It is important to support the entire world population, not only certain groups.
Intensive discussions are going on at the UN to agree, by September 2015, a set of universal Sustainable Development Goals (SDGs) that will affect all the world’s people and countries. The goals are a follow-up to the Millennium Development Goals (MDGs), which are due to be fulfilled by the end of 2015. Although there have been shortcomings in realising these eight relatively simply worded goals agreed in 2000, they have still had groundbreaking importance in development cooperation. The goals have helped to direct and coordinate development cooperation with the help of the international unity that has been achieved, as well as to mobilise resources for alleviating the painful problems the world faces.
When conclusions were drawn about the MDGs, it was found that new development goals for the subsequent period were necessary, and these should focus on reducing poverty and be more comprehensive than the eight MDGs. It was also found, during the UN Conference on Sustainable Development in Rio de Janeiro in 2012, that economic, social-protection and environmental subjects should receive equal attention in achieving sustainable development. Discussions in the UN on the new SDGs have lasted for several years, and several substantial agreements have been reached: coordinated and unified goals are necessary for the entire world, both developing and rich countries. In place of the eight MDGs, 17 SDGs and 169 supporting detailed sub-goals will be adopted in September, covering the next 15 years. They will be as valid for Estonia and the US as for China and Nauru. If agreement is reached, all national governments must link the goals with their national sustainable development strategies and implementation plans.
Health has long been considered one of the most important human rights; UN surveys have also indicated this. At the same time, it can be claimed that the good health of members of society contributes to the sustainability of that society. It is therefore natural that four of the eight MDGs were directly or indirectly connected to the health of humankind.1 Global efforts to fight against disease are not new—the establishment of the World Health Organization in 1948 and the Alma-Ata Declaration of 1978 are two examples. However, greater success was achieved in the field of healthcare only after the adoption of the development goals in 2000.
The MDGs helped to direct global attention and resources towards healthcare-related problems in the entire world, decrease hunger, improve the health of mothers and children, and fight against malaria and HIV. Similarly, improvements in the field of healthcare were supported by the development of medical research and modern medicine, and developments in growing and producing food. International organisations, governments, non-governmental organisations and private enterprises cooperated in alleviating and resolving issues in the field of healthcare. Together, poverty was reduced by half and important steps were taken in combating malaria and tuberculosis; daily access to potable water was made available for more than two billion people. The most extensive public and private sector cooperation programmes, such as Roll Back Malaria and GAVI (The Vaccine Alliance), have been realised in healthcare.
Estonia has also contributed to achieving healthcare goals through development cooperation projects: it has supported the development of the healthcare system in Moldova and helped to create related necessary e-services, supported the creation of a healthcare counselling system in Macedonia, and organised training courses in Afghanistan.
Despite the many success stories in realising the MDGs, several shortcomings have been found in analysing the results—development in the field of healthcare has been unequal, both within and between states. For example, life expectancy at birth is now nearly 80 years in developed countries (77.28 years in Estonia), while it is 60 years in less developed countries.2 The World Bank estimates that in the period 2010–5, an average of 52 of every 1,000 children under the age of five die. In developed countries, the figure is seven and in developing countries 57; in less developed countries it is as high as 99 children per 1,000. The organisation has managed to reduce chronic malnutrition, as well as child and mother mortality, but there is still much to be done in this field. Each year millions of children, primarily in developing countries, die of diseases that could be prevented or cured. Our general knowledge about HIV/AIDS has improved; diagnostics and more efficient medications give HIV-positive patients a longer life expectancy. But at the same time, the medications are not available to many, constant preventative work is necessary, and the discrimination of HIV/AIDS patients must be avoided.
The experience gained from the MDGs showed that better results were achieved by countries that invested in their healthcare system so that it offered support to the entire population, not a section of it (e.g. only pregnant women, children and women). Research has shown that even small additional investments in the healthcare system of poor countries significantly contribute to improving the population’s health. It is therefore necessary to invest in healthcare systems in general, in addition to dealing with specific diseases in the future. A recent negative example of a weak healthcare system is the Ebola epidemic and the rapid spread of the disease in West Africa. Moreover, the world has changed a lot since 2000, including in healthcare.
Notwithstanding the positive developments in medicine, new issues have emerged in the field of healthcare. Increasingly, more people—both in developing and developed countries—are dying of non-infectious diseases such as cerebrovascular insults, malignant tumours and diabetes. It has been raised many times in UN discussions that mental health and the healthcare services connected to it should receive more attention. Environmental impacts on health should also receive greater consideration—e.g. air quality, both outside and in interior spaces, and the purity and usability of water. Painful issues vary, in part according to a country’s level of development, but are also somewhat similar. Development has been uneven in several countries with a fast-developing economy—part of their population still suffers from the problems that the MDGs were supposed to address, while other people already have “modern diseases” like diabetes and cardiovascular disease. Globalisation, travel and migration have created a situation in which various regions are increasingly more closely connected; for example, due to the fact that people travel more, diseases now reach regions where they had not occurred for many decades.
In addition, UN member states have proposed during the discussions that healthcare should have a separate goal in the sustainable development agenda beyond 2015. Consequently, the following objective has been specified as one of the 17 potential SDGs: “[to] ensure healthy lives and promote well-being for all at all ages”. This goal has nine sub-goals that allow continuation of the work that was left unfinished in realising the MDGs: reducing mother and child mortality, restricting the spread of AIDS and tuberculosis, and malaria and other tropical diseases, and combating infectious diseases. There are also new elements in the sub-goals: reducing the number of deaths resulting from non-infectious diseases, greater engagement in preventative work, promoting mental health and general well-being, fighting against drug and alcohol abuse, reducing the number of traffic deaths and injuries, ensuring universal access to sexual and reproductive health services, ensuring wider access to healthcare services and immunisation, and reducing the number of fatalities and diseases caused by hazardous chemicals as well as air, water and soil pollution.
The international healthcare goals for the period 2015–30 that will probably be adopted at the September 2015 summit are thus quite ambitious. Both developing countries and wealthy states need to make an effort to achieve them. Estonia is exemplary in many areas. For instance, its mother and infant mortality rate is very low in comparison to global figures, and it has the cleanest air in the world, according to a 2013 UNICEF report. At the same time, Estonia needs to make a bigger effort in fighting against HIV/AIDS; there are problems with multidrug-resistant tuberculosis, and the incidence of non-infectious diseases needs to be reduced, and preventative work increased.
1 Goal 1 (to eradicate extreme poverty and hunger), but primarily goals 4 (to reduce child mortality), 5 (to improve maternal health) and 6 (to combat HIV/AIDS, malaria, and other diseases).
2 2013: Statistics Estonia (12 September 2014).