Biomed Analysis: Sustainability goals too light on health
The proposed Sustainable Development Goals need more focus on health to continue the progress achieved with MDGs, argues Priya Shetty.
Since 2000, global health efforts have been aligned to the aims of the Millennium Development Goals (MDGs). Indeed, the link has been so close that some public health experts have voiced concern that health goals not specified in the MDG manifesto, such as tackling chronic diseases, have suffered.
By offering up clear targets, the MDGs have galvanised unprecedented funding for public health interventions and research and development (R&D). Yet after 2015 — the deadline for meeting the goals — this focus threatens to evaporate and public health is in danger of entering a void.
This article is part of our coverage of preparations for Rio+20 — the UN Conference on Sustainable Development — which takes place on 20-22 June 2012. For other articles, go to Science at Rio+20
There is, however, a potential successor to the MDGs. Discussions leading up to the UN Conference on Sustainable Development (Rio+20) suggest a set of Sustainable Development Goals (SDGs), proposed to begin in 2015.
But although the early draft ('zero draft') of the Rio+20 declaration addresses issues that the MDGs neglected, such as food security, it is light on health and many social issues (education, for example, or gender equity). This should be of major concern to public health experts.
With post-MDG goals that focus little on health, there is a danger that much of that progress will slip away.
While the MDGs transformed public health, they weren't solely health focused.
The goals were designed to draw attention to problems of the developing world that persisted despite billions of global aid directed at solving them. Several goals were health-focused — for example, MDG 4 aims to reduce child mortality, MDG 5 to improve maternal health, and MDG 6 to combat HIV/AIDS, malaria and other infectious diseases.
But they also emphasised social issues that affect health, such as achieving universal primary education (MDG 2), eradicating extreme poverty and hunger (MDG 1), and promoting gender equity and empowering women (MDG 3). By 2015, the global poverty rate is expected to fall below 15 per cent, which is well below the 23 per cent target.
The progress made so far shows the importance of setting clear targets — it is no coincidence that little has been achieved on environmental sustainability (MDG 7) and developing a global partnership for development (MDG 8). Both goals lacked specific targets.
And there were glaring gaps. There was no provision for chronic diseases, which are a growing threat to health in developing countries, nor was there any mention of neglected diseases that still affect many in Africa, Asia and Latin America.
Sustainability is central
It's not hard to see why the idea of sustainability has taken centre-stagein the new millennium; it has a rightful place at the core of global goals.
The Earth's population has swollen to 7 billion, and natural resources are being stretched ever thinner. In January, the UN launched the International Year of Sustainable Energy for All, and last November, the UN Development Programme published a report outlining why environmental degradation is threatening human development. 
The health of the environment is unarguably linked to the health of people, and protecting human health requires protecting the planet.
The 'zero draft' does acknowledge this link, for instance in stating: "We highlighted the critical importance of water resources for sustainable development, including poverty and hunger eradication, public health, food security, hydropower, agriculture and rural development."
But there is no more discussion of health than this. Instead, the draft circles around issues that are key to achieving better health, such as hunger (malnutrition is a major risk factor for poor health).
The draft calls on member states to "prioritise sustainable intensification of food production through increased investment in local food production, improved access to local and global agri-food markets, and reduced waste throughout the supply chain, with special attention to women, smallholders, youth and indigenous farmers".
There also seems to be little on education, even though education (for young girls in particular) has been linked to better health and development.
Time to refine
Plans for the SDGs are not yet set in stone, and we are still in that critical period when shortcomings can be remedied. While it is vital to take a holistic approach that considers the sustainability of the planet's resources, the focus on health in the developing world must not be lost.
Diseases such as HIV/AIDS tend to attract global attention or funding more easily than some other health problems. Yet with the global economy still struggling, it would be all too easy for the momentum built in improving child and maternal health — which for so long languished in the doldrums — to wane.
The MDGs also fired the global health community with enthusiasm for strengthening healthcare, such as bolstering the infrastructure of health systems; these ideas are only just starting to take shape, and it would be disastrous for them to be neglected again.
Weaving health goals into environmental sustainability will be crucial, and will require bringing together a wide range of experts — in health, environment, resource management, poverty reduction, equity and education.
If approached properly, the SDGs could be even more successful than the MDGs, by tackling issues at the crossroads between health and environmental sustainability — such as the intersection between climate change and infectious diseases.
Fighting environmental degradation is undoubtedly important, but saving the planet will mean little if we ignore the health of the people living on it.
Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.
This article is part of our coverage on Science at Rio+20.
This article was updated on 22 February 2012. A previous version of the article referred to an early draft of the Sustainable Development Goals, rather than the 'zero draft' of the Rio+20 declaration.