With the end date for the Millennium Development Goals (MDGs) approaching, the debate on targets for global development beyond 2015 is underway.
Fewer health targets
At a Global Health Lab discussion hosted by London School of Hygiene and Tropical Medicine on 26 March 2013, contributors acknowledged that health may have a narrower profile in future targets than in the MDGs, where three out of eight goals were health targets.
The current discourse includes health as only one out of 11 sectors. There will be some sectors with a clear overlap with health, such as water and food security, and other sectors, such as governance, will have downstream impacts for health.
So whether there is a single health target termed ‘universal health coverage’ or ‘healthy life expectancy’ or by any other name, it is clear that in the longer term practitioners will additionally need to talk about health in cross-sectoral terms.
How are the targets being decided?
Governments and international agencies are engaging in two main forums of discussion to address the question of what will follow the MDGs.
The UN High Level Panel on the post-2015 development agenda is centred on poverty eradication and building on the work of the MDGs. The UN Open Working Group on Sustainable Development was called as an outcome of the Rio20+ meeting and has a broader remit, focussing on social justice and community level work, with human development as one pillar.
Sustainable development goals?
It is not yet clear what form the post-2015 agreements will take, and how this will affect development work, although targets are likely to be termed Sustainable Development Goals (SDGs). An interesting thorny political question for middle and higher income countries is to what extent future goals will address relative poverty or will simply continue to target absolute poverty at a global level.
Equity and financing of health services
There is a strong argument from international health representatives that any future targets on health must tackle equity in health services and health financing issues, two key concerns which were not sufficiently incorporated in the MDGs.
In order to do this, indicators must be sensitive to reveal whether health improvements are being experienced by people in the lowest quintile. Health systems must also ensure a sufficient level of financial protection for service users, avoiding reliance on out-of-pocket expenses and associated opportunity costs that adversely affect household finances, increase poverty and hamper development.
Improving global health
So while health may have less attention in post-2015 agreements, there is still an underlying commitment at the highest level to improving health for all, and a recognition that health is a key part of sustainable development.