Ensuring the Achievement of the Millennium Development Goals: Strengthening US Efforts to Reduce Global Poverty and Promote Public Health

The American Public Health Association (APHA), in its commitment to global public health and human rights, seeks to end the debilitating economic and social disadvantages that negatively affect the health of the world’s population. Therefore, APHA takes note of the following:

Around the world, 1.4 billion people survived on less than a $1.25 a day in 2005¹ and 1 person in 7 goes to bed hungry each night.² Expanded access to education generates widespread development returns in areas such as health and economic and political development, yet 75 million children are currently out of school across the world.³

Although gender empowerment is a critical component of development,⁴ women still bear the brunt of global poverty and disease—women work long hours earning less money,⁵ have fewer educational and employment opportunities,⁶ and are more vulnerable to failures of weak health systems and diseases such as HIV/AIDS than their male counterparts.⁷ Every year, nearly 10 million children die before their fifth birthday—one every 3 s—nearly all of them from preventable or treatable diseases such as diarrhea, pneumonia, and measles.^8,9

Every year, more than half a million mothers die from complications during child birth, and tens of millions more suffer from pregnancy-related illnesses and injuries.¹⁰ In addition, according to the most recent data from the World Health Organization (WHO), drowning and road traffic accidents are the eighth and ninth leading causes of death among children 1 to 4 years of age.¹¹

Although HIV/AIDS, tuberculosis, and malaria can be prevented and treated, these diseases are 3 of the world’s most devastating. In 2004, HIV/AIDS killed more than 2 million people, tuberculosis killed 1.5 million people, and malaria killed nearly 1 million people.¹²

Poorly funded health systems and chronically low numbers of qualified health care professionals and paraprofessionals, including those lost to the so-called “brain drain” effect, substantially hinders developing countries’ ability to promote public health and to effectively address global health crises.^13,14 This issue has been identified as a priority focus by leading international organizations, such as US Agency for International Development, WHO, and the World Bank.^15–17

Billions of people worldwide lack access to clean water and basic sanitation,¹⁸ and many communities face growing challenges to environmental sustainability and public health, including the disproportionate adverse effects of global climate change on people living in low- and middle-income countries.¹⁹ Road traffic injuries are a significant, but neglected, public health challenge that requires concerted efforts for effective and sustainable prevention.²⁰ Worldwide, an estimated 1.2 million people are killed in road crashes each year, and as many as 50 million are injured.20 Reduction in road traffic injuries can contribute to the attainment of the Millennium Development Goals (MDGs) oriented to reduce worldwide levels of extreme poverty and significantly reduce child mortality.²⁰

Other critical, adverse health impacts and practices substantially erode global poverty-fighting initiatives and negatively affect international efforts to promote sustainable development. These challenges include, but are not limited to, global health and economic burdens associated with alcohol, tobacco, and other drug use; lack of access to affordable treatment and prevention services for mental illness; learning disabilities and other psychosocial impairments; and lack of access to childhood blindness control interventions and support for healthy vision, including critical WHO VISION 2020 programming.^21–23

Cleaner energy and new efforts to improve air quality are also vital—WHO has estimated that approximately 2.4 million premature deaths in 2000 were associated with indoor and outdoor particulates related to the combustion of fuels, including both biomass and fossil fuels, with mortality and morbidity burdens falling heavily on exposed populations in the developing world.²⁴ Warfare and other armed civil and military conflicts threaten the health, public safety and long-term well-being of people living in extreme poverty, especially women and children, whereas extreme poverty and its accompanying effects increase the risk that such conflicts will occur, perpetuating a cycle of poverty and violence.²⁵

Success at making durable progress in the fight against global poverty requires a new compact of global cooperation among developing countries and donor governments that prioritizes sustainable development and builds a transparent and accountable system to reliably finance and effectively target international assistance. In 2000, in a global effort to address these pressing challenges, world leaders from 189 nations endorsed the MDGs, a set of 8 ambitious international targets designed to significantly reduce global poverty and disease by 2015, including specific targets to reduce poverty and hunger (MDG 1); promote universal education (MDG 2); support gender equality and the empowerment of women (MDG 3); reduce child mortality and promote maternal health (MDGs 4 and 5); combat HIV/AIDS, malaria, and other diseases (MDG 6); ensure environmental sustainability (MDG 7); and develop a global partnership for development (MDG 8).²⁶

International efforts to fight global poverty and advance the MDGs were substantially strengthened at the 2005 Gleneagles G8 meeting when member countries provided new aid commitments equal to $37.6 billion by 2010.27 Even before the onset of the current financial crisis, the parties to the Gleneagles agreement were not fully meeting their obligations to increase aggregate Official Development Assistance (ODA) at the committed levels.²⁸ The United States has been an important contributor to global efforts to fight poverty and to improve public health in developing countries, providing vital assistance for African countries and funding HIV/AIDS and malaria treatment and prevention programming.²⁵

The United States was likely to meet its Gleneagles commitment if prior-year trends were continued.²⁵ Yet despite the administration’s budget request to increase poverty-fighting foreign assistance in FY2010, observers have expressed concern that congressional action in a challenging fiscal environment may undercut efforts to meet the Gleneagles funding obligations of the United States.²⁹

More generally, whereas international efforts to achieve the MDGs are yielding important progress in the fight against global poverty,³⁰ the impact of the global economic crisis is deepening, and its effects are likely to erode international and developing countries’ efforts to reach MDG targets by 2015. The expected increase in economic dislocation, extreme poverty, and lack of access to affordable health care and functioning public health systems will make it significantly more difficult for low- and middle-income countries to ensure a sustainable and prosperous future for the poorest and most vulnerable.³¹

The United States has a strong humanitarian and national security interest in strengthening global health and development.³² The United States must demonstrate bold leadership and robust engagement, along with international partners and multilateral institutions, to ensure that the MDGs are fully met by 2015.

Therefore, APHA^33–39

1. Recommends that the United States commit itself to a comprehensive approach to global health and development oriented toward achieving the current targets of the MDGs by 2015 and beyond by developing a long-term development strategy and providing sustained financing to effectively and efficiently disburse funds to programs with multiyear funding cycles; devoting at least 0.7 % of gross national income to Official Development Assistance (ODA) and proportionately increasing funding for all global health and development programs, including programming directed at food insecurity and hunger; fully appropriating the $48 billion for HIV/AIDS, tuberculosis and malaria for 2009–2013 authorized under the President’s Emergency Plan for AIDS Relief; and support efforts to promote comprehensive safe transportation and road safety policies in developing countries.
2. Recommends that the United States support comprehensive health system strengthening by directing increased US aid to recipient country public sector health systems and providing aid and technical assistance, training opportunities, and support for bilateral and multilateral efforts to advance the adoption and implementation of best practices in public health surveillance and epidemiology, laboratory science, health risk management and risk communication, health education, and acute and chronic disease prevention; improve countries’ capacity for health workforce planning by increasing the total number of health workers in resource-poor countries to, at a minimum, 2.3 doctors, nurses, and trained midwives, and 1.8 health auxiliaries (including community health workers) per 1,000 residents; providing support for preservice training and retention for at least 140,000 new health professionals; and ensuring that health workers receive adequate compensation, supervision, health coverage or access to confidential and affordable health care services; and the needed resources to safely and properly perform their jobs.
3. Recommends that the United States reduce global child mortality by supporting child health programs with an integrated approach focusing on family health, clean water, nutrition, affordable health care, maternal education, injury prevention, and social protection to adequately address the essential elements of children’s lives; emphasize attainment of universal coverage of preventive measures endorsed by WHO to promote child survival, with renewed efforts to advance exclusive breastfeeding for 6 months with continued breastfeeding for at least 1 year; continue to make greater investments in childhood vaccination campaigns; combat malnutrition by enhancing preventive efforts and providing nutritious foods to families with young children; increase the use of ready-to-use therapeutic food and acknowledge access to food as a vital component in improving child health (efforts to address food access should support local agriculture production and distribution systems to ensure self-sufficiency and promote access to adequate quality and quantity of food); and increase its support and provide leadership for the WHO’s VISION 2020 programming.
4. Recommends that the United States improve women’s health by providing increased funding for reducing maternal mortality and expanding family planning and reproductive health services; ensure that US health policies are fully grounded in scientific evidence; remove financial barriers to care, specifically user fees for prenatal and obstetrical services, because maternal mortality is strongly correlated with poverty; and address issues documented to be inextricably linked to women’s health, including universal female literacy, economic empowerment for women, psychosocial support, and support for women who are victims of domestic abuse or violence.
5. Recommends that the United States develop a framework to implement the Paris Declaration for Aid Effectiveness and better evaluate assistance programs and measure their effectiveness, efficacy, and likely impact, especially as it relates to achieving the MDGs; require all agencies and foreign assistance initiatives to improve accountability by regularly harmonizing US-funded strategies with existing host-country public health programs, and development agenda, assessing the performance of programs and individual projects, including the variability of impact, and to report those findings publicly; and institute a policy of complete transparency in US foreign aid. Enhanced data collection and data reliability measures and the use of standard performance indicators to allow for comparison of effectiveness of various interventions and across countries are essential to measure progress toward the 2015 MDG targets and measurable return on tax payers’ investment in global health and development.
6. Recommends that the United States exert sustained leadership, along with other countries and multilateral institutions, to address extreme poverty as an acknowledged determinant and precursor to armed conflict, and to prioritize “smart power” approaches to foreign and international policies, including enhanced commitments and funding to fight global poverty and to improve public health, to promote public accountability and good governance, and to demonstrate a heightened commitment to the defense of human rights, freedom of expression, and the status and well-being of women and children and other vulnerable groups.
7. Urges donors, recipient countries, multilateral institutions, and other stakeholder entities to support improved access to cleaner energy sources among developing countries; to advance regional and global air quality initiatives; and in addressing global climate change, to take account of the disproportionate vulnerability of developing countries to changes in atmospheric warming, storm frequency and intensification, food and water scarcity and emerging and endemic infectious diseases; and to ensure that international greenhouse gas emissions control mechanisms fully support adaptation and mitigation efforts in low- and middle-income countries and promote climate-friendly development.
8. Recommends that the United States provide sustained leadership and support in the face of a global economic crisis that will severely and disproportionately affect nearly one third of the world’s population living in extreme poverty, and that US leaders ensure that the international policies of the United States prioritize the fight against global poverty and promote efforts to mitigate economic dislocation in low- and middle-income countries.

References

1. United Nations. Millennium Development Goals Report: 2008 Addendum. Available at: www.un.org/millenniumgoals/2008highlevel/pdf/MDG_Report_2008_Addendum.pdf. Accessed February 9, 2009.
2. Sheeran J. The challenge of hunger. Lancet 2008;371:180–181.
3. United Nations Educational, Scientific and Cultural Organization. EFA Global Monitoring Report 2009. Available at: www.unesco.org/en/efareport. Accessed December 9, 2009.
4. United Nations Development Program. Human Development Report 2003. New York, NY: Oxford University Press; 2003: 18. Available at: http://hdr.undp.org/en/reports/global/hdr2003/. Accessed February 9, 2009.
5. United Nations Development Program. Innovative Approaches to Promoting Women’s Economic Empowerment. New York, NY: United Nations Development Program; 2008: 4. Available at: http://content.undp.org/go/cms-service/download/asset/?asset_id=1639512. Accessed February 9, 2009.
6. United Nations. Investing in Women and Girls Backgrounder. 2008. Available at: www.un.org/events/women/iwd/2008/pdf/IWD%20rev%20E.pdf. Accessed February 9, 2009.
7. United Nations Children’s Fund. Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival, 2008 Report. Vol. 2. New York, NY: UNICEF; 2008; vii. Available at: www.countdown2015mnch.org/reports-publications/2008report. Accessed February 9, 2009.
8. Save the Children. State of the World’s Mothers Report; 2008. Available at: www.savethechildren.org/campaigns/state-of-the-worlds-mothers-report/2008/. Accessed February 9, 2009.
9. United Nations Children’s Fund. Infant and Young Child Feeding: Innocenti Declaration. 2005: 4–5. Available at: www.unicef-irc.org/homepages/files/documents/f_5.pdf. Accessed June 16, 2009.
10. United Nations Children’s Fund. State of the World’s Children: 2009—Maternal and Newborn Health. New York, NY: UNICEF; 2008. Available at: www.unicef.org/publications/index_47127.html. Accessed February 9, 2009.
11. World Health Organization. Leading causes of death in children, both sexes, World, 2004. World Report on Child Injury Prevention. New York, NY: WHO; 2008: 2, Table 1.1. Available at: http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf. Accessed November 8, 2009.
12. World Health Organization. Global Burden of Disease: 2004 Update. 2008; 11. Available at: www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed February 9, 2009.
13. Taskforce on Global Action for Health System Strengthening. Global Action for Health System Strengthening: Policy Recommendations to the G8. 2009; 11. Available at: www.jcie.org/researchpdfs/takemi/full.pdf. Accessed June 16, 2009.
14. Kuehn B. Global shortage of health workers, brain drain stress developing countries. JAMA 2007;298:1853–1855.
15. Members and Partners. Global Health Workforce Alliance. Available at: www.who.int/workforcealliance/members_partners/en/. Accessed November 8, 2009. 
16. Liese B, Dussault, G. The State of the Health Workforce in Sub-Saharan Africa: Evidence of Crisis and Analysis of Contributing Factors. Washington, DC: African Region, the World Bank; 2004. Available at: www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2005/07/05/000090341_20050705112206/Rendered/PDF/328040Health0workforce0AFHD0No175.pdf. Accessed December 11, 2009. 
17. US Agency for International Development. Health Systems: Achievements. Available at: www1.usaid.gov/our_work/global_health/hs/achievements.html. Accessed November 8, 2009.
18. World Health Organization and UNICEF. Progress in Drinking Water and Sanitation. Geneva, Switzerland: World Health Organization and UNICEF;2008; 2. Available at: www.unicef.org/media/files/Joint_Monitoring_Report_-_17_July_2008.pdf. Accessed February 9, 2009.
19. Kasotia P. The health effects of global warming: developing countries are the most vulnerable. UN Chronicle. June 2007. Available at: www.un.org/wcm/content/site/chronicle/cache/bypass/lang/en/home/archive/issues2007/pid/5015?ctnscroll_articleContainerList=1_0&ctnlistpagination_articleContainerList=true. Accessed February 9, 2009.
20. World Health Organization. World Report on Road Traffic Injury Prevention. 2004. Available at: www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.html. Accessed June 16, 2009.
21. World Health Organization (WHO). World Health Report 2005: Make Every Mother and Child Count. Geneva, Switzerland: World Health Organization; 2005: 45. Available at: www.who.int/whr/2005/en/index.html. Accessed November 8, 2009. 
22. Lancet Global Mental Health Group. Scale up services for mental disorders: a call to action. Lancet. 2007;370(9594):1195–1197. 
23. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020—the Right to Sight. Bulletin of the World Health Organization. 2001; 79:227–232. 
24. Ezzati M, Lopez AD, Rodgers A, Murray CJL. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors: Vol. 1. Geneva, Switzerland: World Health Organization; 2004:1354–1436.
25. Rice S, Graff C, Lewis J. Poverty and Civil War. What Policymakers Need to Know. Global Economy and Development Working Paper. Brookings Institution. Washington, DC: The Brookings Institution; 2006. Available at: www.brookings.edu/views/papers/rice/poverty_civilwar.pdf. Accessed December 11, 2009.
26. United Nations General Assembly. United Nations Millennium Declaration Resolution 55/2. New York, NY: United Nations; 2000. Available at: www.un.org/millennium/declaration/ares552e.htm. Accessed February 9, 2009.
27. ONE Campaign. DATA Report: 2008. Available at: www.one.org/report/en/index.html. Accessed June 16, 2009.
28. World Bank. Swimming Against the Tide: How Developing Countries Are Coping With the Global Crisis. Horsham, UK: World Bank; 2009; 8. Available at: www.un.org/ga/president/63/PDFs/WorldBankreport.pdf. Accessed June 16, 2009.
29. Garrett L. The Future of Foreign Assistance Amid Global Economic and Financial Crisis. Advancing Global Health in the U.S. Development Agenda. New York, NY: Council on Foreign Relations; 2009: 5. Available at: www.cfr.org/publication/18167/. Accessed June 16, 2009.
30. United Nations. Millennium Development Goals Report: 2008. New York, NY: United Nations; 2008: 4. Available at: www.un.org/millenniumgoals/pdf/The%20Millennium%20Development%20Goals%20Report%202008.pdf. Accessed February 9, 2009.
31. Schifferes S. Crisis to trap 53 million in poverty. BBC News UK. February 12, 2009. Available at: http://news.bbc.co.uk/1/hi/business/7886334.stm. Accessed February 16, 2009.
32. Clinton HR. Clinton’s Confirmation Opening Statement Secretary of State Designee Calls for Use of “Smart Power” in Opening Statement to Senate Foreign Relations Committee. January 13, 2009. Available at: www.cbsnews.com/stories/2009/01/13/politics/main4718514.shtml. Accessed February 9, 2009.
33. American Public Health Association. APHA policy statement 2002-06: Access to safe water, sanitation, and hygiene promotion in developing countries. Washington, DC: American Public Health Association; 2002. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=280. Accessed December 11, 2009.
34. American Public Health Association. APHA policy statement 2005-03: Expenditure ceilings imposed on poor countries must be lifted to achieve the Millennium Development Goals. Washington, DC: American Public Health Association; 2005. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1308. Accessed December 11, 2009.
35. American Public Health Association. APHA policy statement 78-41: International population and family planning. Washington, DC: American Public Health Association; 1978. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=918. Accessed December 11, 2009.
36. American Public Health Association. APHA policy statement 89-26: Foreign Assistance Act. Washington, DC: American Public Health Association; 1989. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1205. Accessed December 11, 2009.
37. American Public Health Association. APHA policy statement 2007-8: Addressing the urgent threat of global climate change to public health and the environment. Washington, DC: American Public Health Association; 2007. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1351. Accessed December 11, 2009.
38. American Public Health Association. APHA policy statement 2008-9: Strengthening health systems in developing countries. Washington, DC: American Public Health Association; 2008. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1375. Accessed December 11, 2009.
39. American Public Health Association. APHA policy statement LB-08-01: Food crises: addressing the current crisis and preventing the next one. Washington, DC: American Public Health Association; 2008. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1376. Accessed December 11, 2009.

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