Why the health SDG is at risk of leaving the poorest behind

Last Autumn saw a significant moment of hope and positivity in the international development world.  The newly introduced Sustainable Development Goals were celebrated for being more inclusive, collaborative and fair than their predecessor Millennium Development Goals.  A real step forward.  A chance to make sure that no one is left behind in a world bursting with opportunities yet full of inequalities.

This week is the first time since the goals’ adoption that the ‘now what?’ conversations have begun at a formal level.  The Economic and Social Forum (ECOSOC) – at the heart of the UN development system – is hosting a ‘High level political forum on sustainable development’ to discuss their implementation and the ‘2030 Agenda’.  Right now, UN member country representatives are gathered in New York City to discuss the SDGs’ future.  And the ECOSOC President is looking for fast progress towards “inclusive, equitable, and prosperous societies for all.”  

Some view the 17 agreed goals as too ambitious.  Indeed they are accompanied by 169 targets and 230 indicators.  There is a lot of detail in there.  And the problem is – certainly when it comes to Goal 3: Ensure healthy lives and promote well-being for all at all ages – the devil really is in the detail.  The UN-led group responsible for setting the SDG indicators caused a wave of dismay throughout the health policy and medical world this March when they made an eleventh hour change to the detail of the indicator measuring universal health coverage (UHC).

The dismay arose as the UHC indicator (3.8.2) was changed from a previous globally agreed measure of ‘out of pocket payments’ for healthcare, to ‘coverage by health insurance or a public health system’.  Yes it does feel rather technical.  But 100 million people are pushed into poverty each year because of health care costs.  And the change to the indicator means we will no longer have any way of knowing if we are making progress to reduce this figure.  In fact, because the indicator measures the wrong detail, it could mean that more – not less – women, marginalized groups and people living in poverty are excluded from lifesaving healthcare.

For example, 15 year old Nhut (pictured above) from Vietnam has health insurance, but it didn’t cover the costs for his emergency brain tumor surgery in 2014 and ongoing chemotherapy treatment.  Nhut’s family had no choice but to take out high interest loans and sell all their possessions to pay for his care, including livestock, farmland, and even the family home.  “We have nothing left.  All we have now is huge debt and a seriously sick son,” his father told us recently.

An indicator only measuring health insurance or coverage by a public health system will be blind to the impoverishment of millions of families – like Nhut’s – who face out of pocket healthcare costs.

The SDG 3 target to ‘Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all’ could be a game-changer for millions of people around the world.  Being in good health is central to not being left behind – it is so core to our existence and ability to do anything else, that the UN decision makers need to get it right.

The forums and conversations taking place in shiny UN buildings can feel far away from the ‘real’ world and lives of those most affected by health care costs like Nhut and his family.  Yet the reality is that the goals and their indicators are there to make a difference to peoples’ lives around the world – to ‘leave no one behind’.  They are important in the sense that they will not only measure the ‘success’ of each SDG, but also hold those responsible to account.

This is why the discussions happening this week must recognize the urgent need to review, change and finalise the outstanding SDG indicators, including 3.8.2 for financial protection for health.  Without such a change there is a real danger that the SDGs will run counter to their overall ambition.

The entry posted by Sian Jones (@sian3j), Oxfam Global Inequality Campaigner, on 15 July 2015.

Photo: Nhut from Vietnam stands in front of his old house. His family had to sell everything they had to pay for the lifesaving medical treatment that his insurance didn’t cover. Credit: Xuan Truong


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