Governing the UN sustainable development goals: interactions, infrastructures, and institutions.

Three of the eight Millennium Development Goals (MDGs) concerned health. There is only one health goal in 17 proposed Sustainable Development Goals (SDGs). Critiques of the MDGs included missed opportunities to realise positive interactions between goals. Here we report on an interdisciplinary analytical review of the SDG process, in which experts in diff erent SDG areas identifi ed potential interactions through a series of interdisciplinary workshops. This process generated a framework that reveals potential confl icts and synergies between goals, and how their interactions might be governed. In our framework, the 17 SDGs are represented in three concentric layers, refl ecting their main intended outcomes (fi gure). The single health goal is in the inner layer of people-centred goals that aim to deliver individual and collective wellbeing through improved health and education, ensuring equitable distribution within and between individuals and countries. The wellbeing goals are supported by second-level goals that relate to the production, distribution, and delivery of goods and services including food, energy, clean water, and waste and sanitation services in cities and human settlements. We call these infrastructure goals, as they address essential functions of modern societies necessary to deliver the wellbeing goals and provide a platform for delivering the wellbeing goals. The fi gure’s outer layer contains three natural environment goals which relate to the governance of natural resources and public goods in land, ocean, and air, including biodiversity and climate change. The biophysical systems that underpin sustainable development are all here. Although these systems are not dependent on human activities, human activities strongly infl uence them. This organisation of proposed SDGs reveals problems and possibilities for the linking of health with other goals. One key issue concerns governance—ie, the institutional form and relations of accountability. Much work in health has looked at this issue within its own sector. Our framework looks at this problem across sectors, and reveals the interdependency of the health and wellbeing goals with other goals. The institutional structures for delivering wellbeing goals stem from the historical role of states in providing health, education, and welfare. Synergistic opportunities for implementation are associated with the alignment of goals that link education, health, and gender equality. The intersectoral cooperation needed to achieve synergies in wellbeing goals is challenging, but institutional forms to realise this exist. However, the institutional delivery mechanisms for the outer layer, natural environment goals, are not so clear. Despite potential synergies—eg, improvements in forest conservation might reduce climate change, while tackling climate change might reduce loss of coral reefs—governance and delivery models for these goals are limited to agreements under relatively weak intergovernmental conventions. This situation