Health in the post-2015 agenda: perspectives midway through.

On September 2014, the United Nations General Assembly (UNGA) will evaluate the proposals of the UN Open Working Group (OWG) 1 for the Sustainable Development Goals (SDG) in the Post-2015 Agenda, which also includes a health goal. The final version of these goals will be approved at the 2015 UNGA. The document is the convergence of several processes implemented by the United Nations General Secretariat and the UNGA since the conclusion of the United Nations Conference on Sustainable Development, the Rio+20 Conference, such as the Global Consultation and Dialogue 2 and the High-Level Panel of Eminent Persons 3. The OWG suggested 17 SDGs (http://sus tainabledevelopment.un.org/focussdgs.html), which address a wide range of issues from the eradication of extreme poverty and hunger to industrialization, sustainable energy, the protection of the environment, education and other social, economic and environmental issues – the three pillars of sustainable development –, as established in the final document of the Rio+20, The Future We Want 4. Each goal also has “means of implementation”. After long discussions carried out since the Rio+20, the OWG decided to establish the Health SDG as “ensure healthy lives and promote wellbeing for all at all ages”, which is much more comprehensive than the “sectoral” proposal of the World Health Organization (WHO), which has been advocating “universal health coverage” as a SDG for Health. This present proposal is much more coherent with the ideas that health is socially produced and that consideration needs to be given to the social determinants of health. It also fits much better with the WHO Constitution of 1948. There are 13 targets for the Health SDG (http://sustainabledevelopment.un.org/focuss dgs.html). However, these targets narrow down the broader, initial goal, because they are linked only to individual and curative elements of health care. Fundamental elements of public health, that is, those dedicated to “ensuring health and promoting well-being” and not simply “fighting diseases”, were not included: epidemiological, sanitary and environmental surveillance is omitted; health promotion and addressing the social determinants of health are not even mentioned. The goals for implementation are excessively fragmented and uncoordinated with the other SDGs – quite contrary to what would be crucial for the intersectoral governance required to “ensure healthy lives and promote well-being”. The targets, which we call “issue targets”, address health problems in a traditional and fragmented way: maternal and child mortality and communicable diseases (part of the “unfinished agenda of the MDGs”); non-communicable dis-