Sustainable development goals (SDG), initiated in 2015, targets17 challenges through which a country can measure its progress. This agenda has set quantitative and time-bound targets within 2030 irrespective of a country’s capability and starting baseline. Among these, there is one goal concerned with health for all which is sustainable development goal number 3. SDG 3 means universal health coverage. It addresses the needs for the eradication of epidemics like AIDS, TB, malaria, polio and acknowledges universal access to medicines without any discrimination and furthermore, SDG 3 promotes funded researches on vaccines. SDG index helps in determining how far a country has progressed in terms of achieving the targets of SDG. SDG strategies like understanding the interactions between the SDGs and conducting integrated research and decision-making policies, the SDG tracker, the two-child policy, and the seventh five-year plan are essential to advance action on SDGs fundamentally. SDG3 has made noteworthy improvement in Bangladesh which is why Bangladesh is climbing its way up the ranking of the SDG index despite being a developing country. Issues like mental health, depression, suicidal tendency, menstrual hygiene, HIV counseling are given the rightful focus thanks to SDG 3. However, there is a gap in current research and policy analysis. Lack of data on road traffic accidents and inadequate reduction in maternal and neonatal mortality are the big concerns over whether or not Bangladesh will be able to achieve SDG3 in due time. The research illustrates that it might be tough but not impossible for Bangladesh to reach its target of SDG 3 by 2030.
United Nations General Assembly adopted 17 sustained development goals on 25th September 2015. SDG 3 means ensuring healthy lives and promoting well-being for all at all ages.
“Health is a state of complete physical, mental, and social well-being of an individual.”
Through the SDG index, it can be determined how far a country has progressed. The parameters of SDG 3 addresses the following sub-goals: reduction in neonatal and maternal mortality, decrease in the number of active cases of HIV, tuberculosis, malaria, polio, and also non-communicable diseases like cancer and road traffic accidents, availability of vaccine and medicine at an affordable price for everyone.
Maternal and child survival and SDG3
SDG3 ensures an increase in the average lifespan by focusing on how to reduce maternal and neonatal mortality. Sustainable development goal 3 means a persistent growth in the health sector. Improving health suggests increasing the average life span. Not long ago, when people died within the age of 50/60 years. And now in the current status quo, with so many remarkable advances in medical science, people survive up to 70 years and many even more years thanks to the well-planned strategies of SDG 3. For example, reduction of maternal mortality, ensuring there is no child marriage, provision of proper nutrition, reduction of neonatal and under-five mortality through the vast expansion of antenatal and postnatal check-ups are some of the achievements of SDG goal 3.
SDG3 versus epidemics
SDG3 helps in the eradication of epidemics of AIDS, tuberculosis, malaria, polio by promoting funded research to make vaccines and medicines. Living a life is not worthwhile without being a healthy one. That is why the decreasing prevalence of life-threatening diseases is taken into account; diseases like AIDSpreviously had no proven treatment but now, we have antiretroviral drugs among which TRUVADA is noteworthy. Making a vaccine is no play game. It needs a huge amount of funding. Through SDG goal 3, vaccination and medicines are given the topmost priority for the elimination of diseases as seen previously like tuberculosis, HIV, malaria, hepatitis, etc.
Effect of non-communicable disease and road traffic accident on SDG3
SDG 3 has also identified non-communicable diseases and road traffic accidents as the causes of death and imply rules and regulations as preventive measures. It is important to mention that the western population’s death is highly contributed by cancer which is a non-communicable disease. Also, road traffic accident has proven to be a common cause of death all over the world especially Bangladesh in recent years. SDG3 not only encourages research on such emerging causes of fatality but also keeps a record of why they are occurring and how to overcome them strategically. Thus SDG3 keeps a check-and-balance system on the number of deaths and ill health.
read more: Climate Change Impact to Our Health
Governance context of SDG3
SDG3 ensures that no unproven medicine can be commercialized and also states a particular dose that can be tolerated without adverse effect for medicines which are at present in the market. Every medicine has a therapeutic dose and a toxic dose. SDG goal 3 prevents drug addiction and implicates rules to reduce tobacco use by WHO Framework Convention. Tobacco is a chemical carcinogen and can have detrimental effects on our health. Hence, no matter how much tax the tobacco industry provides, it should never be given an upper hand over our health.
Role of SDG3 in immunization
SDG3 ensures equal distribution of vaccines without any discrimination. Vaccination provides artificial active immunity against deadly diseases like polio, measles, mumps, rubella, etc. Hence everyone should get vaccinated as per the EPI schedule in Bangladesh to be able to live a long healthy life. SDG3 promotes research by funding globally and ensures that people get the right medications based on needs and not based on wealth or power alone.
Lessons learned from the challenges faced by SDG’s preceding counterpart-MDG
According to the statistics of Millennium Development Goals (MDG), Bangladesh faced challenges in terms of alleviation of poverty, increasing employment opportunities with the ever-increasing demand of the over-population, reducing under-five mortality rate, decreasing dropout rate, ensuring quality education in primary schools, and improving health for all. Taking all these into account, the 17 targets of SDG were set so that we can achieve a promising milestone by 2030 in a strategic manner.
Fields of SDG3 needed to be focused more
In the 2030 Agenda implementation, the quest for a cohesive policy was of concern amongst both national and international organizations (OECD). The child mortality rate has decreased but not enough. One of the highest neonatal mortality rates remains in Central and Southern Asia and in sub-Saharan Africa sadly. However, the reduction of the maternal mortality rate is believed to be on track as the research shows. In February 2015, the World Health Organization published “Strategies towards ending preventable maternal mortality (EPMM)” (EPMM Strategies)  to reduce MMR (maternal mortality rate) to less than 70 per 1000 by 2030. Mahmoud Fathalla, former Chair of the WHO Advisory Committee on Health Research, said: “Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.” Concerns about the outrageously high cost of medicines were put forth when HIV drug with the trade name TRUVADA cost the American taxpayers millions as it had been made patent in the USA while it was of a mere value comparatively in New Zealand in the name of intellectual property disputes. Hepatitis deaths, on the other hand, are on the rise, but vaccination of infants for hepatitis B is greatly reducing incidence as per the data provided.
An image is attached below to explain the number of deaths contributed by different strains of hepatitis virus infection. This image is an example of how people are still dying due to the hepatitis virus.
Although SDG goal 3 is taking mental health into account, men are still about two times more likely to die by suicide than women. Road traffic accident death data are negligible and therefore, this aspect needs to be given more priority.
Strategic approaches of Bangladesh towards achieving SDG goal 3
Bangladesh has adopted plans like the Seventh Five year plan and SDG tracker. The parameters of the Seventh five-year plan are the elimination of contagious disease, increasing longevity to seventy years, provision of standard nutrition, and an 80% increase in the use of birth control methods. By the introduction of the two-child policy, the exponential birth rate of our densely populated country can be controlled to some extent. Lesser the population, the lower the demand with the available food and medical supplies, and hence, better health. The world health assembly proposed three targets, known together as the “triple billion” target as a strategic approach to SDG worldwide by making policies for 1 more billion people so that more people get universal health coverage. SDG tracker tracks data through multiple cluster survey about reproductive health, for example, early childbearing, family planning measures like use of condoms and vasectomy/tubal ligation for permanent sterilization measures, and many other issues, for example, HIV counseling, spreading knowledge about oral rehydration therapy to prevent diarrhea, salt iodization, menstrual hygiene, the importance of mental health and fighting against depression and suicidal tendency.
SDG interactions framework
SDG interactions framework addresses SDG2 (food), SDG3 (health), SDG7 (energy), and SDG14 (oceans) as per International Council for Science (ICSU). Long term climate change will cause more deaths because of heat exposure, flooding, diarrhea, malaria, and under-nutrition in many geographical locations. Therefore, the achievement of SDG16 (clean water) and SDG13 (climate actions) will reduce the spread of infections. SDG2 enables nutrition by increasing income and hence, increased agricultural productivity for ending hunger is a step towards achieving SDG3 also. However, the use of insecticides in agricultural fields may increase resistance to malaria. SDG7 (clean energy), on the other hand, will reduce respiratory infections. Therefore, by the use of renewable energy, improved health will be achieved. Furthermore, SDG5 (gender equality) promotes better reproductive health. So, several of the SDG targets are interconnected with achieving health for all as per SDG goal 3.
Research demonstrates that Bangladesh scored a rank of 109 out of 157 countries in the SDG Index and Dashboards Report 2017 by the UN Sustainable Development Solutions Network. Bangladesh is 8 spots higher in rank compared to its neighbor India. However, Bangladesh has a ‘red’ threshold on 10 out of the 17 SDGs, indicating that it needs to overcome major challenges in order to meet the goals. Therefore, Bangladesh has an optimistic chance of achieving SDG3 by 2030. Despite all the hurdles of poverty and lack of knowledge regarding proper hygiene and sanitation, Bangladesh as a nation is still fighting its way by implicating strategies like the SDG tracker, the seventh five-year plan, and adequate monitoring through the involvement of all the ministries. All SDGs are taken into account for their inter-relations with SDG3, for example, nutrition, gender equality, and the use of renewable energy to reduce the prevalence of infections. Enhancing the financial aspect is one of the major challenges but through proper utilization of resources, universal health for all can be ensured.
writer Moumita Moazzem student, Ibrahim Medical College (BIRDEM)
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