Measuring the SDGs: a two-track solution.

The Millennium Development Goals (MDGs) expire in 2015 and substantial eff ort is being put into the negotiation of a new set of Sustainable Development Goals (SDGs). The SDG agenda is broader and goes further than that of the MDGs, and critics claim that it is unmeasurable and unmanageable. On the positive side, the consultation process has been far more inclusive and credible than for the MDGs. The resultant Open Working Group (OWG) proposal provides a global agenda for action that is relevant to all nations. As an example of the change, whereas three of the eight MDGs were focused on health, the new SDG for health aims to “ensure healthy lives and promote wellbeing for all at all ages” and is only one of 17 SDGs. This single health goal is far closer to being all-encompassing than all three of the health MDGs combined, and the social determinants of health are further elaborated in other SDGs (eg, water, sanitation, nutrition, education, clean air, reduced poverty, increased equity, and empowerment of women and girls). If the SDG agenda were enacted in its totality, this would have an enormous eff ect on health and wellbeing for humanity, with particular improvements in the lives of the poor. Two processes are currently underway towards the establishment of the SDGs—political and technical. First, a political negotiation about the content of the SDGs will result in a proposal of goals and targets to the UN General Assembly in September, 2015. In view of the diffi culty in establishing consensus among the many represented member states, this fi nal proposal is likely to be very similar to the OWG proposal, with several acknowledged technical weaknesses. The targets listed are often bundles of intervention areas and not specifi c or measurable, without quantifi ed targets or end goals. Also, many of the targets—especially nonhealth targets—do not have readily available data with which to measure them. Second, a technical process is ongoing to defi ne an accountability framework to allow measurement of these goals and targets by means of a robust set of indicators. Part of the challenge will be the complexity of the new goal and target structure. Each of the 17 SDGs has 3–19 targets, and an additional 0–4 so-called enablers, which defi ne how each goal can be implemented. 126 targets and 43 enablers mean that at least 169 indicators are needed to track all the separate elements. Not surprisingly, a preliminary list of indicators produced by the UN runs to more than 300 indicators, with technical demands for further expansion and development of new indicators. However, to ensure feasibility, aff ordability, and a focus on information, pressure is being applied to reduce the list to a maximum of 120 indicators. The technical process is therefore locked between two competing pressures—to sustain the full content of the intricately negotiated agenda, but also to reduce the number of indicators to be feasible and aff ordable. Technical experts have not managed to convince the negotiators that indicators at impact and process level are diff erent, and that both types are needed. Proponents of potentially useful umbrella indicators, which would measure progress at the goal level (eg, proposals that the health goal be at least partially measured through reductions in preventable mortality), have also not prevailed. As the pressure to reduce the number of indicators mounts, the only suggested mechanism to reduce the list is through an assessment of indicators by statistical agencies. The future therefore looks bleak for goals that do not have highly rated indicators—including several important determinants of health (eg, indicators to measure food insecurity, protection of households from catastrophic out-of-pocket health expenditure, population in urban areas exposed to excess outdoor