Health and the UN goals

• India and the Health targets:
• Of the eight MDGs, 3 relate directly to health. 
• The first goal was to reduce mortality among children under the age of five; this is only moderately on-track. 
• The second goal was to reduce maternal mortality. On this India is off-track. 
• India is on-track for the third goal, which was to halt and reverse the spread of HIV/AIDS, and 
• only moderately on-track on the fourth goal, which was to halt and reverse the spread of malaria and other major diseases. 
• In short, we have achieved only one out of four targets. 
• Globally, this is a worry, because if India does not achieve the MDGs, given its size, neither will the world.
•  Are the SDGs any different from the MDGs? 
• For one thing, only one SDG addresses health, as compared to three MDGs. 
• On maternal and child health, the SDGs extend the MDGs, since they have largely not been met in many developing countries. 
• Non-communicable diseases have been included, reflecting concern for the growing incidence of non-communicable disease even among the poor. 
• Alcohol abuse and tobacco have also been targeted.
• Issues with health targets in SDG:
• Interestingly, the targets that have a specific timeline mentioned are those for which cost-effective interventions have been identified — for example, institutional delivery to reduce maternal mortality. It raises the question: Are we adopting goals that have the “right” cost-effective interventions, rather than discovering cost-effective interventions for the right goals? For instance, mental illness is one of the most prevalent morbidities in India, and suicide is the leading cause of death among people between 15 and 29. There is only a passing mention of suicide in the SDGs. Perhaps because there is no cost-effective intervention against mental illness and suicide?
•  Issues with MDGs:
• First, the goals and targets were interpreted too literally, without reference to the starting point from which different countries began the journey. 
• Second, the cost-effectiveness analysis focused on addressing the biological causes of disease, with little recognition of the social determinants of health. It was this biological agent that was the target of the cost-effective intervention, maybe because biological causes are easier to tackle.
• This should teach us that the goals we set should be informed by the realisation that health issues cannot be seen in isolation from the social context.