Sustainable health: the need for new developmental models

Editorials 699 In 2015, the eight Millennium Development Goals (MDGs) will probably be replaced by 17 Sustainable Development Goals (SDGs). Although only one SDG names health directly, it has been assumed that health involves a broad range of social determinants covered by the other SDGs and that sustainable health requires a sustainable world. Although any form of development that allows good-quality population health to be sustained far into the future would be very welcome, the SDGs have some inherent contradictions that illustrate the problems faced by those attempting such development. For instance, part of SDG 8 – target 8.1 – calls for " per capita economic growth … and in particular at least 7% per annum GDP [gross domestic product] growth in the least-developed countries " and target 10.1 similarly demands above-average income growth for the poorer 40% of the population. 1 Given the link between income inequality, poverty and poor health, 2 it is clear that population health in many places would be improved if these two targets could be met. However, target 9.2, which aims to " promote inclusive and sustainable industrialization, and by 2030 raise significantly industry's share of employment and GDP … and double its share in LDCs [least developed coun-tries] " elicits concern about the substantial health burden caused by past and present industrialization. It has recently been estimated that emissions – particularly those from industries, transportation and power generation – were responsible for 3.7 million premature deaths in 2012. 3 How can industry grow – and benefit health by reducing poverty and, hopefully, economic inequality – without increasing the health burden of industrialization? This challenge has been recognized for some time. In 1997, the World Health Organization (WHO) distinguished between traditional environmental health risks – e.g. indoor air pollution and lack of sanitation – and so-called modern risks – e.g. industrial pollution and climate change. 4 Meanwhile, recent data confirm that these modern risks appear to be posing a growing threat to health. 5 In 2005, the Millennium Ecosystem Assessment concluded that climate change, land degradation, biodiversity loss and the depletion and contamination of freshwater had had – or would have – substantial adverse effects on human health. These effects are direct (e.g. increasing floods and heat waves) or indirect, including those mediated through ecosystems (e.g. increased risks of infectious diseases, reduced food yields, loss of livelihood, population displacement and armed conflict). Paradoxically, such …