Sep. 29 2015

A Critical Thinker’s Guide to the UN’s Sustainable Development Goals

Beyond the headlines, photo ops, and traffic jams, how should public health think about the SDGs?

A few miles downtown from the Mailman School, heads of state are committing to a set of 17 objectives aimed to achieve a world without poverty by 2030. Broad and ambitious, the United Nations’ Sustainable Development Goals have implications for nearly every facet of public health: Goal 11 outlines a vision for healthy and sustainable cities, while Goal 13 works to address the impacts of climate change. Goal 3—the official and far-reaching health goal—aims to “ensure healthy lives and promote well-being for all at all ages,” with specific targets that include everything from reducing traffic accidents to ending AIDS, tuberculosis, and malaria; and from strengthening substance abuse prevention and treatment to achieving universal health coverage.

To fully understand the SDGs, you need to know about their predecessors. If you participated in Model UN in high school, you might be familiar with this history: In September 2000, the UN issued eight Millennium Development Goals to align global efforts on issues like poverty and child mortality. Between 1990 and 2015, the world made immense progress. Extreme poverty was cut in half. The number of children dying under age five dropped from 12.7 million to nearly 6 million. Maternal mortality ratios fell by 45 percent. But can we credit the MDGs for this progress, or is it due to economic development and other forces?

Lynn Freedman, a professor of Population and Family Health who also served on the UN Millennium Project Task Force on Child Health and Maternal Health, one of several UN Task Forces designed to help provide a road map for countries to achieve the MDGs, believes that crediting the MDGs alone is a stretch. But she can’t deny the focus and funding the MDGs brought to issues that might otherwise have gone ignored. “Maternal mortality would never have gotten the attention it has gotten in the last 15 years if it had not been an MDG,” she says.

To the frustration of many, the process for determining which issues were included in the MDGs was not transparent or open. In 2015, that’s changed. The consultation process for the SDGs spanned years, with meetings and panels organized around the world to allow governments and NGOs to provide input and lobby for their issues. 

Another difference between the SDGs and their predecessors is whom they are intended for. The MDGs focused on improving health in lower-income countries, with the expectation that higher-income countries would help foot the bill. The new goals call on every nation, rich and poor, to address the unique health needs of their populations. For the United States, relevant targets include preventing and treating non-communicable diseases such as heart disease and cancer, promoting mental health and well-being, reducing deaths and injuries from traffic accidents, and improving air, water, and soil quality.

“Health is a human right” is the first sentence of the Public Health Oath at the Mailman School—but you won’t find health guaranteed as a right in either the MDGs or the SDGs. While the SDG process was more inclusive and transparent, decisions were made by people and agencies in power, rather than marginalized groups or those working for change at the community level. While global goals have a place, real change in community health begins, says Freedman, “at the front lines of the health system and works backward from there, instead of world leaders picking a global goal and hoping everything will be solved from up high.”

On Friday, world leaders voted unanimously to formally adopt the SDGs. Now the hard work of achieving them begins. Despite a few shortcomings, the goals are a big part of the future of public health for the next 15 years. “There’s no question the goals will be the vocabulary and framework that everyone in global health will use. For this reason, it’s crucial to have a critical eye on what these goals do and don’t do,” says Freedman. “You have to know the difference between aspiration and implementation.”