2015 has been a year of reflection regarding the successes and failures of the now retired Millennium Development Goals (MDGs), and, despite the debates, a year characterized by an inexorable drive to move forward with a yet more comprehensive set of goals (17 SDGs) and indicators (over 300). Crucially, the SDGs have evolved to address some critical factors relevant to development that were largely overlooked before, including goals specific to,
-fighting inequality and injustice (Goals 8, 10 and 16)
-addressing climate change, specifically (13), as well as ocean health (14), and --ecosystem health (15) for well-being and development.
While aspirational, and arguably comprehensive to a fault, the inclusion of specific goals organized around environmental health and climate change, spurred by the UN but subsequently institutionalized by global development institutions including the World Bank and IMF is a remarkable development, and suggests a genuinely progressive shift in development thinking when compared to the 1990s era of narrowly-scoped industrialization and hyper liberalized markets.
Indicative of this shift are the specific goals addressing inequality, which inherently require a more comprehensive look at the mechanisms that leave the poorest behind, whether they be political, economic or social factors. Critics of the MDGs point out that the lack of focus on inequality permits country to improve national averages, and even successfully meet its goals, while leaving the most vulnerable behind. An example might be South Africa, which easily met its gender equality goals under the MDGs thanks to robust enrollment of girls in primary education, despite a glaring absence of women in business or leadership.
Earlier this year, the World Health Organization (WHO) published its “State of Inequality: Reproductive, maternal, newborn and child health,” an analysis of 86 low to middle income countries and their “RMNCH” outcomes following the conclusion of the MDGs. Inequality plays a special role in explaining outcomes.
As the WHO notes and illustrates with disaggregated data, “there are vastly different stories to tell about a person’s health depending on where they live, their level of education, and whether they are rich, poor, etc.” (2015: 4). The report looks at health indicators such as modern contraceptive use, maternal health interventions, and childhood immunization in relation to dimensions of inequality such as economic status, education of the child’s mother, and place of residence. It then highlights several “stories” where a health indicator was more influenced by inequality than other factors.
One story examines care-seeking for sick children through the lens of place of residence. In nearly one-in-five of the countries scrutinized, care-seeking for children with symptoms of pneumonia was at least 20 percentage points higher in urban versus rural areas. This points to the synergistic affect of distance on access to healthcare in that facilities are not only more difficult to reach, but the strenuous journey presents a deterrent to deciding to seek care in the first place.
The implications of these indicators come to light when looking at the unequal distribution of child mortalities between urban and rural areas. On average, 23 more children under the age of five die each year per 1000 live births in rural areas, and 60 more children in seven of the countries studied. Insufficient distribution of healthcare facilities is also a stumbling block to proper maternal health and emergent care. For example, only 57% of the Indian population lives within 50 km of a well-resourced hospital, (Dare 2015) a leading cause of death due to acute abdominal conditions. Furthermore, women in rural areas are 20 percentage points less likely to give birth in the presence of a skilled birth attendant than urban areas in half of the countries included in the report. It is clear that rural populations suffer on behalf of several roadblocks to healthcare, a challenge that is especially prevalent in the rural and mountainous regions where we focus.
With the redoubled focus on closing within-country inequality gaps, AMRDI is poised to address these challenges head-on, and embrace inequality as one of the most important factors hampering arctic and mountain region well-being and development. These regions – whether the Guatemalan Highlands or Far Western Nepal – continue to wrestle with improving maternal and infant health, especially.
The SDG inauguration this weekend is a time to take stock of these challenges, but are also a call to recommit to these efforts, to leave no one behind, and to work with the outliers that have been historically excluded from opportunities, and find culturally appropriate pathways to prosperity.
Dare, Anna J et al. (2015). Deaths from acute abdominal conditions and geographical
access to surgical care in India: a nationally representative spatial analysis. The Lancet Global Health, Volume 3.Issue 10, e646-e653 Retrieved from http://www.thelancet.com/journals/langlo/article/