- About HHR
Carmel Williams and Alison Blaiklock
Last weekend at the UN General Assembly, world leaders adopted the 17 Sustainable Development Goals (SDGs) and their 169 targets with much celebration. It had taken three years of political negotiation, public consultation, and enormous diplomacy to agree on the goals.
Contributors to our SDG SERIES welcome the SDGs as providing valuable opportunities to advance human dignity and rights. But their analyses of the SDGs also highlight missed opportunities, and signal the need for ongoing vigilance to keep human rights central to global development.
The SDGs were developed out of a far more participatory and global process than the Millennium Development Goals (MDGs), and now have a broader coverage of topics and targets. For example, the importance of peace to human development is explicitly recognised. The influence of human rights advocates can be seen in the acknowledgement of rights throughout the text of “Transforming our World: The 2030 Agenda for Sustainable Development” (2030 Agenda).1
Human rights could have provided an integrating framework to the SDGs. Instead, as most contributors to the SDG SERIES note with disappointment, there is no cohesive approach, let alone a consistent rights-based approach, to the goals and targets.
This is seen in SDG 3, ‘Ensure healthy lives and promote well-being for all at all ages’, which broadly addresses all of health. However, many in civil society were hoping the goal would have been simply ‘Ensure universal health coverage’ (UHC). As Audrey Chapman writes, “UHC can be considered to be an expression of the right to health. …Significant progress toward UHC, consistent with the requirements of the right to health, would have the potential of enabling the one billion people currently estimated to not have access to the health services they need each year, to obtain them.” Instead of being a goal, UHC is just one of the 13 SDG 3 targets with none of the 13 prioritized. Chapman fears some goals and targets risk being neglected or forgotten, and that moves towards UHC may happen in ways that do not promote equity.
There is no obvious rationale for the choice of the other SDG 3 targets. Health systems, which are critical for the realization of the right to health, are not mentioned at all in the 13 health targets. SDG 3.c addresses health financing and development of a health workforce, but overlooks the other enabling components of the health system such as health facilities, access to medicines, finances, or management.
The named targets in the SDGs are—as happened with the MDGs—at risk of being viewed and implemented vertically, as standalone projects.
Several authors in the SDG SERIES note that the goals have to be cross-referenced to achieve the ‘integrated and indivisible’ aspirations outlined in the 2030 Agenda. For example, Goals 5 and 10, ‘achieving gender equality’ and ‘reducing inequality within and among countries’, need to be interrelated with all other goals and targets.
Writing on climate change, which is addressed by SDG 13, authors Cecilia Sorenson and Jay Lemery note that the 2030 Agenda does not acknowledge the link between climate, poverty and health. They observe this produces an inadequate response to the threat of climate change throughout the rest of the SDGs, all of which will be affected by climate change.
As experienced under the MDGs, statistical measures of change are more easily moved in the desired direction by focusing on coverage in better developed, less impoverished areas first, overlooking the poorest and most vulnerable people. Looking at child health, Elizabeth Gibbons writes that despite global progress towards reductions in child mortality, in fact the poorest children have been left behind. This is contrary to the catchphrase of the 2030 Agenda, “leave no one behind”. With pressure on governments to achieve SDGs, they may easily reach for the ‘low hanging fruit’ as Inga Winkler and Virginia Roaf describe it, and not fulfill rights obligations towards people already experiencing the greatest inequalities. They, along with Elizabeth Gibbons, Rebecca Brown writing on sexual and reproductive health, Brian Citro on TB, Allan Maleche on AIDS, illustrate where the 2030 Agenda is missing opportunities to frame the SDGs in the unambiguous terms of reducing inequalities and fighting discrimination.
The 2030 Agenda reflects neoliberal discourse in various goals; MacNaughton and Frey identify this “disturbing aspect to Goal 8” with the linking of full employment and decent work to economic growth, despite the fact that it is during economic downturns that the human right to decent work is most important. Without a grounding in human rights, as Fran Quigley illustrates, the SDGs stand no chance at all of trumping contractually based trade deals. It is an argument, he says, in favor of continuing the struggle to make economic and social commitments as rights-based and binding as possible.
The private sector has been given a pivotal role. As it has an overiding concern to return a profit to shareholders, accountability for its impacts on human rights is crucial. There is a risk that inequality will deepen if, for example, health services are geared towards people who are more accessible, and can afford to pay user fees.
For those countries which did not meet the MDGs, and there are many, there is little in the SDGs to indicate how they will now do better. Gibbons shows that the goal of eliminating infant and child mortality in the poorest performing countries would require a three to four times rate of improvement to reach the minimum SDG targets. Few developing countries have the systemic capacity to possibly achieve such improvements and especially so by 2030.
Refugees, people who are trafficked, people who are too poor to be able to share in scientific advancement, children, and those without access to water and sanitation—these are not people who need the world’s charity; they are people, equal to all others, who are entitled to the protection and fulfillment of their human rights. Had the 2030 Agenda been grounded in human rights, then it would have explicitly stated that under international human rights law nations are entitled to extra-territorial assistance to achieve the SDGs.
The contributors seek accountability mechanisms that will monitor SDG progress from a human rights perspective. Paul Hunt, in his essay, writes that SDG accountability can benefit from the experience of the health sector. He calls for the creation of a lean independent body whose mandate would be to review progress, promises, commitments and responsibilities, of both state and non-state—including private sector—partners in SDGs. Within the ‘web of accountability’, he also writes of the need for civil society to be vigilant of SDG impacts.
The real human rights work of the SDG era is only just beginning. Although the SDGs lack a robust human rights framework, the 2030 Agenda repeatedly affirms the importance of human rights, and states that the SDGs seek to realize human rights. Rights-based approaches will be essential in shaping interventions that prioritize those who are most vulnerable; integrating implementation across different goals and targets; ensuring active and informed participation; developing human rights informed indicators; and contributing to the monitoring, review, and accountability processes that have yet to be determined.
The challenge will be to build on what has been achieved so far and use the SDGS, as Rasanatham et al. say, as a means of integrating human rights into
sustainable development. This shifts the development paradigm away from charity or profit motives, and towards empowering people to claim all their rights, not just those documented by 17 goals and 169 targets.
Carmel Williams, PhD, is Executive Editor of the Health and Human Rights Journal and Fellow at the FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Harvard University
Alison Blaiklock, MBChB, MPHTM is a public health physician and Honorary Senior Clinical Lecturer, Department of Public Health, University of Otago Wellington, New Zealand
1 “Transforming Our World: The 2030 Agenda for Sustainable Development”, Draft outcome document of the United Nations summit for the adoption of the post-2015 development agenda, UN Doc A/69/L.85 , Para. 7, available at: http://www.un.org/ga/search/view_doc.asp?symbol=A/69/L.85&Lang=E.
Letter to the Editor: The Rule of Law as a Social Determinant of Health
O.B. K. Dingake
Letter to the Editor: Refusal to Treat Patients Does Not Work in Any Country – Even if Misleadingly Labelled Conscientious Objection
Christian Fiala and Joyce H. Arthur
Letter to the Editor Response: Much to Debate about Conscientious Objection
Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield
Papers in Press
The Cholera Epidemic in Zimbabwe, 2008-2009; A Review and Critique of the Evidence
C. Nicholas Cuneo, Richard Sollom, and Chris Beyrer
Letter to the Editor: Human Rights, TB, Legislation and Jurisprudence
O. B. K. Dingake
UNstoppable: How Advocates Persevered in the Fight for Justice for Haitian Cholera Victims
HIV Criminalization Laws and the Right to Health
Canada’s Mining Industry in Guatemala and the Right to Health of Indigenous Peoples