The Rio+20 outcome gives the millennium development goals a more sustainable framework

Over the past decade, the proportion of the world’s children affected by malnutrition has not improved as much as gains seen in under-five mortality. This reflects the focus of the Millennium Development Goals (MDGs) on enhancing human survival (MDG 4 and 5) and not on systematically creating an environment in which survivors can thrive.

Last month in Rio de Janeiro, the U.N. Conference on Sustainable Development brought together world leaders to tackle related issues and concerns, and to help navigate the future of our global environment and economic development.

By all accounts, the outcome of the summit pleased none of its key stakeholder groups entirely. The environmentalists claim that it goes no farther than the commitment made at the original Earth Summit 20 years earlier. Developing nations and advocates for an equitable global economy and access to health argue that in Rio leaders lacked the political will to solve its most pressing problems.

Most have given little praise outside the fact that 180 countries agreed to hold further talks and develop new international targets — the Sustainability Development Goals (SDGs). Justified as such criticism may be, we argue that global health faired much better than broadly interpreted, in two specific ways.

The first is that, at the eleventh hour, a recommitment to the MDGs, the call for universal healthcare and the recognition that health is a human right was added to the The Future We Want, the official Rio+20 outcome document.

Second, and more importantly, the forthcoming SDGs should be seen as a crucial platform to ensure that MDG-related health gains become durable, part of national development objectives and continue to contribute to future social development and equity improvement. The Future We Want uses a rights-based approach to energy, water, food and access to land, thus also supporting the right to health, work, a safe environment etc.

The MDGs have provided the focus for concerted international work on major diseases of poverty, reducing inequities in access to prevention, care and treatment for populations at risk. The resulting single-disease initiatives demonstrated that significant, rapid health gains can be made by deploying a limited number of highly cost-effective interventions. This provided the international community the confidence that large scale health intervention can produce impact rapidly. This is no better exemplified than by investments in global malaria control.

Over the past decade, a global investment of about $10 billion in malaria control has resulted in 1.4 million lives saved in Africa alone. Overall, 43 countries reduced their malaria cases by 50 per cent and globally deaths decreased by 25 per cent. A recent evaluation, conducted by the World Bank in Kenya, reports that approximately one-third of the decline in under-five mortality can be attributed to the scaling-up of long-lasting insecticide-treated mosquito nets.

What the MDGs did not provide was a focus for action that created employment or reduced hunger; the accepted truth that progress in health outcomes would be sufficient to reduce poverty was not confirmed during the past decade. Consequently, little reduction was seen in the prevalence of malnutrition, suggesting that the improved health outcomes and survival alone do not necessarily result in an improved environment or livelihoods through which people and households can thrive. These observations underscore the limited accountability of governments to deliver basic social services to their people and the persistent chasm between equitable survival and essential opportunities for people, households and communities to thrive.

In our view, the Rio+20 outcome provides the platform to bridge this relentless gap, by building upon the successes and weaknesses of the MDGs, and extending disease-specific control agendas into a framework for broader sustainable improvement of livelihoods. This, we contend, can only be done by positioning the MDG gains and experiences within a development construct that has access to basic means of production such as land, water, energy and markets, as its cornerstones.

If the SDGs allow for focused, medium-term investments that enhance equitable access by all communities to energy, water, arable land and commodity markets, then disposable household income is likely to increase, enabling conditions in which short-term health gains are more likely to be sustained. Experience from Brasil’s Bolsa Familia cash transfer programme, which targets poor women in a similar way, suggests that health outcomes significantly improve when people are empowered to take ‘spending’ decisions themselves.

This is why we welcome the forthcoming development of SDGs, as a platform for sustaining the long-term malaria control investments that will allow progress in control and elimination of the disease over the next 30 years. This will also continue to reduce under-five mortality rates to a new low of 20/1000 by 2025, as expressed in Child survival: Call to action hosted and launched by the governments of Ethiopia, India and the United States.

By anchoring health in such a broad framework, the Rio+20 meeting outcome opens a new horizon for the health-related MDGs, and offers ways of making the gains of the past ten years sustainable in the decades to come. The Future We Want expresses world leaders’ aspirations to create a more equitable world. We must not forget, however, that thriving is only possible if people survive.

(Thomas Teuscher is Executive Director of Roll Back Malaria Partnership. Michael Maguire is with the Miller School of Medicine, University of Miami.)

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