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All countries achieve universal health coverage at every stage of life, with particular emphasis on primary health services, including mental and reproductive health, to ensure that all people receive quality health services without suffering financial hardship. Countries implement policies to create enabling social conditions that promote the health of populations and help individuals make healthy and sustainable decisions related to their daily living.

Targets and Indicators

5a. Ensure universal coverage of quality healthcare, including the prevention and treatment of communicable and non-communicable diseases, sexual and reproductive health, family planning, routine immunization, and mental health, according the highest priority to primary health care.

34. [Consultations with a licensed provider in a health facility or the community per person, per year]— Indicator to be developed

35. [Percentage of population without effective financial protection for health care] – Indicator to be developed

36.Percentage of children receiving full immunization as recommended by WHO

37. [Functioning programs of multi-sectoral mental health promotion and prevention in existence] – Indicator to be developed

5b. End preventable deaths by reducing child mortality to [20] or fewer deaths per 1000 births, maternal mortality to [40] or fewer deaths per 100,000 live births, and mortality under 70 years of age from non-communicable diseases by at least 30 percent compared with the level in 2015.

38. Neonatal, infant, and under-five mortality rates (modified MDG Indicator)

39. Maternal mortality ratio (MDG Indicator) and rate

40. Healthy life expectancy at birth

41. HIV prevalence, treatment rates, and mortality (modified MDG Indicator)

42. Incidence and death rates associated with malaria (MDG Indicator)

43. Incidence, prevalence, and death rates associated with TB (MDG Indicator)

44. Probability of dying between exact ages 30 and 70 from any of cardiovascular disease, cancer, diabetes, or chronic respiratory disease

5c. Implement policies to promote and monitor healthy diets, physical activity and subjective wellbeing; reduce unhealthy behaviors such as tobacco use by [30%] and harmful use of alcohol by [20%].

45. Percentage of population overweight and obese

46. Household Dietary Diversity Score

47. Current use of any tobacco product (age-standardized rate)

48. Harmful use of alcohol

49. Evaluative Wellbeing and Positive Mood Affect

Evidence

The health MDGs have mobilized all stakeholders in health to demonstrate that tremendous progress in health outcomes can be achieved even in a short period of time. The gains in public health, notably in the reductions of child mortality (MDG 4), maternal mortality (MDG 5), and the control of epidemic diseases (MDG 6), reflect increased investments in public health, improved diagnostics and medicines, and improved primary health systems, including the deployment of community health workers. Even if the health MDGs will not be met in all countries by 2015, the gains point the way to further dramatic reductions in the number of deaths and disease prevalence, and the extension of primary health services to include preventative care and the treatment or management of many high-burden non-communicable diseases such as hypertension, metabolic disorders, some cancers, and mental illness.

By 2030, every country should be well positioned to ensure universal health coverage for all citizens at every stage of life, with particular emphasis on the provision of comprehensive and affordable primary health services delivered through a well-resourced health system. Particularly in low-income settings community health worker systems provide an important means to broaden the coverage of essential health interventions. We emphasize the importance of ensuring universal access, including for marginalized groups and people with disability, as well as affordability so that all people receive the quality health services they need without suffering financial hardship. To improve financial protection, countries should seek to replace direct out-of-pocket payments for health care with equitable public financing.

The MDG health targets need to be retained, updated, and expanded. Preventable child deaths and maternal mortality should be ended by 2030. We therefore propose mortality targets that all countries should achieve. Countries that have already exceeded those targets should aim for higher reductions by setting more ambitious national targets. Likewise, major infectious diseases including HIV/AIDS, TB, and malaria, and relevant high-burden non-communicable diseases should be controlled and comprehensively treated in all countries. Women and men around the world should have access to sexual and reproductive health and family planning services.

To achieve the health goals, health systems also need to be supported by enabling actions in other sectors, including gender equality, education, improved nutrition, water, sanitation, hygiene, clean energy, healthy cities, and lower pollution. Modern technologies including ICT can lower the cost of healthcare provision and increase its efficacy.

Public health and wellbeing also depend on healthy life choices by individuals, including healthy diets, physical exercise, and reduced alcohol and tobacco use. Healthy behaviors are especially important in view of the obesity epidemic, which is sweeping across many countries and reflects the dangers of inadequate physical activities and imbalanced diets. Public policies can help in promoting healthy behaviors, such as by restricting the advertising of unhealthy food products (especially to children); ensuring that cities promote healthy lifestyles; taxing alcohol, tobacco, and other unhealthy products; and restricting the use of trans-fats by the food industry.

Many scholars and an increasing number of governments are now collecting data on subjective wellbeing (SWB) and social capital. Subjective wellbeing refers to an individual’s own report of his or her sense of happiness or life satisfaction. These subjective accounts have been shown to be systematic and informative of the individual and social conditions in a country that are conducive to a high quality of life. Social capital refers to the levels of trust, cooperation, friendship, and favorable social connections (contrasted with isolation) in the community or nation. These dimensions of social wellbeing are strongly related to individual subjective wellbeing, and like SWB, can be monitored effectively through surveys. To inform public policy, we suggest that countries systematically monitor subjective wellbeing and social capital.

Sources

FAQs

What is transformative about goal 5 “Achieve Health and Wellbeing at all Ages”?
The most transformative aspect of this goal is the dramatic broadening of the agenda beyond a small set of diseases and age groups, as per the MDGs, to cover a larger array of health concerns for a greater diversity of populations, including those in developed countries. Significant changes include tracking the incidence and morbidity of non-communicable diseases (NCDs), and tracking healthy diets and behaviors. Another key transformative inclusion is measurements of wellbeing, including access to mental healthcare and tracking subjective (evaluative) wellbeing to ensure healthy lives across multiple dimensions of health. A third transformative dimension is the focus on universal health coverage as a key policy choice in accomplishing this goal, with indicators on access to service, quality of service, and affordability of service.

What is meant by measuring “subjective wellbeing and social capital” (Target 5c)?
Many scholars and an increasing number of governments now collect data on subjective wellbeing (SWB). SWB refers to an individual’s own report of his or her sense of happiness or life satisfaction. These subjective accounts have been shown to be systematic and informative of the individual and social conditions in a country that are conducive to a high quality of life. The proposed numerical targets for reducing tobacco use and harmful use of alcohol derive from the World Health Assembly resolution 66.10. We propose that the 2025 target of reducing harmful use of alcohol by 10% be increased to 20% by 2030.

Why do some goals focus on outcomes whereas others focus on outputs or means?
Where possible, the SDGs should focus on outcomes, such as ending extreme poverty. Yet, the distinction between outcomes, outputs, and inputs needs to be handled pragmatically, and the design of goals and targets should be – we believe – guided by approaches that are best suited to mobilize action and ensure accountability. For example, ensuring universal access to healthcare or high-quality early childhood development (ECD) are important commitments for every government. Goals and targets that focus on these outputs will ensure operational focus and accountability. In some instances it also makes sense to target inputs. For example, official development assistance (ODA) is critical for ensuring many SDGs and needs to be mobilized in every high-income country. Mobilizing resources for sustainable development is difficult, so subsuming ODA as an implicit input into every SDG would make it harder for government leaders, citizens, and civil society organizations to argue for increased ODA. It would also weaken accountability for rich countries. Similar considerations apply, for example, to the proposed target on integrated reporting by governments and businesses on their contributions to the SDGs.

What does reducing to “zero” or “universal access” mean?
Many targets call for “universal access” (e.g. to infrastructure) or “zero” deprivation (e.g. extreme poverty, hunger). For each such target, the technical communities and member states will need to define the precise quantitative standard for their commitment to “universal access” or “zero” deprivation. We hope that in most cases these standards will indeed be 100 percent or 0 percent, respectively, but there may be areas where it is technically impossible to achieve 100 percent access or 0 percent deprivation. In such cases countries should aim to get as close as possible to 100 percent or 0 percent, respectively.

Why are some targets not quantified and marked with an asterisk? Why do some targets have numbers in square brackets?
It is important that every target can be measured at the national or local level, but not every target can be defined globally in a meaningful way, for three distinct reasons:

i. The starting points may differ too much across countries for a single meaningful quantitative standard at the global level;
ii. Some targets need to be adapted and quantified locally or may be relevant only in subsets of countries (e.g. those that refer to specific ecosystems);
iii. For some targets no global consensus exists today, and these still need to be negotiated, as is the case with greenhouse gas emission reduction targets. In the meantime, countries should establish their own plans and targets.

In some cases proposed numerical targets are presented in square brackets since these numbers are preliminary and may need to be reviewed by the corresponding technical communities.