High-level political forum: Health in the 2030 Agenda

Thematic review of SDG 3 Ensure healthy lives and promote wellbeing for all at all ages 

During the high-level political forum (HLPF) a thematic review took place of SDG 3 Ensure healthy lives and promote wellbeing for all at all ages. This provided the first opportunity, since the adoption of the 2030 Agenda at the Summit in 2015, to look at the health goal in detail and to assess interlinkages for health with the other goals that were also reviewed. Insofar as SDG 3 will not be reviewed again until after the end of the current cycle, we will be posting a series of articles looking at the various presentations and statements, as well as related documentation. These postings will, we hope, assist organizations and networks in assessing how the 2030 Agenda can best be used in promoting all aspects SDG 3 and related health targets in the coming years.

The first of this series of postings is below.

HLPF: Health in the 2030 Agenda (1)

Thematic session on Goal 3 Ensure healthy lives and promote wellbeing for all at all ages – Panel presentations

This 5th session of the High-level Political Forum (HLPF), recognizing that health is a precondition, indicator and an outcome of sustainable development, explored inter-sectoral solutions to advance its implementation and the 2030 Agenda, as a whole. The following are summaries of the presentations by members of the panel:

The moderator, Dr Nata Menabde, Executive Director of WHO Office at the United Nations, New York, in introducing the discussion, said that while being a different kind of review to those for the health MDGs, it provided an opportunity to build on MDGs 4,5 and 6. Approaches today will be different but one element that has not changed is rigorous monitoring. As said by Dr Margaret Chan, the former WHO Director-General, “what gets measured, gets done”. It was encouraging to see so many new countries reporting their voluntary reviews. For WHO the key is to ensure the right of every individual to basic health services. All countries are encouraged to focus on target 3.8 on universal health coverage (UHC). Speaks to universality of 2030 Agenda. When countries are healthy, families, communities and countries all benefit. Currently 400 million still people lack basic health services and 100 million are being thrust into poverty as they have to pay for services out of their own pockets. The 2030 Agenda and all goals and targets should be examined as to those that interlink with social and environmental determinants of health. Meeting targets beyond SDG 3 will benefit health just as much as meeting SDG3 will benefit other targets.

Francesca Perucci, UN Statistics Division, presented on trends in SDG 3. She noted the progress in maternal mortality rate, which was reduced by 37% between 2000 and 2015, although there are still 303,000 maternal deaths every year. It will be necessary to double the current rate of progress to reach the target by 2030. Progress has also been made in child survival, however, wide disparities remain with almost double child mortality rate in Africa. There has been progress in communicable diseases, including a 46% reduction in HIV incidence, although the rate increased in North America and Europe. An impressive decline can be seen in the incidence of tuberculosis, and a 21% drop in malaria. While the rate of progress not sufficient to achieve the SDG target, there has been a decline in premature deaths as well as a fall in risk of dying from the four most common non-communicable diseases (NCDs) between ages of 30 and 70, 2000-2015.

HE Laura Flores Permanent Representative of Panama, a member of the UNDP/UNFPA/UNOPS Executive Board, stressed the importance of intervening in the structural causes of poverty to achieve sustainable development, as a human right, as set out in the 2030 Agenda. Inequalities must be combatted and opportunities created for those who have been left behind to help them achieve a decent standard of living, prosperity for all, and protection of the planet. Dimensions of poverty exist, not related to income, such as deprivations in the areas of food and nutrition, access to education, and health.

The right and access to basic health and sanitation is a precondition, a result and an indicator of sustainable development. SDG 3 links to 14 of the 17 goals and 38 of the 169 targets that contribute directly or indirectly to ensure healthy lives and promote well-being for all, at all ages. Similarly, health is key to the achievement of the other SDGs, which relates to the central role of health in development. The challenge is how to adapt this integrated, articulated and holistic framework to the SDGs and indicators and to the institutions that make the national health policy, in order to accelerate progress.

Despite progress made during the MDG stage, significant challenges remain, exacerbated in the context of reduced or eliminated financial resources. The task relates to reduce maternal, neonatal and child mortality; improve nutrition; ensure universal access to sexual and reproductive health; and combat communicable diseases such as HIV/AIDS and other sexually transmitted infections, tuberculosis, malaria, neglected tropical diseases and hepatitis.

Reliable information systems for monitoring and evaluating SDG indicators constitute one of the catalysts for progress together with the availability of timely and disaggregated data. Political will of governments is required to address the social determinants of health and to transform public health.

Emerging issues that are major current challenges in health, include: aging and disabilities, antimicrobial resistance, which is a silent crisis, consequences of climate change, environmental degradation and pollution, mental health, migration and urbanization. They transcend thematic boundaries. Prevention, moreover, remains the best cure and the key to the success of the Agenda.

Michael Myers, Managing Director, Rockefeller Foundation said that for the last decade, the Rockefeller Foundation has been a global leader on UHC. It is important because of equity issues, including how to ensure that the spirit and letter of SDG 3 meets that standard. UHC is the centre of the agenda for the new WHO Director-General. It has been necessary to set the political conditions for UHC, as well as making the technical expertise available. The Rockefeller Foundation has contributed to this in a joint learning network of 27 countries and it also supported the WHO landmark report on UHC in 2010 and celebrated the UNGA session in 2012. Through its efforts, the Foundation has brought together economists to confirm that investments in health are good for growing economies.

Myers remarked on the following general lessons:

  • Equity doesn't just ‘happen’. We have to be intentional to reach the last mile of populations, even gender and meeting the needs of women and girls
  • We must look to the future rather than just address the present, eg looking at air pollution and environmental causes of disease and morbidity and climate change, which affects nutritional basis for foods. The projection is that the non-communicable disease (NCD) burden
  • We must operate multi-sectorally, which the SDGs present an opportunity to do, eg one of the strongest investments for health is girls’ education, with a 22:1 return on investment in health. Clean water and sanitation are also important for health, as is clean energy 
  • We are dealing predominantly with political questions, eg how we organize domestic and international resources.  And, we need to be more sophisticated going forward… 

The moderator referred to the strong contribution from civil society to the UHC agenda, which had been crucial in making it happen.

Rachel Cohen, Regional Executive Director, Drugs for Neglected Diseases Initiative (DDI) referred to SDG target 3.b on support for research and development of vaccines medicines for communicable diseases and NCDs and access to affordable medicines. Old fault lines between communicable diseases and NCDs are becoming perhaps out-dated. The current system for financing and incentivizing bio-medical innovation is deeply broken and leaving many people behind, despite major scientific advances. Need to address dearth of innovation and the high prices of medicines which remain out of reach for millions of people regardless of the income-level of the country in which they live. Lack of access for children to affordable anti-retroviral medicines; for adults to hepatitis C treatment; or treatment for drug-resistant gonorrhoea reflect market failure.


If not tackled in the right way, progress cannot be made on the health targets.  Patient needs and public health priorities should be put first together with strategies that promote collaboration in science, not competition. There must be a commitment to delivering medicines and other health technologies at an affordable price. This requires public leadership and public funding and safeguards to protect return on investment. High prices of medicines must be challenged and principles such as equity and affordability adhered to, not only for tropical diseases but for all areas of health.

Marie Hauerslev, Vice President for External Affairs, International Federation of Medical Students’ Associations (IFMSA) highlighted that:

(a) Political will is needed to beat NCDs. These are diseases of the poor and also of young people, occurring in all population groups and particularly affecting those living in poverty hardest. NCDs are a social justice issue.


Sexual and reproductive health rights should equip young people with the knowledge, skills, attitudes and values they need to enjoy their sexuality and to achieve health and disease prevention and to be in healthy relationships. Comprehensive sexuality education (CSE) is a culturally relevant approach to educate young people to exercise their sexual and reproductive health and to empower them to make informed decisions about their health and sexuality. While IFMSA provides CSE globally, they see it as being a fundamental component of Member States’ responsibilities. Access to family planning services, including contraceptives, is required, as well as access to safe abortion and stigma and discrimination in health care should be eliminated.


People in conflict situations are particularly vulnerable and health as a human right should also apply to them. Again, political will is necessary in addressing attacks on sex and health care services and should be addressed urgently. The medical curriculum currently does not train medical students in disaster medicine and IFMSA is now developing a course to address this.

(b) Policy coherence is most important in addressing policies that that are mutually supportive and strengthening them across governments most effectively.  It is important that they are inter-related and coherent within the health sector and with other part of  Government.

The SDGs, moreover, are interlinked. For SDG 3 every Minister in the Government should be thought of as a minister for health. It is necessary to think about health outside the health sector eg linking health with indoor (through cook stoves) and outdoor air pollution and climate change and the drivers of climate change.

It also means addressing the commercial determinants of health in a comprehensive manner. And, it will not be possible to achieve the SDGs without addressing issues outside the traditional health spheres such as international finance, trade and investment policies.

(c) Investments in health: Current funding for cost-effective health interventions is grossly inadequate and unbalanced as donors support some areas such as communicable diseases and maternal and child health to a larger degree than they support NCDs, which have a much greater impact. Regulatory and fiscal policies can be used to make positive change, eg taxation of tobacco and alcohol.

Industry interference is a challenge to achieve such policies. Lowering prices on healthy products such as fruits and vegetables and allowing individuals to make healthy choices can also be effective.

Investing in the health workforce can bring economic growth. The doctor / patient ratio is 1:200 in some countries as opposed to 1: tens of thousands in other countries and there are challenges for example such as low numbers of health care workers in rural areas. Simply, there are not enough doctors and nurses.

Youth are affected by many of these diseases with of the diseases, despite being perceived as ‘healthy’. Seventy per cent of risk factors for NCDs start in adolescence, and there are other health concerns that affect this age group, such as teen-age pregnancy, child marriage, high rates of suicide, mental health and traffic injuries. Young people must be involved as there is “nothing about us without us”. There is a need for find the best ways for youth participation at all levels and bright, innovative young people stand ready to help.

Editor’s comment: The comments from Francesca Perucci, although not covering all the targets included under SDG 3, provide a realistic assessment that, while progress has been made since the end of the MDGs, there is still much work to do between now and 2030.  While the presenters focused predictably on NCDs and UHC, sexual and reproductive health and rights and the health of women, young people and girls was also addressed. Linkages were also made to other goals and targets, which will be important in ensuring that health concerns remain on the agenda for the remaining years of this review cycle. In particular, the linkages between health and water, energy and urban development in 2018 and between health and education, reducing inequalities and climate change in 2019 will be most relevant.


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