Making the SDGs useful: a Herculean task

www.thelancet.com Vol 388 October 8, 2016 1453 The Sustainable Development Goals (SDGs) have been called “senseless, dreamy, garbled”, given that they include 17 goals, 169 targets, and 230 indicators, in contrast to the Millennium Development Goals (MDGs) that focused on eight goals, 18 targets, and 48 indicators. Among the earliest sceptics of the SDGs was the Bill & Melinda Gates Foundation, which argued that any new goals should be specifi c, measurable, attainable, relevant, time bound, and easy to communicate. The Institute for Health Metrics and Evaluation has taken on the unenviable task of assessing whether the SDGs are indeed measurable and attainable in 188 countries by drawing on their Global Burden of Disease (GBD) database. Has the leading institute in this area been able to achieve their goal of helping to make the SDGs relevant and useful? The simple answer is yes. The GBD 2015 SDG Collaborators have created a health-related SDG index, which is a function of the GBD measures of 33 of 46 health-related SDG indicators. The index is measurable and clearly helps to communicate countries’ progress, with Iceland ranking the highest (85·5 [95% uncertainty level 84·2–86·5] on a scale of 0–100) and Central African Republic the lowest (20·4 [15·4–24·9]). The complicated answer to whether the SDG index is relevant and useful depends on whom in global health we are talking about. Is it useful for major donors who fund international cooperation? Yes. Donors—particularly the USA, the UK, and the Gates Foundation—are increasingly insisting that any money invested in health must directly demonstrate progress. This stance is particularly relevant to their contributions to international institutions such as the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, and GAVI, The Vaccine Alliance, which need to show results to attract further replenishment in funding. Similarly to how global estimates of mortality, morbidity, and risk factors help to raise the attention and priority given to vari ous health conditions, the SDG index is a powerful tool to communicate to the public the merits of investing in health by showing gains evidenced by one (at face value) simple number. Is the SDG index useful for governments in lowincome and middle-income countries? The answer is not immediately clear, especially since the SDG index relies on GBD data, which have been criticised for having limited use at the national level. Bloomberg Philanthropies in fact launched a US$100 million Data for Health initiative in 2015 to develop national data for mortality and morbidity, since its public health team felt that global estimates of disease were not suffi ciently useful for governments in terms of planning purposes, tracking disease control and disease management, or for funding priorities. Igor Rudan and colleagues outlined several other critiques of GBD at the country level, including its heavy reliance on modelling where reliable information is scarce. Is the SDG index useful for poor communities worldwide? The experience of Go4Health, a consortium funded by the European Union seventh framework programme, suggests no, or even that global priorities risk over-riding local concerns and priorities. The consortium undertook community consultations with marginalised groups about the MDGs and the post-2015 agenda in Uganda, Bangladesh, Australia, and Guatemala. Notably, community priorities diff ered from global blueprints such as the MDGs; for example, members of one community argued that dental care should be a top three health priority. The common thread was that the communities consulted wanted to determine their own health priorities based on their values and needs, and rejected the notion that Making the SDGs useful: a Herculean task