Health as a key indicator of sustainable development.

Ensuring healthy lives and promoting well-being at all ages are important preconditions to build prosperous societies. Recognizing the interdependence of health and development, the Sustainable Development Goals (SDGs) provide an ambitious, comprehensive plan for ending the injustices that underpin poor health and development outcomes. Good health is a human right and essential for sustainable development, and SDG 3 reflects the complexity and interconnectedness of the two. An integrated approach to health and well-being is crucial for progress across the multiple SDGs.

Achievements and challenges

According to the progress report on the SDGs of 2019, historic achievements have been made in improving the health of millions of people since the creation of the Millennium Development Goals, increasing life expectancy, reducing maternal and child mortality and fighting against leading communicable diseases. For instance, between 2000 and 2015, the number of new HIV-infections each year has dropped from 3.1 million to 2 million and over 6.2 million lives were saved from malaria. Since 1990, maternal mortality fell by 45 % worldwide, and preventable child deaths have declined by over 50% globally.

Despite this incredible improvement however, the world is off-track to achieve the health-related SDGs, mostly due to the uneven progress between and within countries. Progress has stalled or is not happening fast enough with regard to addressing major diseases, such as malaria and tuberculosis. AIDS is still the leading cause of death among adolescents in sub-Saharan Africa, and 15 million people living with the disease are not accessing life-saving antiretroviral therapy while in some parts of the world new HIV infections continue to rise, and typically marginalised groups are over-proportionally affected. At least half the global population does not have access to essential health services and for poor households, chronic and catastrophic disease remains one of the main factors that push them into life-threatening deprivation.

Everywhere in the world non-communicable diseases (NCDs) inflict a large burden on public health. Currently, NCDs – mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes – are the cause for over 60% of all deaths worldwide. The cumulative economic losses to low- and middle-income countries from those four diseases are estimated to surpass $7 trillion by 2025.

Concerted efforts are required to achieve universal health coverage and sustainable financing for health, to address the growing burden of NCDs including mental health, and to tackle antimicrobial resistance and determinants of health such as air pollution and inadequate water and sanitation. Multisectoral, rights-based and gender-sensitive approaches are essential to build good health for everyone regardless of social status and the country’s developmental stage.

Scope of SDG 3

SDG 3 aims to ensure health and well-being for all, including the commitment to end the epidemics of AIDS, tuberculosis, malaria, hepatitis, and other communicable diseases by 2030. It also seeks to achieve universal health care coverage including financial risk protection, promotes universal access to reproductive care and family planning, and aspires to provide access to safe, affordable, and effective medicines and vaccines everywhere.

Reducing the mortality rate of mothers during labour, unborn babies, and children under five continues to be a focus along with combatting premature mortality from NCDs like cardiovascular disease, cancer, diabetes, or chronic respiratory disease. SDG 3 also touches on the risks which suicide, substance abuse, hazardous chemicals and pollution, and traffic accidents pose to human life and health.

Another target under SDG 3 with special relevance in the light of current Covid-19 pandemic is the goal to improve early warning systems for global health risks by strengthening the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks.

UAE: The local situation

Many countries have made impressive improvements, but national averages can hide imbalances. These are often related to economic and social inequalities and emerging challenges such as lifestyle-related illnesses, with rapid urbanization and environmental threats being additional factors.

While the UAE is well positioned with regards to income distribution – for 2018 it recorded a GINI index of 0.29, outperforming countries such as the UK (0.37) and the USA (0.46) – low income earners still suffer from limited access in areas such as dental care where treatments are not routinely covered by basic packages but problems can have severe negative effects on overall and long-term health.

A world-class healthcare system is one of the six national priorities of the UAE according to their National Agenda and Vision 2021. A mapping undertaken at the SDG target and indicator level reveals that SDG 3 is being addressed by four out of the six National Agenda priority areas: World-class health care, competitive knowledge economy, safe public and fair judiciary, and cohesive society and preserved identity. Since the establishment of the SDGs, the UAE government has been allocating increasing amounts of the federal budget (8.6% in 2017) to the health sector, which is in addition to the significant spending by the local emirates. According to the Sustainable Economic Development Assessment (SEDA) scores from the Boston Consulting Group (BCG), healthcare standards in the UAE outperform regional and worldwide averages on multiple dimensions such as well-being and education.

The UAE Government is working with health authorities across the country to ensure that public and private hospitals are accredited according to clear national and international quality standards. Furthermore, the National Agenda emphasizes the importance of preventive medicine and seeks to reduce cancer and lifestyle-related diseases such as diabetes and cardiovascular diseases. In addition, the Agenda targets a reduction in the prevalence of smoking and an increase in the healthcare system’s readiness to deal with epidemics and risks. Some of the national KPIs that measure the progress in achieving these priorities are average healthy life expectancy, prevalence of smoking, rate of deaths from cardiovascular diseases, prevalence of diabetes, prevalence of obesity amongst children, rate of deaths from cancer, rate of physicians, and road traffic deaths. Mental health is another focus area that received increasing attention over the past years as well as currently, of course, the novel coronavirus.

Happiness and well-being as national policy priorities

One of the core concerns of the SDGs is to ensure the well-being of people around the world. Until very recently, governments typically have not attempted to measure vague concepts such as citizens’ happiness or subjective well-being but over the past two decades, the measurement of human well-being has received more attention. Viewed by the UN as a ‘holistic approach to development’, happiness has been incorporated as a key measure of social progress. Several government-driven health, happiness and well-being initiatives have been initiated in the UAE over the past years both on the federal and the individual emirates’ level.

Rise in obesity, physical inactivity and unhealthy diets constitute a huge challenge in the UAE. The federal Ministry of Health and Prevention (MOHAP) is working jointly with different sectors to promote a multisector approach to enhance collaboration and improve accountability. An excise tax on tobacco (100%), energy drinks (100%), and soft drinks (50%) was rolled out in 2017 accompanied by a mass media awareness campaign focusing on health risks associated with drinking sugar-sweetened beverages.

MOHAP also launched the Ma’kom (“With You”) Initiative with the goal to increase the proportion of UAE residents who adopt healthy behaviours and reduce unhealthy ones through four main programs covering healthier life, ideal weight, active lifestyle, and balanced diet. Besides improving knowledge and attitudes in relation those topics, the campaign aims to increase opportunities for safe physical activity, create and improve conducive policies, and build environments that support healthy eating and active living. Comprehensive programs target schools, the workplace, as well as mothers and children and so far over 58,000 individuals have participated in the 876 programs run to date.

Philanthropic contributions to fight diseases worldwide

The UAE provides healthcare services to many countries through local entities which have succeeded in curing thousands of people around the world from blindness, blood and heart ailments and many other diseases.

Mohammed Bin Rashid Al Maktoum Global Initiatives (MBRGI) combats the root causes of poverty and disease worldwide. Its programs have assisted over 40 million people in 99 countries so far. In the fight against the spread of disease, it has prevented and treated blindness and provided vaccines and medications, e.g. to treat children in vulnerable countries affected by intestinal worms which threaten their health and future.

The Emirates Polio Campaign for polio eradication supports healthcare programs in Pakistan, which has one of world’s highest rates of polio infection, helping to bring the epidemic under control and prevent and negate the health hazards afflicted on children in the affected areas. The effort is part of the UAE Government’s 2013 pledge of AED 440 million (over 116 million vaccines) for supporting global efforts to eradicate polio by 2018. The government’s efforts have since been complemented by Emirati official’s donations for the purchase and delivery of vital vaccines to prevent diseases and save the lives of Afghani and Pakistani children (e.g. H. H. Sheikh Mohamed bin Zayed Al Nahyan: personal donation of USD 30 million in 2017, H. H. Sheikh Mohamed bin Zayed Al Nahyan: USD 50 million, matched by the same amount by Bill Gates, in 2011) and a continued collaboration with the Bill & Melinda Gates Foundation.

Private sector contributions

To accelerate progress and address new health challenges, all actors including the private sector need to partner to develop health care solutions that work for people, families, communities, and nations. At the very least, business has a responsibility to respect all human rights, including the right to health. Small, medium, and large companies can both benefit from and contribute to achieving healthy societies. The SDGs provide an opportunity for the private sector to support the delivery of health needs around the world through their products, services, and business activities including value chains and distribution networks, communication activities, occupational health and safety practices, and provision of employee benefits. By ensuring that workers have safe working conditions and access to health services, companies establish healthier staff and better relationships which in many cases has positive effects on productivity.

Nestlé Ajyal Salima program: a Benchmark for Worldwide Programs promoting Healthy Eating & Exercise among schoolchildren

International consumer goods corporation Nestlé employs 291,000 people in over 180 countries. The company’s approach to sustainability is closely aligned with the SDGs and incorporated into its strategies and business conduct. Recognizing that nutrition is one of the key determinants of a society’s good health and well-being, the producer implements efforts to support SDG 3, which is the goal directly aligned with their industry.

In order to emphasize individual health and well-being, improving product quality is at the core of the consumer goods business. Within the GCC, Nestlé, as member of the International Food & Beverage Alliance, committed in 2016 to remove trans-fatty acids (TFAs) and reduce the salt and sugar content in its products. By 2018, the objective of less than 1 gram of trans-fat per 100 grams of product was achieved worldwide. In the Middle East, Nestlé has reduced 10.7 % of salt content across its products from 2014-2016, as well as 30 % of sugar content in cereals.

By 2020, Nestlé aims for a further reduction of sugar by 10 % in cereals and by 5 % in confectionery. In addition to reformulating food contents, Nestlé deploys several initiatives promoting health-conscious behaviour by providing information and raising awareness. For instance, the company implemented Ajyal Salima (“Healthy Children”), a school nutrition education program for 90,000 children in six countries including the UAE, Saudi Arabia, and Bahrain. As a result, consumption of fruits and vegetables doubled, and purchase of soft drinks and unhealthy foods dropped significantly.