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Editorial
Sustainable Development Goals: Challenges and Opportunities
Health has been recognized as central to international
development for more than 20 years, and major efforts
have been made to reduce morbidity and mortality either
universally or through a focus on specific population
subgroups such as “the poor, woman, and children.”1
Health is a right, as well as a means of measuring
success across the whole development agenda. 2
Achieving health and well‑being at all ages requires
new perspectives: An emphasis on health rather than
disease and effectively defining “well‑being.”3 Post‑2015
sustainable development framework can bring together
the full range of human aspirations and needs to ensure
a life of dignity for all.
What is Sustainable Development?
The sustainable development encompasses the
achievement of three interconnected objectives,
i.e., economic development, social inclusion, and
environmental sustainability which are necessary for
the well‑being of individuals and societies.4
Why Sustainable Development Goals?
The adoption of Millennium Development Goals (MDGs)
in 2000 represented a major shift in galvanizing global
political will for poverty eradication and improvement
of health and well‑being of populations. The job started
with MDGs, therefore, needs to be finished.4
Since the MDGs were devised, many new challenges
have emerged while the existing ones have been
exacerbated. Inequality has deepened, environmental
degradation has increased, migration challenges and
unemployment for youth have grown, conflicts and
political instability have halted or reversed progress in
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many countries, organized crime including trafficking in
people, and drugs violates human rights and undermines
development. People across the world are demanding
more responsive governments, better governance, and
rights at all levels.4
At the same time, the world has changed radically since
the turn of the millennium. New economic powers have
emerged, new technologies are shaping our societies,
and new patterns of human settlement and activity are
heightening the pressures on our planet. A  new era
demands a new vision and a responsive framework.
Sustainable development, enabled by the integration
of economic growth, social justice, and environmental
stewardship, has become our global guiding principles
and operational standards.4
The deepening ways, in which the lives of people
and countries are linked, demand a universal agenda
addressing the world’s most pressing challenges and
seizing the opportunities. In view of these dire and
unprecedented challenges, there is a need for change
producing global goals.4
Transition from Millennium
Development Goals to Sustainable
Development Goals
In 2000, the member states of the United Nations agreed
on a bold vision for the future enshrined in the MDGs that
recognized the need to pool efforts to advance on three
fronts simultaneously: Development, peace and security,
and human rights. The MDGs expressed widespread
public concern about poverty hunger, unmet schooling,
gender inequality, and environmental degradation. By
packaging these priorities into an easily understandable
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Cite this article as: Singh Z. Sustainable development goals: Challenges and
opportunities. Indian J Public Health 2016;60:247-8.
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248 Singh: Sustainable development goals: Challenges and opportunities
set of eight goals, and by establishing measurable and
time‑bound objectives, the MDGs helped promote global
awareness, political accountability, improved metrics,
social feedback, and public pressures.4
There has been substantial progress in achieving the
MDGs and several successes in reaching specific targets
globally and in individual countries. 17,000 fewer
children die each day than in 1990. Since 2000, measles
vaccines have averted nearly 125.6 million deaths.
Maternal mortality has fallen by almost 50% since 1990.
Antenatal care increased from 65% in 1990 to 83% in
2012. New HIV infections in 2013 were established at
2.1 million, which was 38% lower than in 2001. New
HIV infection among children has declined 58% since
2001. Tuberculosis (TB)‑related deaths in people living
with HIV have fallen by 36% since 2004. Over 6.2
million deaths have been averted between 2000 and
2015. The global malaria incidence rate has fallen by an
estimated 37% and the mortality rates by 58%. Between
2000 and 2013, TB prevention, diagnosis and treatment
intervention saved an estimated 37 million lives. The TB
mortality rate fell by 45% and the prevalence rate by 41%
between 1990 and 2013. However, more than a billion
people still live in extreme poverty; large populations
face income disparity and gender inequality.5
The transition from MDGs to sustainable development
goals  (SDGs) has undergone massive consultations
led by the United Nations since 2012. In a series of
global, regional, and national consultations in nearly 100
countries and through a social media platform, more than
a million people have shared their views on the post‑2015
development agenda. A notable set of illuminating reports
on the subject includes a report of High‑level Panel
of Eminent Persons on the post‑2015 Development
Agenda cochaired by Presidents of Indonesia, Liberia,
and Prime Minister of UK, reports by the Sustainable
Development Solutions Network, the Global Compact
Office, the United  Nations System Task Team on the
post‑2015 United  Nations Development Agenda, the
regional commissions, civil society organizations, and
academic institutions, who have provided important
inputs and recommendations for the formulation and
content of the sustainable development agenda.4
Sustainable Development Goals
Countries adopted on September 25, 2015, a set of
17 goals and 169 targets to end poverty and hunger,
Indian Journal of Public Health, Volume 60, Issue 4, October-December, 2016
ensure healthy lives, promotion of well‑being, inclusive
and quality education for all, achievement of gender
equality by empowering all women and girls, ensuring
access to safe water and sanitation, energy, information
and technology, reduce inequality within and among
countries, make cities safe and sustainable, ensure
sustainable consumption and production patterns, take
urgent action to combat climate change, conserve and
sustainably use the oceans and seas, manage forests
to protect biodiversity, promote just, peaceful and
inclusive societies, and revitalize the global partnership
for sustainable development.6
Every country will promote the well‑being and
capabilities of all their citizens, enabling all citizens to
reach their potential irrespective of class, gender, ethnic
origin, religion, or race. Every country will monitor the
well‑being of its citizenry with improved measurements
and reporting of life satisfaction. Special attention will
be given to early childhood, youth, and elderly people,
addressing the vulnerabilities and needs of each age
cohort. A particular focus should be on early childhood
development, especially girls. In a world, where 12%
of the population, and 22% of that of more developed
regions, will be older than 65 years by 2030, new targeted
programs and social protections will be needed for elderly
people in many countries.7
Health Goal (Sustainable Development
Goal‑3) Targets
The health goal to ensure healthy lives and promote
well‑being for all at all ages after 2015 has 13 targets,8,9
such as reduction of global maternal mortality ratio
to  <70/100,000 live births, end preventable deaths of
newborns and under‑five children, epidemics of AIDS,
TB, malaria and neglected tropical diseases, and combat
hepatitis, waterborne diseases, and other communicable
diseases, reduce by one‑third premature mortality
from noncommunicable diseases through prevention,
treatment, and promotion of mental health and well‑being
prevention and treatment of substance abuse, to achieve
universal access to sexual and reproductive health‑care
services, information and education, and the integration
of reproductive health into national strategies and
programs, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water soil
population, and contamination, to end open defecation
by providing access to safe drinking water and sanitation
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Singh: Sustainable development goals: Challenges and opportunities
for all, substantially increase health financing and
workforce, strengthen and implement tobacco control,
achieve universal health coverage  (UHC), including
financial risk protection, access to safe, effective, quality,
and affordable essential medicines and vaccines for all
by 2030; end all forms of malnutrition to reduce stunting
and wasting in children under 5 years of age by 2025;
halve deaths and injuries from road traffic accidents by
2020.
Modalities of Implementation of
Sustainable Development Goals
The SDGs need the identification of new critical pathways
to sustainability. The SDGs will need the unprecedented
mobilization of global knowledge operating across
many sectors and regions. Governments, international
institutions, private business academia, and civil
society will need to work together to identify the
critical pathways to success. All nations must agree
to four building blocks for implementing the SDGs,
i.e.,  far‑reaching vision for the future anchored in
human rights, a set of concise goals and targets aimed
at realizing priorities of the agenda, a global partnership
for development to mobilize means of implementation,
a participatory monitoring framework for tracking
progress and mutual accountability mechanisms for
all stakeholders.10
Challenges
There are a number of challenges for achieving SDGs
such as lack of effective leadership, coordinated
partnerships, investments, implementation, and
indicators with effective data collection. Leadership
is essential for progress in relation to policy change,
legislation, investment, implementation, advocacy, and
popular representation.11,12 SDGs demand an increasing
interface with global governance for health among those
institutions and processes that directly and indirectly
impact on health in the context of globalized trade,
security, migration, and environment.13
To adopt a universal post‑2015 development agenda with
sustainable development at its core, all countries need to
recognize the profound transformation required to address
the emerging challenges of sustainable development.
These include economic shifts to sustainable patterns of
production and consumption, effective governance and
renewed global partnership and means of implementation
Indian Journal of Public Health, Volume 60, Issue 4, October-December, 2016
249
Another set of challenges is lack of social inclusion,
widespread regional disparities and urban‑rural gaps,
gender inequality between men and women.10
A key challenge is to adopt a meaningful standard
of basic needs worldwide, i.e., access to safe and
sustainable water and sanitation, adequate nutrition,
primary health services, and basic infrastructure
including electricity, roads, and connectivity to the global
information network. The global economic downturn,
violent conflicts in some countries, biodiversity loss,
degradation of water, drylands, forests, and climate
change are the challenges to the peace and prosperity
as they threaten to reverse the achievements to date and
undermine any future gain.3
Although the SDGs have been accepted in principle, they
have also been criticized for being too large in number
and too wide in their scope. It is a challenge to create
and maintain public awareness, mobilization, advocacy,
and continuity for 17 goals and 169 targets enshrined
in SDGs as compared to only 8 goals and 18 targets of
MDGs which were easy to state, simple to understand,
and practical for adoption by the governments, business,
and civil societies worldwide.
Several targets are aspirational and unachievable,
for example, target 3.2 to “end preventable deaths
of newborns and under‑five children” or target 3.3
to end the epidemics of AIDS, TB, and malaria. It
is a challenge to end these health crises within just
15 years. Another challenge is that too many of the goals
and targets are vague and immeasurable, for example,
SDG3 ‑ how will the progress toward “well‑being for all”
be measured. Similarly, target 3.8 “to achieve UHC” is a
challenge unless the package of services and the metric
for measuring its coverage are clearly articulated and
specified.14
Opportunities
There is an opportunity to achieve the sustainable
development collectively by the committed leadership,
conviction and courage, hard work and devotion to the
common progress assisted by improved science and
technology. It is an opportunity for the health champions
to highlight the interdependence of health and the
themes of education, growth, population, energy and
governance, and present health as a precondition for
social sustainability and progress to prosperity.
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250 Singh: Sustainable development goals: Challenges and opportunities
The interconnected nature of the SDGs makes them
complex but also demonstrates complementary benefits
from specific goals and targets. For instance, clean drinking
water and sanitation would enhance health, leading to
improved nutrition and well‑being.10 For health to remain
central in post‑2015 SDGs, it will need to be pervasive
in each of the dimensions of sustainable development
economic, social, environmental, and not quarantined
from them. Emergence of this new sustainability paradigm
offers an unprecedented opportunity.3
The transformative actions of the post‑2015 development
agenda provide an opportunity to be supported by
multistakeholder partnerships which include not only
governments but also private organizations, international
organizations, parliaments, civil society, local authorities,
trade unions, research and educational institutions. The
success of such partnerships depends on assigning specific
roles and responsibilities to ensure accountability.
Conclusion
Acting on the common challenges in post‑2015 development
agenda demands a renewed commitment to international
cooperation. Strong national ownership, well‑managed
policies that foster robust and inclusive growth, decent
employment and social protection, allocation of more
resources for essential services, supported coherently by
partners at all levels can help in achieving the SDGs.
(Brig.) Zile Singh
Professor and Head, Department of Community
Medicine, Pondicherry Institute of Medical Sciences,
Puducherry, National Member, Advisory Committee,
Indian Journal of Public Health, India
E‑mail: drzile_singh@yahoo.com
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