No goals at half-time – the Millennium Development Goals
Welcome back to a new week at The Lancet Student. We’re kicking off with a blog below on the Millennium Development Goals (MDGs), inspired by a conference one of our interns went to last week. Just as a reminder, tomorrow is the start of The Lancet Student water and sanitation week, so look out for our blogs on all things to do with these issues, as well as a special petition we’re hoping you’ll sign. If anyone wants to write us a blog on something water and sanitation related in the next week (we can even give you a more specific topic to write on!) then do get in touch on student@lancet.com. In other health-related news, a member of Obama’s transition team has indicated that many of Bush’s policies are under review and may be quickly rolled back, including the prohibitive restrictions on stem cell research. Good news for US medical research!
Picture courtesy of the MDG monitor
In the wake of the UN meeting in New York on the 25th September, the MDGs, a series of 8 goals, 21 targets and 60 indicators, have experienced in boost in the media and one hopes also on development agendas. But how much progress has actually been made and what now needs to be done? This was the question discussed at last week’s conference at the London International Development Centre (LIDC), a collaborative project of six of the Bloomsbury colleges, and this blog will pick up on a few of those threads.
In theory we are now over the halfway point, between the goals’ creation in 2000 and the deadline of 2015. It is worth remembering, however, that the data baseline for the MDGs is actually 1990 and so, for instance, the MDG1 target of halving the proportion of people living on less than $1 a day by 2015 uses the 1990 proportion as the original value. While many of the MDG targets are now difficult, if not nigh impossible to achieve by 2015 due to lack of progress, they were originally conceived as realistic goals, based on existing trends throughout the 80s and 90s. Another lesser known fact is that the MDGs are not binding, unlike the UN Millennium Declaration. The MDGs were in fact conceived by a UN working group after the UN Millennium Summit in September 2000, though they have been widely accepted and endorsed since. Additionally, the MDGs are global goals, though they are often not treated as such. It is technically fallacious to say “Africa is not on target to reach the MDGs” and indeed rather unfair in many situations; as mentioned before, the MDGs were based on average global trends and so by definition some countries started off on a better base than others. Many argue, however, that to foster the necessary willpower and promote large-scale change, it is necessary to apply the MDGs to regions and countries as well.
Brief summary of the MDGs (see the UN MDG monitor and the UN MDG indicators site for more information and relevant data):
- 1 Halve the proportion (note the choice of proportion over absolute number) of people in extreme poverty and hunger
- 2 Achieve universal primary education
- 3 Promote gender equality and empower women
- 4 Reduce the number of deaths in children under 5 by two thirds
- 5 Reduce the maternal mortality rate by three quarters
- 6 Combat HIV/AIDS, malaria and other diseases
- 7 Ensure environmental sustainability
- 8 Develop a global partnership for development
Each of these goals encompasses multiple targets (with the exception of MDG2) and numerous progress indicators. MDGs 4, 5 and 6 are considered the “health MDGs”, but it is intuitively obvious from the goal descriptions that they all ultimately impact on health.
Many criticisms have been levelled at the MDGs, including the arguments over scale mentioned above. Another slightly sore point is the political and rather arbitrary lumping of multiple development issues into the goals. MDG7, for instance, includes targets as diverse as reaching environmentally sustainable development, reducing biodiversity loss, improving access to clean water and sanitation and improving the lives of slum dwellers. MDG8 is also rather a dustbin and contains all the targets aimed at the richer countries of the world, including bringing Official Development Assistance (ODA) up to 0.7% of GNI and improving market access. The targets themselves may be called into question, for instance Professor Angela Little argued that MDG2 is “limited in vision”, due to its focus on enrolment rather than actual learning and the fact that it focuses exclusively on primary education, when secondary and tertiary education are essential for building a skilled workforce and moreover training the additional teachers needed to achieve universal and quality primary education.
A more frequent criticism is the choice of indicators, which are problematic in themselves as, in using an indicator to assess progress to a target, there is a danger that improving the indicator ends up becoming the target. The speakers addressing MDG3 were particularly scathing about the limited indicators for this goal, which comprise gender parity (ratio of girls to boys) in education, the percentage of women in non-agricultural wage employment and the number of seats women hold in national parliaments (which comes in around 26% in developed countries and 16% in sub-Saharan Africa). A recent World Bank report has proposed MDG3 plus indicators, including rate of completion of education, rates of pay, uptake of contraception and the percentage of young mothers, which would broaden the scope of this goal, though rates of violence against women remain out in the cold. With regards to MDG4, Professor Kim Mulholland spoke about the poor indicator data available for child mortality and how this can affect assessments. Using the example of Eritrea, the only African country on track for MDG4, he showed that there was likely massive underreporting of mortality amongst the poorest quintiles of the population and that this was skewing the results. He also mentioned that even high level organisations are not above occasional data-spinning to demonstrate the desired progress.
To move away from the MDG framework and onto the progress itself; there have been both successes and failures. ODA has increased substantially over the years to $103.7 billion in 2007, though to reach the target the G8 set themselves in Gleneagles, this must be $130 billion by 2010. MDG1 has suffered from measurement difficulties and has been severely set back by the recent high food prices. A World Bank document has estimated that this may have pushed 100 million people into poverty, at a time when the full effects of the current economic crisis have yet to be felt. Primary school enrolment ratios have increased (MDG2) and, while this sometimes disguises other problems, in some countries there has been a genuine improvement in access to education, largely due to widespread abolition of primary school fees. MDG3 is unusual as it has an initial target of 2005, which has been completely missed. Substantial change is needed if it will reach the target by 2015. Advances have been made in MDG4, though sub-Saharan Africa, starting off worst of any region, has also made the slowest progress. For a more detailed summary of MDG5 I’d direct you to one of our blogs last month. Goal 6 is an MDG of mixed successes and failures; the HIV pandemic is levelling off globally but is also changing substantially in nature; and disease control for malaria and TB has been massively ramped up, with particular emphasis on proven interventions such as bed nets and DOTS respectively. However, progress is not happening quickly enough, there are many new problems on the horizon (such as MDR- and XDR-TB) and there is a surfeit of vertical programs that coordinate poorly with one another. MDG7 will be dealt with in much more detail than is possible here as the week goes on. MDG8 has had successes, many of which, such as the G8 Multilateral Debt Relief Initiative, look set to be undone by the economic situation, for instance an assessment earlier this year found that 21 Heavily Indebted Poor Countries (HIPCs) were at a moderate to high risk of slipping back into serious debt. In a common pronouncement about the MDGs – more needs to be done for goal 8 as well.
This paints a rather bleak picture but the mood at the end of the day was not despairing. In the final panel discussion it was emphasised by one of the members that the MDGs are a strong force for good. They have provided a global social compact based on some kind of mutual accountability, they have a broad human development approach and they have spurred on government and public funding like never before. The panel also spoke of the need to move away from the idea that money needs to be poured into low-income countries before anything can be achieved and instead for high-income countries to act as partners to help others strengthen their infrastructure and reach the goals on their own terms. Another clear point to come out was the necessity for multi-disciplinary approaches at all levels; in research, policy and implementation. Academics, always careful with their words and usually unwilling to speak of moral obligations with regard to subjects like poverty, should perhaps consider doing so and must avoid their research being used to promote the cause of one MDG over another. The MDGs, though fragmented and often contentious, like the measures taken to achieve them, overall represent a very human attempt to make the world a better place for its people and as such deserve our support and constant efforts.
For more information we’d also direct you to the Guardian’s report on the MDGs, written after the UN meeting in September.