Leprosy and the millennium development goals.

In September 2000, 189 nations committed to working towards measurable targets to reduce poverty and achieve the basic needs and rights of all. However, the UN’s 2010 Millennium Development Goals (MDG) Report recognised that most of the eight MDGs are not on track to be achieved by the proposed 2015 deadline. Ban Ki-Moon, UN Secretary General, stated that ‘improvements in the lives of the poor have been unacceptably slow.’ During the lead up to the MDG Summit in New York in September 2010, NGOs stressed the urgent need for governments to assess why the world’s most marginalised are still unreached. For people affected by leprosy, many of whom are also disabled, stigma and social exclusion can lead to lack of livelihood (MDG 1), and an inability to access education (MDG 2) and health care (MDG 4, 5 & 6). They are among the most marginalised, often lack sanitation facilities (MDG 7) and are rarely included in mainstream development programmes. The Leprosy Mission’s (TLM) advocacy campaign to improve the impact of the MDGs on people affected by leprosy focused on the fact that over 500 million of the world’s poor are disabled and one billion are affected by Neglected Tropical Diseases (NTDs). A failure to specifically mention these two groups in any of the eight MDGs, 21 targets or 60 indicators holds particular significance as to why the most marginalised have not benefited. So why focus advocacy on the issues of disability and NTDs rather than directly promoting inclusion of people affected by leprosy? The MDGs have become a numbers game. Although 244,796 new cases of leprosy were diagnosed in 2009, leprosy is not seen as a health priority, even in endemic countries. A single disease approach was unlikely to get the attention of the decision makers. It therefore seemed appropriate to follow the WHO’s new integrated approach, focusing on 17 diseases that affect one billion of the world’s poor. After all, one billion people cannot be ignored. Successful inclusion of NTDs in the ‘Keeping the Promise’ Summit Outcomes Document also meant inclusion of people affected by leprosy. Similarly, with disability; approximately 14,000 people report with Grade 2 leprosyrelated disability each year, with over three million people worldwide disabled by the disease.