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WHO Library Cataloguing-in-Publication Data Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. 1.Global Health. 2. Health Priorities. 3.Conservation of Natural Resources. 4.Organizational Objectives. I.World Health Organization. ISBN 978 92 4 156511 0 (NLM classification: WA 530) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Design and layout by L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Printed in France. ACKNOWLEDGEMENTS The principal authors of this report are Ties Boerma, Colin Mathers, Carla AbouZahr, Somnath Chatterji, Daniel Hogan and Gretchen Stevens, assisted by Wahyu Retno Mahanani, Jessica Ho, Florence Rusciano and Gary Humphreys. All chapters are based on contributions from WHO departments, programmes and partnerships, as well as other United Nations agencies and academic institutions, with specific contributions from Jonathan Abrahams, Heather Adair-Rohani, Najeeb al-Shorbaji, Valentina Baltag, Shannon Barkley, John Beard, Nicole Bergen, Douglas Bettcher, Michel Beusenberg, Ann Biddlecom, Monika Blössner, Elaine Borghi, Cynthia Boschi Pinto, Bela Bovy, Rick Brennan, Sylvie Briand, Alexander Butchart, James Campbell, Diarmid Campbell-Lendrum, Andrew Cassels, Jorge Castilla, Daniel Chisholm, Doris Chou, Richard Cibulskis, Giorgio Cometto, Alison Commar, Marilys Corbex, Melanie Cowan, Bernadette Daelmans, Cornelis de Joncheere, Carlos Dora, Tarun Dua, Chris Dye, Tessa Edejer, David Evans, Majid Ezzati, Cristin Fergus, Jane Ferguson, Christopher Fitzpatrick, Alexandra Fleischmann, Katherine Floyd, Silvia Franceschi, Claudia Garcia-Moreno, Abdul Ghaffar, Philippe Glaziou, Andre Griekspoor, Michael Gruber, Laurence Grummer-Strawn, Michelle Hindin, Rifat Hossain, Ahmad Reza Hosseinpoor, Justine Hsu, Hamid Jafari, Rick Johnston, Sowmya Kadandale, Rania Kawar, Edward Kelley, Ron Kessler, Marie-Paule Kieny, Rüdiger Krech, Joseph Kutzin, Jeremy Lauer, Katherine Lofgren, Belinda Loring, Daniel Low-Beer, Blerta Maliqi, Matthews Mathai, David Meddings, Christopher Mikton, J. Jaime Miranda, Nirmala Naidoo, Lori Newman, Margaret Peden, Vladimir Poznyak, Amit Prasad, Annette Prüss-Ustün, Mario Raviglione, Dag Rekve, Leanne Riley, Gojka Roglic, Alex Ross, David Ross, Nancy Sampson, Shekhar Saxena, Lale Say, Anne Schlotheuber, Gerard Schmets, Amani Siyam, Shams Syed, Tibor Szilagyi, Tamitza Toroyan, Edouard Tursan D’Espaignet, Nicole Valentine, Meindert Onno Van Hilten, Cherian Varghese, Eugenio Villar Montesinos, Joanna Vogel, Milton Were, Teodora Wi, Stefan Wiktor.
PREFACE In 2015 the Millennium Development Goals (MDGs) come to the end of their term, and a post-2015 agenda, comprising 17 Sustainable Development Goals (SDGs), takes their place. We stand on the threshold of a new era. This is an important moment to look back at the trends that have defined health-related development under the MDGs, noting achievements, highlighting lessons learned, drawing attention to unfinished business, and looking forward to the challenges we must now face. Dr Margaret Chan Director-General World Health Organization While progress towards the MDGs has been impressive in many ways, much work remains to be done. In health, unprecedented progress has been made in reducing maternal and child mortality and in the fight against infectious diseases, even though several global and many country MDG targets were not met. The unfinished agenda needs to be addressed, but more importantly the dramatic progress paves the way for more ambitious achievements by 2030. Similarly important is addressing other significant, ongoing public health challenges that were left out of the MDGs altogether, notable among them the challengse of acute epidemic diseases, disasters and conflict siituations, the burgeoning epidemic of noncommunicable diseases and mental health disorders and large inequalities in all parts of the world. The SDGs address many of these issues head on, setting a new health goal (“Ensure healthy lives and promote well-being for all at all ages”) with a broad set of targets. The SDGs also significantly broaden the scope of action with 17 goals, covering a wide range of human activity across the three sustainable development dimensions (economic, social and environmental): people, planet, prosperity, peace and partnership, the five Ps of the new agenda, an agenda for all countries. Fundamental to achieving the SDGs will be the recognition that eradicating poverty and inequality, creating inclusive economic growth, preserving the planet and improving population health are not just linked but interdependent. This has profound implications for development strategy, many of which will only be revealed as we move forward. But some seem fairly clear at the outset, including the fact that silo-based, vertical approaches to development will have to give way to broader, cross-cutting approaches coordinated around and aligned with countries’ needs and priorities. By taking a more integrated approach to development the SDGs present us with an opportunity to advance, seizing opportunities to collaborate and exploit synergies. However, there are clearly challenges too. For example, in order to take on cross-cutting issues, it will be necessary to achieve far greater intersectoral coherence and coordination of effort. To achieve that end, a new impetus will have to be given to global and regional partnerships and collaborations, with a focus on country action. A great deal has been achieved since 2000. However, progress can easily be reversed if we do not maintain our commitment to making the world a better place for all, leaving no one behind. Key to achieving that vision will be focusing our efforts intelligently, and setting clear, measurable goals that national governments and development partners can support. In health the target on universal health coverage (UHC) provides the platform for integrated action across all 13 health targets. Rather than being seen as one target among many, it is my belief that UHC should be seen as the linchpin of the health development agenda, not only underpinning a more sustainable approach to the achievement of the other health targets, but allowing for a balance between them. Relevant to all, it can now be monitored within an accepted framework which will allow for target setting and measurement of progress. It is, I believe, our way forward. This report is a first step in a series of actions that I am taking to make WHO fit to fully support the implementation of the SDG agenda. HEALTH IN 2015: FROM MDGs TO SDGs iii
Page 1: from M I L L E N N I U M DEVELOPMEN
Page 6 and 7: CONTENTS vii Abbreviations 1 1 From
Page 8 and 9: 7 153 Mental health and substance u
Page 10 and 11: IHR IPCC ITN LLIN MCV MDG MDR TB mh
Page 13 and 14: SUMMARY This report aims to describ
Page 15 and 16: sourced development finance. 11 The
Page 17 and 18: Despite their overall success, the
Page 19 and 20: The 13 targets that underpin the br
Page 21 and 22: Box 1.1 Life expectancy improvement
Page 23: 40 Advanced research on European he
Page 27 and 28: SUMMARY The SDGs position health as
Page 29 and 30: Figure 2.2 Trends in fertility by r
Page 31 and 32: Ageing Populations around the world
Page 33 and 34: The recent influx of refugees into
Page 35 and 36: and implementing policies and progr
Page 37 and 38: that dialogue is to demonstrate an
Page 39 and 40: One of the challenges we face as we
Page 41 and 42: Most recently, the right to health
Page 43 and 44: 2100 Figure 2.15 Global average sur
Page 45 and 46: Figure 2.17 Proportion of health fa
Page 47 and 48: 42 World development report 2014: r
Page 49: 3 UNIVERSAL HEALTH COVERAGE
Page 52 and 53: UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
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SUMMARY Deaths among pregnant women
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Figure 4.3 MDG and SDG targets rela
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have declined from 25% to 14% betwe
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Chapter 5). As noted above, there h
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Figure 4.8 Wealth-related inequalit
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young children. 61 Specific indicat
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CHALLENGES Access to skilled care a
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CHALLENGES Scaling up effective int
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CHALLENGES Leaving no country behin
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CHALLENGES Endemic countries: Polio
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Figure 4.22 Prevalence of stunting
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CHALLENGES Spurring action in count
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CHALLENGES Ending child marriage: D
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43 Financing global health 2014: sh
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5 INFECTIOUS DISEASES
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Infectious and parasitic diseases a
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Figure 5.4 Global number of deaths
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International TB funding increased
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Improving quality of care: The qual
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Table 5.1 Summary of specific targe
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HIV/AIDS More than 30 years since t
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TUBERCULOSIS TB is a treatable and
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MALARIA Almost half the world’s p
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NEGLECTED TROPICAL DISEASES NTDs 89
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HEPATITIS Viral hepatitis is caused
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WATERBORNE DISEASES Waterborne dise
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CHOLERA Cholera is an acute diarrho
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SEXUALLY TRANSMITTED INFECTIONS STI
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NOTES AND REFERENCES 1 Global Healt
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84 Dye C, Maher D, Weil D, Espinal
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SUMMARY NCDs are included as a spec
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Figure 6.2 Probability of death fro
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as task sharing using community hea
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The stated aim of the strategy is p
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CHALLENGES Despite declines in mort
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CHALLENGES Lack of access to effect
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CHALLENGES Diabetes is an increasin
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CHALLENGES Increasing use in some r
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CHALLENGES Air pollution remains a
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40 From burden to “best buys”:
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7 MENTAL HEALTH AND SUBSTANCE USE
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Mental disorders, including dementi
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the effectiveness of task sharing b
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• To provide comprehensive, integ
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DEPRESSION AND SUICIDE Mental disor
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DEMENTIA The world’s population i
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SUBSTANCE USE AND SUBSTANCE USE DIS
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NOTES AND REFERENCES 1 Global Healt
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8 INJURIES AND VIOLENCE
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Injuries, whether sustained acciden
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due to limited data. However, the s
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aiming to stop the predicted increa
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ROAD TRAFFIC INJURIES Every year, a
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VIOLENCE AND HOMICIDE There were an
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WAR AND CONFLICT In 2012, an estima
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DISASTERS Disasters are often assoc
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NOTES AND REFERENCES 1 Global repor
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SUMMARY In September 2015, heads of
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A 10-page declaration precedes the
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THE PLACE OF HEALTH IN THE SDGs 1 H
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that health systems providing integ
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FOLLOW-UP AND REVIEW 9 Monitoring t
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NOTES AND REFERENCES 1 Transforming
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WHO South-East Asia Region: Banglad
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ISBN 978 92 4 156511 0
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