If you’re not familiar with the Millennium Development Goals (MDGs), they are a set of eight targets defined and committed to by the member states of the United Nations in 2000 to reduce extreme poverty worldwide. The idea is to achieve the goals (specific measureable indicators are set for each) by the year 2015. The goals cover issues such as reducing hunger and developing global partnerships, but several of them address health issues, including the Goals 4 and 5, which focus on promoting child and maternal health (e.g., reducing under age-5 mortality and increasing access to reproductive care), and Goal 6,which focuses on combating HIV/AIDS, malaria, and tuberculosis.
In light of the changing global public health landscape, I think the UN should consider revising the MDGs before 2015, or at least devising a new set of health-based goals when the time comes.
Why change them? For one, despite being two-thirds of the way toward the 2015 deadline, many of the goals are nowhere close to being met. For example, the latest progress report on the UN website shows that, as of mid-2009, half of the indicators for improving child health (Goal 4) are either not on track to be achieved by 2015 or are actually deteriorating; the same is true for more than half of the indicators for Goals 5 and 6.
But another compelling reason to revise the MDGs has to do with a study published earlier this month inPLoS Medicine. The researchers argue that more cohort studies (including clinical trials, surveillance, and epidemiology) need to be done in sub-Saharan Africa on noncommunicable diseases (NCDs). They base their argument on research showing that NCDs such as cardiovascular, mental illness, cancer, and diabetes are now major sources of morbidity and mortality in the region. For example, the authors report that 23% of 1500 rural villagers over age five in Tanzania, Malawi, and Rwanda had hypertension associated with diet. The fact that individuals in developing countries are gaining access to more traditional Western foods and medicines, and assuming more “Western” life styles means they are also more prone to getting the same conditions and diseases that people in industrialized countries get.
Since the emergence of HIV/AIDS, health goals and groups addressing the lower African continent have focused on that disease and other communicable diseases such as malaria and tuberculosis. But, summarizes the PLoSstudy, NCDs are likely to overtake infectious diseases by the year 2030 and sub-Saharan Africa leaders do not have adequate resources to address these new health challenges. The study authors call for global health funders to take notice. The UN should also take notice.
This September, UN leaders will discuss MDG progress as part of a special summit. An agenda outline for the summit was released earlier this month (the full proposal is still being written) highlights ways to try to reach the goals by 2015 such as strengthening national ownership of the goals and mobilizing additional financing (a tall task in the current economic environment), but it does not appear that UN leaders are going to consider re-examining the actual MDG targets.
When the year 2015 comes, it will be a shame if the MDGs are not met, but it will be even more troubling if global leaders overlook NCDs and the new health challenges posed by NCDs in the developing world.