8.1, and 50 percent have at least one data record for 3.8.2 since 2005. Globally 86 percent of children received their third dose of diphtheria, pertussis and tetanus (DPT3) vaccine in 2015. The median availability for selected essential medicines was only 60 percent and 56 percent in the public sector of low-income and lower-middle-income countries respectively, with access to medicines for chronic conditions and NCDs being worse than for acute conditions. Innovation for new products also continues to be focused away from the health needs of those living in developing countries, while health research and development is “insufficiently aligned with global health demands and needs.”

The distribution of health workers worldwide is uneven with regions with the highest disease burden having the lowest proportion of health workforce. The workforce is even distributed inequitably in countries with higher national workforce densities, with a tendency to understaffing in rural and hard-to-reach areas. Moreover, only about half of the Member States register at least 80 percent of the causes of death. The report of the High-level Commission on Health Employment and Economic Growth “Working for health and growth: investing in the health workforce” identifies the social and economic gains that could be made from investments in the health workforce beyond decent work and economic growth (SDG8), including poverty elimination (SDG1), good health and well-being (SDG3), quality education (SDG4) and gender equality (SDG5). (paras 26-31)

Environmental risks (targets in SDGs 3, 6, 7, 9, 11, 12 and 13)

Insofar as some 3 billion people still use solid fuels (wood, crop wastes, charcoal, coal and dung) to cook and heat their homes using open fires and leaky stoves, there were in 2012 4.3 million deaths due to household air pollution, women and children being particularly at risk. Meanwhile, some 92 percent of the world’s population was living in 2014 in places that did not meet the WHO air quality guidelines and in 2012 an estimated 871,000 deaths resulted from contaminated drinking water, water bodies and soil, and inadequate hand-washing facilities etc. There were also 108,000 deaths from unintentional poisonings in 2015, which was a reduction from 133,000 in 2000. (paras 32-36)

Health risks and disease outbreaks (SDG target 3.d)

In addressing capacity-strengthening for early warning, risk reduction and management of national and global health risks, the “International Health Regulations (2005) monitoring process involved assessing, through a self-assessment questionnaire sent to States Parties, the implementation of 13 core capacities, such as legislation, coordination and preparedness.” The response in 2016 was 66 percent, with the average score being 76 percent. (para 37)

Part II: Progress made in implementing resolution WHA69.11

Sixty WHO country offices have already engaged with governments, either directly or via UN country teams and a further 65 countries are beginning the process. The aim is to align national health policies, strategies and plans with the SDGs. In addition, WHO has partnered with the EU and Luxembourg to develop national health policies, strategies and plans in more than 30 countries and many European countries have aligned their national health policies with Health 2020: the European policy for health and well-being, which is aligned to the 2030 Agenda. Activities have already begun to be carried out in all WHO Regions and the Secretariat has provided advice to the IAEG-SDGs on health-related indicators, as well as reviewing data for the indicators in the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). Support has been given to countries presenting their voluntary national reviews to the High-level Political Forum in July 2017; to the International Health Partnership for UHC 2030; and to national level efforts to “leave no one behind”.

Among initiatives supported by WHO are the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030); the Energy for Women’s and Children’s Health initiative; and the Expanded Special Project for Elimination of Neglected Tropical Diseases, including onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths and trachoma. WHO is also with FAO leading implementation of the UN Decade of Action on Nutrition and is working to protect health at the human-animal-ecosystem interface through its One Health programme, established in January 2017, including the interesctoral management of antimicrobial resistant pathogens. The Alliance for Health Policy and Systems Research, an international partnership hosted by WHO, has, moreover, developed an innovative model of embedded research led by decision-makers. It addresses context-specific factors relevant to health system priorities. (paras 38-52)

The alignment of WHO’s activities to the implementation of the 2030 Agenda can be seen in its statement in paragraph 51:

“It is clear that the control of communicable diseases (category 1) and noncommunicable diseases (category 2) depends on promoting health through the life course (category 3, responding for example to questions concerning gender, equity, ageing, and social and environmental determinants) and on strengthening health systems (category 4, for example by aligning national health policies and plans with the Sustainable Development Goals).”

The WHA is asked to note the report.