SDG3 - Good Health & Wellness
"The essence of global health equity is the idea that something so precious as health might be viewed as a right." – Dr. Paul Farmer
This is the fifth installment of the SDGs spotlight series. Sustainable Development Goal 3 is to “ensure healthy lives and promote well-being for all at all ages.” It addresses all major health priorities, including reproductive, maternal and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines. It also calls for more research and development, increased health financing, and strengthened capacity of all countries in health risk reduction and management.
In light of the World Health Organization’s World Immunization Week this week and ahead of SDG3’s review at the High Level Political Forum in July, here’s some background about what SDG3 means and how it’s being or could be pursued.
What is “good health and wellbeing”?
Particularly following health investments made during the MDG era (2000-2015), significant gains have been made with respect to increasing life expectancy, reducing child and maternal mortality, increasing access to clean water and sanitation, and reducing the incidence of infectious disease.
Maternal and child health:
Between 2000 and 2015, the global maternal mortality ratio decreased by 37% to an estimated ratio of 216 per 100,000 live births in 2015. Almost all maternal deaths are preventable and occur in low-resource settings.
Global under-five mortality rates fell 44% from 2000 to 2015, but an estimated 5.9 million children under the age of 5 died in 2015, with a global under-five mortality rate of 43 per 1,000 live births. The neonatal mortality rate declined from 31 deaths per 1,000 live births in 2000 to 19 deaths per 1,000 live births in 2015.
Child Mortality under 5 (World Bank)
Worldwide, in 2015, approximately 3 in 4 women of reproductive age (15 to 49 years of age) who were married or in union satisfied their need for family planning by using modern contraceptive methods; in sub-Saharan Africa and Oceania, however, the share was less than half.
Childbearing in adolescence has steadily declined in almost all regions, but wide disparities persist: in 2015, the birth rate among adolescent girls aged 15 to 19 ranged from 7 births per 1,000 girls in Eastern Asia to 102 births per 1,000 girls in sub-Saharan Africa.
Globally in 2015, the number of new HIV infections among all people was 0.3 new infections per 1,000 uninfected people; 2.1 million people became newly infected that year. The highest incidence of HIV was in sub-Saharan Africa, with 1.5 new cases per 1,000 uninfected people.
In 2014, 9.6 million new cases of tuberculosis (133 cases per 100,000 people) were reported worldwide, with 58% of them in South-Eastern Asia and the Western Pacific.
Almost half the world’s population is at risk of malaria and, in 2015, the incidence rate was 91 new cases per 1,000 people at risk, an estimated total of 214 million cases. Sub-Saharan Africa accounted for 89% of all malaria cases worldwide, with an incidence rate of 235 cases per 1,000 people at risk.
In 2012, nearly 1 million people died from infectious diseases caused largely by inadequate sanitation and hygiene. In the same year, household and ambient air pollution resulted in some 6.5 million deaths.
Non-communicable disease:
According to estimates from 2012, around 38 million deaths per year, or 68% of all deaths worldwide, were attributable to non-communicable diseases. Of premature deaths (deaths under the age of 70) 52% were as a result of non-communicable diseases. Over three-quarters of premature deaths were caused by cardiovascular disease, cancer, diabetes and chronic respiratory disease. Globally, premature mortality from those four main categories of non-communicable disease declined by 15% between 2000 and 2012.
In 2015, over 1.1 billion people consumed tobacco, with far more male (945 million) than female (180 million) smokers.
Worldwide in 2015, average alcohol consumption was estimated at 6.3l of pure alcohol per person among those aged 15 or older, with wide variations across countries. Alcohol consumption was highest in the developed regions (10.4l per person) and lowest in Northern Africa (0.5l per person).
In 2013, only about 1 in 6 people worldwide suffering from drug-use disorders received treatment. Approximately 1 in 18 people with drug-use disorders received treatment in Africa that year, compared with 1 in 5 in Western and Central Europe.
The most common mental disorders are anxiety and depression, which can lead to suicide. In 2012, an estimated 800,000 people worldwide committed suicide, and 86% of them were under the age of 70. Globally, suicide is the second leading cause of death among those between the ages of 15 and 29.
Total official flows from all providers for medical research and basic health sectors were $8.9 billion in 2014. Of these funds, ODA from DAC donors was $4.5 billion in 2014, an increase of 20% in real terms since 2010, with the UK and the USA accounting for $2.6 billion of that total. In 2014, $1 billion was spent on malaria control and $1.2 billion was spent on other infectious diseases, excluding AIDS.
The targets set for SDG3 are:
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
By 2020, halve the number of global deaths and injuries from road traffic accidents 3.7
By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate
Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
According to the World Health Organization, 40 million new health and social care jobs must be created globally by 2030 to meet SDG3. At the same time, the International Labour Organization says global youth unemployment reached 71 million in 2016. An article by Devex proposes using the two problems to solve each other.
A report from the Business Commission suggests that achieving the Global Goals opens up US$12 trillion of market opportunities in food and agriculture, cities, energy and materials, and health and wellbeing. Together, these represent around 60% of the real economy.
There is a consensus of recommendations for businesses interested in engaging on SDG3: Target the bottom of the pyramid to improve access and grow markets. Dr. Michael Hopkins suggests that businesses work with public health sectors to develop cheaper and more appropriate products, especially for maternal and child health and development. The Business Commission drew up a list of market opportunities related to delivering SDG3:
Other recommendations from the UN include implicating other SDGs, for instance reducing “the use of harmful chemical and pollutants that negative impact people’s health.”
Companies working on SDG3 take both a CSR/philanthropic approach and an inclusive business approach. Businesses trying the former include Flora pro.activ and Vaseline in the Unilever family:
Flora pro.activ’s It Takes a Village initiative works on lowering the world's cholesterol.
In partnership with the NGO Direct Relief, the Vaseline Healing Project provides dermatological care, medical supplies, Vaseline products, and local health worker training to vulnerable people around the world. In 2015, Vaseline donated 1.2 million units of Vaseline and sponsored three dermatological missions to Jordan, the Philippines and Kenya.
Kaiser Permanente is an integrated managed care company based in the US. It invests in community health initiatives through innovative efforts to increase nutritious foods, physical activity, economic vitality, safety, and wellness in local schools, workplaces, and neighborhoods.
A report from Tufts called The Inclusive Innovators covered 20 cases of companies serving the “bottom of the pyramid” to tackle the SDGs:
Coca-Cola, the world’s largest beverage company with more than 3,600 products worldwide, seeks to provide transparent nutrition information, support healthy living, and market responsibly. Coca-Cola offers low- or no-calorie beverage options in 191 markets, with transparent nutrition information on the front of all packaging. It advocates for improved public health in the communities where it does business: By 2014, Coca-Cola had implemented 330 programs targeting increased physical activity in 112 communities. In 2014 Coca-Cola also developed a new, more comprehensive responsible marketing policy banning advertising to children under 12 across all forms of media.
Diageo is a global beverage company that operates in over 180 countries with over fifty brands of alcohol products (think: Guinness, Smirnoff, Captain Morgan, Baileys, etc., etc.). The company has six priorities for its inclusive business strategy, including reducing alcohol-related harm by 10%, protecting water resources, and protecting employee safety and rights.
Janssen Pharmaceuticals, Inc. is a leading global pharmaceutical company and a subsidiary of Johnson & Johnson. Janssen uses tiered pricing to reach the bottom of the pyramid and maximize access to healthcare: “For example, in oncology, Janssen has an equity-based tiered pricing program in place in middle-income countries that often have an uneven distribution of wealth. Whereas before frontier markets were deemed too high-risk for higher-value products, the flexibility afforded by tiered pricing is believed to be a model that ‘paves the way for market introduction.’”
Genzyme, a subsidiary of Sanofi (the world’s fifth largest pharmaceutical company), is a biotech company working on therapies for rare diseases. Genzyme relies on organizational partners, including Project HOPE, ANERA, Direct Relief, and others, for their local expertise and relationships, which help Genzyme support patients and navigate the challenges of access. A major success for Genzyme has been finding ways to subsidize the cost of treatment for patients. Partners, including the Gates Foundation, remain vital to this initiative.
Essilor is the world’s largest corrective eye care company and predicts that 95% of the 2.5 billion people worldwide without access to corrective eye care live in emerging countries. Among other steps, the company has developed standardized products for consumers at the bottom of the pyramid, which allow for some customization while reducing costs.
Companies are organizing not just within but also between themselves in the pursuit of SDG3: GBCHealth, for instance, is a coalition of companies and organizations committed to investing their resources to make a healthier world for their employees, for the communities in which they work, and for the world at large. GBCHealth helps companies develop and implement their own global health programs, brokers global and local public-private partnerships and connections, and leverages business advocacy in the service of public health.
SDG Compass produced tools for businesses related to the SDGs, including human rights assessments and benchmarks and technical guidance.
Mentioned earlier, Direct Relief is a common example of a nonprofit working on SDG3: It’s a humanitarian aid organization active in 72 countries with a mission to improve the health and lives of people affected by poverty or emergencies. Direct Relief’s assistance programs focus on maternal and child health, the prevention and treatment of disease, and emergency preparedness and response. As we’ve seen, Direct Relief is very active with corporate partnerships, including work with Genzyme/Sanofi and Vaseline/Unilever.
Individuals and companies can donate to Global Impact’s SDG Fund, which is a philanthropic nonprofit that supports charities working on the SDGs. Donations to this goal's fund support AmeriCares, Amref Health Africa, Catholic Medical Mission Board, Direct Relief, Doctors Without Borders/Médecins Sans Frontières USA, International Medical Corps, Medical Teams International, PACT, and PATH.
