SDG 3: Good Health and Well-Being
Health featured prominently in the Millennium Development Goals so it is no wonder that it is the largest goal in the whole 2030 Agenda. With a whopping 9 substantive targets and an additional 4 Means of Implementation, it covers a large range of topics related to preventing and treating sickness and prolonging life expectancy. What sets SDG 3 drastically apart from its MDG predecessor is the focus on ‘well-being’. I this this is best demonstrated with the WHO’s definition of health:
“A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."
Health is interlinked with many other SDGs. A healthy population is crucial to economic prosperity (SDG 8) - after all you cannot generate wealth without workers and consumers who are not sick or worried about medical bills. Inequality (SDG 10) has been directly linked to poor health or access to health services. In addition, a degraded environment is a huge contributor to health issues - lacking access to clean water and sanitation (SDG 6) causes many health issues and makes treating them difficult, air pollution causes a range of respiratory issues, and interactions with wildlife (SDG 14, 15) can lead to the spread of zoonotic diseases and, in some cases, cause pandemics (*cough, cough* COVID-19).
Let’s dive in and look more closely at this goal.
Target 3.1
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
What it means
The maternal mortality ratio refers to the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births (SDG Tracker). What’s notable about this target is its prevalence in developing countries compared to that in developed countries. In fact 94% of all maternal deaths occur in low and lower middle-income countries (WHO). Maternal mortality is extremely preventable but is directly linked to health infrastructure and income. The UNDP outlines the determinants to maternal mortality in several major categories:
individual attributes of women - age, parity, knowledge of services, previous obstetric history
family characteristics – economic status, access to resources, support from natal and marital family, marital relationship
community context – rural-urban-tribal, social position (class, caste, ethnicity), social capital, distance to facilities
culture and social values – women’s status, gender norms, religion, health beliefs, social cohesion
health services – availability of services (emergency obstetric care, blood availability), skilled staff, acceptability of services, fees and charges for services
structural determinants – laws, policies, budgets, education, social protection
Where we are currently
Good progress has been made on fighting maternal mortality. Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal deaths per 100,000 live births) dropped by about 38% worldwide from 342 deaths to 211 deaths per 100,000 live births worldwide (UN Stats). However, still 810 women die every day from pregnancy or childbirth. Over 40 per cent of all countries have fewer than 10 medical doctors per 10,000 people; over 55 per cent of countries have fewer than 40 nursing and midwifery personnel per 10,000 people.
Target 3.2
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
What it means
Similar to the first target, child mortality is mostly preventable and occurs disproportionately in poor countries. Four out of every five deaths of children under the age of 5 happen in Sub-Saharan Africa and Southern Asia; children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high income countries (WHO). The WHO explains that the “leading causes of death in children under-5 years are preterm birth complications, birth asphyxia/trauma, pneumonia, congenital anomalies, diarrhoea and malaria, all of which can be prevented or treated with access to simple, affordable interventions including immunization, adequate nutrition, safe water and food and quality care by a trained health provider when needed.”
Where we are currently
In 2019, an estimated 5.2 million children under the age of 5 died, mostly from preventable causes, with almost half of these in the first month of life (WHO). This represented significant progress - a decline from 12.6 million in 1990 to 5.2 million in 2019. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990, compared to 1 in 27 in 2019.
Nutrition-related factors contribute to about 45% of deaths in children under-5 years of age, as malnourished children have a higher risk of death from common childhood illness such as diarrhoea, pneumonia, and malaria.
Target 3.3
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
What it means
Communicable diseases are “ illnesses caused by an infectious agent or its toxins that occurs through the direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector or the inanimate environment to a susceptible animal or human host” (CDC).
AIDS - HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. If left untreated, HIV can lead to the disease AIDS. (HIV.gov)
Tuberculosis - is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. (WHO)
Malaria - an intermittent and remittent fever caused by a protozoan parasite which invades the red blood cells and is transmitted by mosquitoes in many tropical and subtropical regions.
Neglected tropical diseases (NTDs) are a group of bacterial, parasitic, viral, and fungal infections that are prevalent in many of the tropical and sub-tropical developing countries where poverty is rampant.
Ending the epidemics of these diseases is threefold - preventing incidences, decreasing deaths, and, eventually, decreasing their prevalence in the population (WHO). Think about it this way, when a disease exists in the population there are several priorities. You want to prevent others from catching it so it does not spread, this is the incidence dimension. You also want to treat those who have it so they do not die, this is reducing mortality or death rates. And then, over time, you want to decrease the prevalence of the disease overall in the population. The balance between these factors can be complex.
If we take HIV, for example, the epidemic started in the 80s and grew rapidly until its peak in 2005. Between 1990 and 2005, incidence, prevalence and death rates were all increasing, but in 2005 the death rate and incidence began to sharply decline. Prevalence continued to grow because more people were able to live with HIV thanks to huge developments in treatment through antiretroviral therapy. By 1990, an estimated 9M people were living with HIV, in 2019 38M people were. If one just looked at only the prevalence dimension, you may think this is a bad thing but when taking the full picture of death rates and incidence rates decreasing into account we see promising progress.
Source: Our World in Data
Incidence, mortality rate, and prevalence look different for every disease and the interventions vary greatly. Tuberculosis can be vaccinated against for prevention, but only through global vaccine rollout, especially to poor countries that can often not afford it. For malaria there are a range of prevention methods from cheap mosquito nets for beds to anti-Malaria pills to mosquito control, and some promising vaccines for children. Treating all these diseases is possible but only with access to strong health care systems, which many do not have in the areas where these diseases are the most prevalent.
Preventing and treating HIV has an added layer of complexity because of harmful social stigma around the disease. HIV is passed primarily through unprotected sex and drug use, and often disproportionately affects marginalized communities like sex workers, people who inject drugs, and the LGBTQ+ community.
Where we are currently
AIDS - According to UNAIDS, the UN’s Programme on HIV/AIDS, 26M people were accessing antiretroviral therapy as of the end of June 2020, 38M people globally were living with HIV in 2019, and 1.7 million people became newly infected with HIV in 2019. 690 000 people died from AIDS-related illnesses in 2019. This represents marked progress as at the peak of the epidemic in 2004/05 2 million people died from AIDS and has since reduced by 60%. AIDS is the leading cause of death for women of reproductive age worldwide (WHO) and it is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most common cause of death among adolescents globally (UN Youth Envoy).
Tuberculosis - A total of 1.4 million people died from TB in 2019, including 208 000 people with HIV (WHO). While tuberculosis occurs in every country and age group, 30 high TB burden countries accounted for 87% of new TB cases. India has the most cases of TB globally. Globally, TB incidence is falling at about 2% per year and between 2015 and 2019 the cumulative reduction was 9%.
Malaria - In 2019, an estimated 229 million clinical episodes, and 409,000 deaths were recorded; 94% of deaths in 2019 were in the African Region. (CDC). The global malaria incidence rate has fallen by an estimated 37% and the mortality rates by 58% (WHO).
Neglected Tropical Diseases (NTD) - In 2019, 1.74 billion people were reported to require mass or individual treatment and care for neglected tropical diseases, down from 2.19 billion in 2010, and about 12 million people fewer than reported in 2018 (WTO).
Target 3.4
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
What it means
Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors (WHO). NCDs are not transmitted person-to-person and most are preventable. The leading factors contributing to NCDs are tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol.
The main types of NCD are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), diabetes, and suicide.
NCDs are the #1 cause of death and disability worldwide, accounting for 70% of all deaths (NCD Alliance). NCDs disproportionately affect people in low- and middle-income countries where more than three quarters of global NCD deaths – 31.4 million – occur.
To treat NCDs, it is crucial to prevent them, screen for and identify them, and provide appropriate care.
Where we are currently
Over 41M people per year are killed by NCDs. To break this down further these are attributed to:
Cardiovascular diseases account for most NCD deaths, or 17.9M people annually
Cancers - 9.3M
Respiratory diseases - 4.1M
Diabetes - 1.5M
Tobacco - 7.2M
Excess salt/sodium intake - 4.1M
Alcohol - 3.3M
Insufficient physical activity - 1.6M
Suicide - 800,000
There is no general trend for NCDs, some are increasing and some are decreasing.
Target 3.5
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
What it means
Substance abuse refers to excessive use of a drug or alcohol in a way that is detrimental to self, society, or both. This definition includes both physical dependence and psychologic dependence (NCBI).
While this target seems relatively straightforward it is actually quite complex from a policy angle because of the intersection with the criminal justice system. It is notable that substance abuse is seen as a health issue in the 2030 Agenda because in many countries it is treated as a criminal issue, despite the evidence pointing to the fact that addressing it is best done in the health system (WHO).
Prevention is understood as any activity designed to avoid substance abuse and reduce its health and social consequences. This broad term can include actions aimed to reducing supply (based on the principle that the decreased availability of substances reduces the opportunities for abuse and dependence) and decreasing demand including education, health promotion, disease prevention, (Medina Mora), and tackling environmental factors (economic opportunity, for example) that may contribute to substance abuse.
Effective treatment of substance abuse issues looks at the complex web of psychosocial, environmental, and biological factors that play into an addiction.
Where we are currently
269 million people used drugs worldwide in 2018, which is 30 per cent more than in 2009. 35M people are estimated to be suffering from a drug abuse disorder. Cannabis was the most used substance worldwide in 2018, with an estimated 192M people using it worldwide. Opioids, however, remain the most harmful, as over the past decade, the total number of deaths due to opioid use disorders went up 71%. Drug use has increased far more rapidly among developing countries over the 2000-2018 period than in developed countries. (UNODC)
Globally, alcohol consumption causes 2.8 million premature deaths per year. Total volume of alcohol consumed per year increased by as much as 70% between 1990 and 2017.
Target 3.6
By 2020, halve the number of global deaths and injuries from road traffic accidents
What it means
While one may think of road traffic accidents as accidents between cars, it actually includes all incidents that happen on roads including those that involve vulnerable road users like pedestrians, cyclists, and motorcyclists. In fact, more than half of all road traffic deaths are attributed to these more vulnerable road user groups (WHO). While we are looking at the health aspect of road traffic accidents, they also have an incredible economic cost, costing most countries 3% of their gross domestic product (GDP).
Preventing road accidents involves tackling various risk factors including:
Speeding
Driving under the influence of alcohol and other psychoactive substances
Nonuse of motorcycle helmets, seat-belts, and child restraints
Distracted driving due to mobile phones
Unsafe road infrastructure or vehicles
Inadequate post-crash care
Inadequate law enforcement of traffic laws
Where we are currently
Approximately 1.35M people die each year as a result of road traffic crashes, this figure has remained relatively stable since 1990 (Our World in Data). Road traffic injuries are the leading cause of death for children and young adults aged 5-29 years. 93% of the world's fatalities on the roads occur in low- and middle-income countries, even though these countries have approximately 60% of the world's vehicles (WHO). Men, and particularly young men, are more likely to die in road traffic accidents. 73% of all road traffic deaths occur among young males under the age of 25 years. Men are almost 3 times more likely to be killed in a road traffic crash than young women.
Target 3.7
By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
What it means
Sexual and reproductive health-care services address reproductive processes, functions and system at all stages of life and include both physical and psychological well being when it comes to sexuality. This SDG target is measured by two indicators one focused on meeting family planning needs and the other on adolescent birth rate (i.e. the number of women between the ages of 10-19 having babies) but of course when we unpack what it takes to address these indicators there are a host of important issues that need to be addressed these include information on and access to modern contraception, emergency contraception, menstruation products; HIV and STI (sexually transmitted infection) testing and treatment; gynaecology, pregnancy testing and services, safe abortion; and counselling, including that specifically related to gender-based violence, sexual assault, and other harmful practices (Plan International)
Where we are currently
As of 2020, only 55% of married or in-union women aged 15 to 49 make their own decisions regarding sexual and reproductive health and rights, based on data from 57 countries (UNFPA). There are vast differences in these numbers depending on region, for example this number is less than 40 per cent in Middle Africa and Western Africa but it is nearly 80 per cent in some countries in Europe, South-eastern Asia, and Latin America and the Caribbean.
Approximately 12M girls aged 15–19 years and at least 777,000 girls under 15 years give birth each year, mostly in developing regions. Of the estimated 5.6M abortions that occur each year among adolescent girls aged 15–19 years, 3.9 million are unsafe, contributing to maternal mortality, morbidity and lasting health problems (WHO).
Target 3.8
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
What it means
The key to universal health coverage is that individuals can receive the health services they need without suffering financial hardship - it is both about the services available and the cost of those services. Essential health services include health promotion and prevention, treatment, rehabilitation, and palliative care over the lifespan of an individual. This target is measured by two indicators 1) the proportion of a population that can access essential quality health services 2) the proportion of the population that spends a large amount of household income on health. The WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries:
Reproductive, maternal, newborn and child health (family planning, delivery care, child immunization)
Infectious diseases (prevention and treatment for diseases listed in target 3.3)
Noncommunicable diseases (prevention and treatment for diseases listed in target 3.4)
Service capacity and access (hospital access, health worker density, access to essential medicines)
Where we are currently
Half of the world’s population does not have access to the health care they need. About 930 million people worldwide spend at least 10% of their income on health services. 100 million people each year fall into poverty due to out-of-pocket health spending.
The WHO has an indicator dashboard to dive into more detail on individual dimensions of Universal Health Care.
Target 3.9
By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
What it means
This target includes three major components:
Air pollution - including outdoor ozone pollution, outdoor particulate pollution, and household pollution (from smoking or cooking with solid fuels)
Clean water, sanitation and hygiene - not having access to these services can lead to preventable diseases (diarrhea, cholera, worms) and deaths
Poisoning - including household chemicals, chemicals used in products (mercury, lead, asbestos, etc.), pesticides, even snake bites
All of these are measured by the number of deaths attributed to each cause per 100,000 individuals.
Where we are currently
Air pollution
In 2016, 91% of the world population was living in places where the WHO air quality guidelines levels were not met. Outdoor air pollution in both cities and rural areas was estimated to cause 4.2 million premature deaths worldwide in 2016. These rates have remained quite steady over the last decade.
Indoor air pollution is very problematic in developing countries. Around 3 billion people cook using polluting open fires or simple stoves fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal. Each year, close to 4 million people die prematurely from illness attributable to household air pollution from inefficient cooking practices using polluting stoves paired with solid fuels and kerosene. In addition, nearly half of deaths due to pneumonia among children under 5 years of age are caused by particulate matter (soot) inhaled from household air pollution. (WHO)
Clean water, sanitation and hygiene
As of 2017, 829 000 people die each year from diarrhea as a result of unsafe drinking water, sanitation and hand hygiene. 785M people lack a basic drinking-water service and 884M people do not have safe water to drink, however this represents progress as this number was over 1B as recently as 10 years ago. 2B people still do not have basic sanitation facilities such as toilets or latrines.
In least developed countries, 22% of health care facilities have no water service, 21% no sanitation service, and 22% no waste management service. (WHO)
Poisoning
According to WHO data, in 2012 an estimated 193,460 people died worldwide from unintentional poisoning. Of these deaths, 84% occurred in low- and middle-income countries. In the same year, unintentional poisoning caused the loss of over 10.7 million years of healthy life.
Means of Implementation
Target 3A Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate
Target 3B Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
Target 3C Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States
Target 3D Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
Keep Learning
Here are a few great resources for further reading and learning:
CDC (USA focused but with a lot of great global information)
How to Support?
With every video, I provide links to related organizations that you may or may not choose to support with your pocketbook.
Médecins Sans Frontiers / Doctors Without Borders - provides medical care to people in humanitarian situations - Donate
Bill and Melinda Gates Foundation - one of the largest foundations dedicated to global health - Donate
There are literally thousands of health related charities - by disease/health issue, region, etc. These include institutions that fund research, respond to emergency situations, provide treatment and care, and more. If you are interested in a particular health area, you are sure to find an organization working in this area.