Overview
The United Nations’ Sustainable Development Goal (SDG 3) for good health and wellbeing aims to ensure healthy lives and to promote wellbeing for all people at all ages. The UN has defined 13 SDG 3 targets, composed of 28 indicators. Almost all the other 16 SDGs and associated targets are directly related to health or contribute to it indirectly, illustrating the breadth and depth of global health challenges and the importance of adopting a multidisciplinary approach in exploring pathways to good health and wellbeing.
The World Health Organisation (WHO) advocates One Health as ‘an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes’. The One Health approach to governance is rooted in effective communication, collaboration, coordination, and capacity building (‘the 4 Cs’) between people from different sectors, backgrounds and disciplines in societies across the world.
In tackling complex health threats, as amply demonstrated during the COVID-19 pandemic, the One Health concept depends on an interdisciplinary, intersectoral, integrated and unifying approach designed to achieve a sustainable balance which optimises the health of people, animals and ecosystems. By pooling knowledge, resources and methodologies, clinical, natural, social and behavioural scientists explore the causes of global health challenges and adopt a holistic perspective in their search for solutions.
In a context of population decline and ageing, unrelenting climate change and the ubiquitous digitisation of society, the United Nations declared 2021−2030 the Decade of Healthy Ageing. The UN called upon governments, international and regional organisations, civil society, the private sector, academia and the media to participate actively in formulating and delivering policies to improve the lives not only of older people but also of their families and communities. The World Medical Association’s 2022 Oslo Declaration on social determinants of health focused on this interactive dimension of health by confirming that such policies should address the social, cultural, environmental, economic and other factors known to be major causes of both ill-health and the magnitude of health inequities.
Key evidence
Data from the WHO’s Global Health Observatory and Health Inequality Data Repository, together with Our World in Data and other international and national statistical offices, provide evidence on which to base policy and to draw lessons from other countries.
- The first SDG 3 indicator (3.1.1) sets a target of reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births per year. The WHO estimated that 300,000 women globally died from pregnancy-related deaths in 2017, or around 800 each day on average, with 40 times higher rates reported in lower-income than in high-income countries.
- The target for SDG 3.4 is to reduce by one third premature mortality from non-communicable diseases − cardiovascular disease, cancer, diabetes or chronic respiratory diseases − through prevention and treatment in all countries by 2030. The available data show that non-communicable diseases have become the most common causes of death in wealthier countries, and are usually associated with the increase in obesity, unhealthy life styles and population ageing. In low-income countries, Africa and Asia in particular, with poor access to clean water, sanitation and healthcare, people are much more likely to die from infectious diseases, maternal, neonatal, and nutritional causes, as evidenced by SDG 3.2 and SDG 3.3.
- The SDG 3.8 target for 2030 sets out to ‘achieve universal health coverage including financial risk protection, access to quality essential health-care services and to safe, effective, quality and affordable essential medicines and vaccines for all’. The WHO’s Universal Health Coverage (UHC) Index tracks progress in capacity of, and access to, services among the general and most disadvantaged populations. Analysis of their Global Triple Billion target shows that, after significant progress between 2000 and 2021, the world is off-track for meeting SDG targets. Furthermore, growth in capacity and access to coverage is slowing down, meaning that an increasing proportion of the population are facing severe financial hardship and falling deeper into extreme poverty due largely to health costs.
Policy context
Scrutiny of each of the SDG and UHC indicators reveals major differences in health and wellbeing between and within regions and countries. Analyses and monitoring reports based on disaggregated data from the World Health Inequality Data Repository have contributed to an increasingly reliable evidence base that governments use in their quest to formulate and implement effective policy measures for reducing the health inequities broadly attributable to the circumstances and environments in which people live.
Systematic reviews of social determinants of health have identified major factors influencing whether people are likely to be healthy, encompassing: where they live (country, urban or rural, inner city, housing, local community); the state of the environment (climate, pollution, working conditions, indoor air quality); their genetics, gender and ethnicity, their income and social protection; early childhood development and educational level; food security; lifestyles and relationships with friends and family. These cumulative factors are shaped, in turn, by economic policies and systems, development agendas, social norms, social policies and political systems.
Other reviews show how, in the long term, the impact of these socio-cultural factors can be greater than that of indicators such as access and use of health care services and other policy interventions directly targeting health, leading to the conclusion that many health risks are preventable. WHO analyses suggest that social determinants of health account for between 30−55% of health outcomes, while other commentators estimate that up to four-fifths of the underlying causes of poor health are outside the control of the individual and health services, further demonstrating that the contribution of sectors outside health to population health outcomes exceeds that from the health sector.
The European Union developed its Global Health Strategy in the context of three complementary priorities: deliver better health and wellbeing for people across their life course; strengthen health systems and advance universal health coverage; prevent and combat health threats, including pandemics. Applying a One Health approach, the EU is thereby seeking to regain the ground lost to reach the universal health-related targets in the 2030 SDGs.
Recommendations
To achieve universal health coverage, a broad consensus has developed demanding a quantum shift from
- treatment to prevention by moving from reactive to proactive, comprehensive prevention actions implemented across the life course
- hospital to community and primary care while expanding professional training capacity, improving workplace conditions to attract and retain talent, leveraging innovations to increase productivity;
- analogue to digital, by enabling all areas of health systems to become digitally mature, facilitating sharing of health and non-health data, and using technology to improve patient outcomes.
Advocates of a ‘causes of the causes’ approach to prevention recommend:
- giving every child the best start in life;
- providing good quality education and opportunities for life-long learning;
- improving access to secure employment and healthy working conditions for all;
- ensuring that everybody has the minimum income necessary for a healthy life;
- providing healthy and sustainable places to live and work.
Promoters of a One Health approach to governance emphasise the need to
- enhance communication, collaboration, coordination, and capacity building across sectors.
This briefing was written by Linda Hantrais FAcSS.