V.

HEALTH AND SUSTAINABLE DEVELOPMENT (2 hours)

1. The concept of health.
2. Health and sustainable development.
3. Health indicators.
4. Life expectancy at birth - a basic indicator of sustainable development.
5. Health and longevity as a premise and consequence of sustainable development.
6. Impact of COVID-19 on the Sustainable Development 

1. The concept of health.

The concept of health was developed in 1947 by the World Health Organization (WHO). It
states that health is “a state of complete physical, mental, and social well-being and not merely the
absence of disease of infirmity”.1
Changing Concepts of Health
• Biomedical Concept (Health has been viewed as an “absence of disease”, and if one was
free from disease the person was considered healthy)
• Ecological Concept (Health implies the relative absence of pain and discomfort and a
continuous adaptation and adjustment to the environment to ensure optimal function)
• Psychosocial Concept (Health is both a biological and social phenomenon)
• Holistic Concept (A sound mind in a sound body, in a sound family, in a sound
environment; All sectors of society like agriculture, animal husbandry, food, industry, education,
housing, public works, communication & other sectors have an effect on health)
Definitions of Health

1
World Health Organization. Constitution of the World Health Organization. Basic Documents. Forty-fifth edition.
Supplement, October, 2006. http://www.who.int/governance/eb/who_constitution_en.pdf
 • WHO Definition: “ Health is a state of complete physical, mental and social wellbeing and not
merely an absence of disease or infirmity and the ability to lead a socially and economically
productive life”.
• Operational Definition of Health: “ A condition or quality of the human organism expressing the
adequate functioning of the organism in given conditions, genetic or environmental”.
• Thus Health means (a) No obvious evidence of disease and that the person is functioning normally
(b) Several organs of the body are functioning adequately as well as in relation to one another
(Equilibrium or Homeostasis).2
New Philosophy of Health
• Health is a fundamental Human Right
• Health is the essence of productive life
• Health is inter sectorial
• Health is an integral part of development
• Health is central to the concept of quality of life
• Health involves individuals, state and international responsibility
• Health & its maintenance is a major social investment
• Health is a worldwide social goal. 3
“Health is a fundamental human right indispensable for the exercise of other human rights. Every
human being is entitled to the enjoyment of the highest attainable standard of health conducive to
living a life in dignity.”
- Committee on Economic, Social and Cultural Rights - General comment No. 14 on the highest
attainable standard of health
As specified in the General comment no. 14, the right to health is an inclusive right. It extends not
only to timely and appropriate health care but also to the underlying determinants of health, such
as:
 access to safe and potable water and adequate sanitation;
 an adequate supply of safe food, nutrition and housing;
 healthy occupational and environmental conditions; and
 access to health-related education and information.
Key aspects of the right to health
The right to health has a number of essential elements:

2
Rai Fuad Hameed. Concept of health. https://www.gfmer.ch/GFMER_members/pdf/Concept-health-Rai-2016.pdf
3
Rai Fuad Hameed. Concept of health. https://www.gfmer.ch/GFMER_members/pdf/Concept-health-Rai-2016.pdf
  Availability
 Accessibility
 Acceptability
 Quality
 Participation
 Accountability
Other human rights and the right to health
The right to physical and mental health is closely related to — and depends upon — the realisation of
other human rights. The right to health intersects, for example, with HIV/AIDS, disability, and
climate change. Protecting the right to health means upholding other human rights such as:
 The right to social security: A comprehensive social protection system helps to address the
multiple dimensions of deprivation and hardship often linked to poor health, and ensures an
adequate standard of living through illness.
 The right to food: A healthy diet helps to build resilience, while poor or inadequate nutrition
has significant negative health effects.
 The right to education: Access to accurate information and health education allows us to
make healthy choices about how we eat, how we protect ourselves from poor health and how
we choose health care and services.
This calls for a whole-of-government, whole-of-society approach to setting effective health policies
that leave no one behind.4
Dimensions of Health • Health is multidimensional, WHO definition envisages three (3)
specific dimensions, however there are many more dimensions:
• 1. Physical (Perfect functioning of the body). What are the Signs of Physical Health? • Evaluation
of Physical Health: • i) Self assessment of overall health ii) Inquiry into symptoms of ill health and
risk factors iii) Inquiry into medications iv) Inquiry into level of activity v) Inquiry into use of
medical services vi) Standardized questionnaires for cardiovascular diseases vii) Standardized
questionnaires for respiratory diseases viii) Clinical examination ix) Nutrition and dietary assessment
and x) Biochemical and laboratory investigations

4
OHCHR and the right to health.

https://www.ohchr.org/EN/Issues/ESCR/Pages/Health.aspx#:~:text
=%E2%80%9CHealth%20is%20a%20fundamental
%20human,living%20a%20life%20in%20dignity.%E2%80%9D
Dimensions of Health • Community Assessment: At the Community Level, state of health may be
assessed by such indicators as: • Death Rate; Infant Mortality Rate and Expectation of Life • 2.
Mental (Mental Health has been defined as “ a state of balance between the individual and the
surrounding world, a state of harmony between oneself and others, a coexistence between the realities
of the self and that of other people and that of the environment”.) Psychological factors can induce all
kinds of illness not simply mental ones which may include: Essential Hypertension; Peptic Ulcer and
Bronchial Asthma • Some major Psychiatric Illnesses like Depression and Schizophrenia have
biological component
Dimensions of Health (Mental Health Continued) • Attributes of a Mentally Healthy Person include: •
A) Free from internal conflicts, is not at war with him or herself • B) Well adjusted: Is able to get
along well with others. Accepts criticism and is not easily upset • C) Searches for Identity • D) Has a
strong sense of self esteem • E) Knows oneself, ones needs, problems and goals (this is known as self
actualization) • F) Has good self control, balances rationality and emotionality • G) Faces problems
and tries to solve them intelligently, i.e., coping with stress and anxiety • One of the keys to good
health is Positive Mental Health
Dimensions of Health • 3. Social (Social wellbeing implies “ Quality and quantity of an individuals
interpersonal ties and the extent of involvement with the community”. • Social health takes into
account that every individual is a part of a family and a wider community and focuses on social and
economic conditions and well being of the “Whole Person” in the context of his social network. •
Social Health is rooted in “Positive material environment” (focusing on financial and residential
matters) and “Positive human environment” which is concerned with social network of the
individual.
Dimensions of Health • 4. Spiritual (Spiritual health in this context, refers to that part of the
individual which reaches out and strives for meaning and purpose in life) This dimension seems to
defy concrete definition. It includes: • i)Integrity ii)Principles of Ethics iii)Purpose in life
iv)Commitment to some higher being v) Belief in concepts that are not subject to “state of the art”
explanation • 5. Emotional (Initially mental and emotional dimensions were seen one in the same
thing but as more research becomes available a definite difference is emerging. Mental health can be
seen as “Knowing” or “Cognition”, while Emotional health refers to “Feeling”).
Dimensions of Health • 6. Vocational (Importance of this dimension is exposed when individuals
suddenly loose their jobs or are faced with mandatory retirement. For some this dimension may
merely be a source of income but for others it may be source of self worth and life success. Goal
achievement and self realization in work are source of satisfaction and enhanced self esteem) • 7.
Other Dimensions include Philosophical, Cultural, Socioeconomic, environmental, educational,
nutritional, curative and preventive.5

2. Health and sustainable development.

Health is central to the three dimensions of sustainable development. Health is a beneficiary
of and a contributor to development. It is also a key indicator of what people-centred, rights-based,
inclusive, and equitable development seeks to achieve. Health is important as an end in itself and as
an integral part of human well-being, which includes material, psychological, social, cultural,
educational, work, environmental, political, and personal security dimensions. These dimensions of
well-being are interrelated and interdependent. Investments in health, particularly prevention of ill
health, enhance a country’s economic output through their effects on educational achievement and
skills acquisition, labour productivity and decent employment, increased savings and investment, the
demographic transition and impacts on the earth’s ecosystem. For these reasons, three of the eight
MDGs are focused on health, and the rest are key determinants of it.6
Yet, ill health remains a significant cause, and a consequence of poverty in all countries. Ill
health limits productivity and school attendance, thereby preventing many poor people from escaping
poverty. Every year 100 million people are either pushed into poverty by health-care costs, including
out-of-pocket expenses for health care, or unable to afford essential health services so that preexisting
sickness is aggravated. The ability to enjoy the rights to work and education, which are, in turn,
5
Rai Fuad Hameed. Concept of health. https://www.gfmer.ch/GFMER_members/pdf/Concept-health-Rai-2016.pdf â
6
TST issues brief: HEALTH AND SUSTAINABLE DEVELOPMENT.
https://sustainabledevelopment.un.org/content/documents/18300406tstissueshealth.pdf
essential to the enjoyment of an adequate standard of living, is determined by health. At the same
time, poverty-related structural disadvantages such as lack of clean water, sanitation and decent work,
hinder the prevention and fuel the spread of diseases. Countless people, particularly those with social
disadvantages and marginalized and vulnerable populations, face steep economic, environmental, and
social barriers to healthy living on a daily basis.7
Development policies and programmes can enhance or undermine both individual and
population health, by influencing the social, environmental, economic, cultural and political
determinants of health, including occupational health. In order to protect and promote public health, it
is therefore essential to consider the health implications of policies and programmes in all sectors, for
example energy, transport, agriculture, and as part of broader policies concerning labour rights, trade
liberalization, intellectual property and environmental protection, among others. Health can therefore
serve as an indicator of whether development and sector policies benefit individuals and their
families in ways that are tangible and easily understood. Careful selection of health indicators can
also help identify and strengthen synergies among sector policies, human rights protection and human
development investments. The achievement of health goals requires policy coherence and shared
solutions across multiple sectors: that is, a whole-of-government or health in all policies approach.8
The influence of environmental, behavioural, social, cultural, economic, and political factors
on health and human development has varied throughout history and continues to vary, making it
difficult, if not impossible, to formulate a general theory about criteria required for successful
outcomes, i.e. for continuing health gains indefinitely. While the basic determinants of health include
genetic makeup, environmental exposures, social circumstances, behavioural patterns, and health
care, there are multiple complex interactions at individual and population levels.9
Genetic factors generally are more relevant at individual and family level than at the
population level, but gene-environment interactions are responsible for much human diversity.
Environmental determinants of health are too numerous and complex to describe and discuss in
detail, nevertheless the wide range of possible exposures to pathogenic organisms and environmental
pollutants, and the individual and population-level responses to these exposures, are well known.10
7
TST issues brief: HEALTH AND SUSTAINABLE DEVELOPMENT.
https://sustainabledevelopment.un.org/content/documents/18300406tstissueshealth.pdf
8
TST issues brief: HEALTH AND SUSTAINABLE DEVELOPMENT.
https://sustainabledevelopment.un.org/content/documents/18300406tstissueshealth.pdf
9
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 12. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
10
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
 Correlations:
POVERTY. At the dawn of the new millennium, poverty is likely to remain the number one killer
worldwide. Poverty is an important reason that babies are not vaccinated, clean water and sanitation
are not provided, drugs and other treatments are unavailable, and mothers die in childbirth. A
disproportionate burden of disease will continue to be borne by disadvantaged or marginalized
women, including those living in environmentally degraded or ecologically vulnerable areas, in zones
of conflict or violence, or compelled to migrate for economic or other reasons. The feminisation of
poverty is a major threat to sustainable development.
URBANIZATION. Many health problems will continue to be exacerbated by pollution, noise,
crowding, inadequate water and sanitation, improper waste disposal, chemical contamination,
poisonings and physical hazards associated with the growth of densely populated cities. Badly
managed urban settlements and overcrowded housing make it easier for infectious diseases to spread
and for illicit drugs and violence to take hold. Urban growth has outstripped the capacity of many
municipal and local governments to provide even basic health and other services. Urban growth also
means greater dependence on transport systems, which, if automobilebased, generate further
pollution and risk of injuries. Air pollution, both ambient and indoor, including the work
environment, will continue to be a major contributor to respiratory and other ill-health conditions and
of particular concern to the health of children (asthma and acute respiratory infections, for example),
women and the elderly (chronic respiratory illness). Already more than 1 billion people in urban
areas are exposed to health-threatening levels of air pollution, and the figure is expected to increase.
GLOBALIZATION. Today, the prospects for future health depend to an increasing - but as yet
uncertain - extent on the processes of globalisation and on the emergence of global environmental
changes occurring in response to the great weight of humankind's economic activity. The
globalization of trade, travel and culture is likely to have both positive and negative impacts on
health. Increased trade in services and products harmful to health and the environment, travel and
mass migration of people constitute additional global threats to health. Communicable diseases (such
as tuberculosis), for example, are increasingly spreading to developed nations, where they affect the
most vulnerable and poorest people.
GLOBAL ENVIRONMENTAL CHANGE. Global environmental threats to health include climate
change, depletion of the ozone layer, reduction of biodiversity, degradation of ecosystems and the
spread of persistent organic pollutants. The long-term health consequences of human-induced climate

World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 12. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
change are likely to be profound and include threats to the food supply, natural disasters, infectious
diseases, sea-level rise, changes in precipitation patterns and increased frequencies of extreme
climate events, which may impinge particularly upon some of the least developed countries. Planning
for the protection of human health from the potential impacts of global environmental threats requires
a much improved understanding of the disease-inducing mechanisms involved and of the
vulnerability of populations.
DISASTERS. Disasters, both human-induced and natural, offset years of development and are
foremost causes of poverty and renewed vulnerability. Currently around 250,000 people are killed
every year as a result of natural disasters, with about 95 per cent of the deaths occurring in
developing countries, reflecting the differences in disaster mitigation and preparedness levels
between developed and developing countries. Population displacement, increases in populations
living in vulnerable areas, transportation of toxic and hazardous materials, rapid industrialisation,
water and food scarcity, and chronic conflict increasingly lead to complex humanitarian emergencies,
including the collapse of public health services. The International Strategy for Disaster Reduction
provides an important framework for international efforts aimed at disaster prevention and
mitigation.11
Health and Poverty. The link between poverty and ill-health has been well documented. Poverty is
the predominant underlying cause of ill-health, expressing itself through a multiplicity of pathways,
resulting in a huge burden of disease in poorer countries (and a disproportionate burden among the
poor elsewhere). The absence of sustainable systems in every sector of socioeconomic life (including
the heath sector) ultimately undermines health. Poor health in turn impedes sustainable development
of countries and communities, the causes of which also occur through a multiplicity of pathways.
This section outlines these well-established links and recognises the added burden carried by the most
vulnerable in society. It then asks the obvious questions – if the links have been evident, what efforts
have been made to “sustainably” improve health and why have many of these had limited success?
Why is success so often short-lived? What are the weaknesses and how should they be tackled? There
have been important successes in the development of national health systems and in tackling some
major burdens of disease. There are invaluable lessons to be drawn from these.12

11
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 17-19. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
12
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 21. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
Poverty and ill-health • Economic underdevelopment, including through reduced production and raw
goods prices, and protective trade and market practices, damage health through a number of paths,
including unemployment and low incomes. Countries cannot ensure basic services for their citizens
and individuals are unable to purchase the necessities of health. Long work hours and poor working
conditions are among the many stresses that undermine the health of workers in poor countries. •
Shortfalls in agricultural production and lack of land reform have a direct effect on food security and
hence on malnutrition. Malnutrition directly causes illness and vulnerability to infection. • Lack of
education, and in particular women’s education, limits the ability of the poor to identify and take
appropriate actions to improve their own health and indeed to secure their basic needs. • The
oppressed position of women in poverty leads to poorer health in many ways, including a weak
position in ensuring safer sex practices. • People living in low-income settlements with poor
infrastructure are exposed to the health problems of social instability and communicable disease, as
well as to environmental hazards and NCDs (see box on the range of environmental health problems
in low-income settlements). • Some billions of people live without access to safe water or sanitation,
exposing them to water borne and water washed diseases. • Lack of general infrastructure, such as
good roads and transport not only impede health services, but add to fatalities from accidents. • The
digital divide not only entrenches poverty by holding back development, but also impedes the
chances of care in an emergency. • Governance and institutional weaknesses, although not uniform,
influence health both indirectly and directly. Governments are faced with an array of pressures and
health and health services are not necessarily afforded the priority required; nor is what is available
necessarily equitably distributed or efficiently managed. The effectiveness of public and
infrastructure services, the basis for development and for encouraging investment may also be weak.
This quality of governance impacts on economies and through this, on health. • Besides directly
causing death, war and conflict have had catastrophic effects on health, disease control and disability.
Not only are health services prone to collapse, resources are diverted away from health-promoting
actions and poverty becomes more pervasive as the health impact extends beyond the war zone.
Displaced people become victims of the health impacts of even more acute poverty.13
Environment and Health in Low-income Settlements While those living in poverty suffer overall
from poor health status, the share of the burden of disease arising from (physical) environmental
hazards is greater in low income settings. It is not surprising that poor groups suffer most from the ill-
13
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 23-24. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
health, injury and premature death caused by environmental hazards. Individuals and households
without adequate incomes are less able to afford accommodation that protects them from
environmental risks – that is, good quality housing in neighbourhoods with piped water and adequate
provision for sanitation, garbage collection and drains. In their struggle to secure a livelihood, they
are liable to undertake work that exposes them (and often their families) to environmental hazards.
They have the least resources to cope with illness or injury when they occur. And they generally have
the least political power to demand that these problems be addressed. The range and severity of the
environment, health and development problems in many low-income settlements often go
unrecognised, however: • Their houses and neighbourhoods are the worst served with water,
sanitation, garbage collection, paved roads and drains, and their residents can least afford clean fuels,
ventilation, adequate living space and hygiene facilities. This can be seen in the scale of the
differentials between wealthy and poor areas in environmental hazards, in access to public services
and in health indicators. Infant or child mortality rates in poorer districts (even within the same city)
are often many times those in richer districts. • It is generally poorer groups who live in the locations
where the ambient pollution levels and environmental risks are highest. There is also the tendency for
polluting industries, waste dumps and waste management facilities to concentrate in the vicinity of
lowincome neighbourhoods, often not planned for residential settlement, and with less basis for
effective political resistance. Health in the Context of Sustainable Development • Low-wage jobs
often expose workers to a range of environmental hazards that threaten their health and well-being.
Thus street vendors are exposed to high levels of vehicular pollution, waste pickers are exposed to
hazardous materials, and cramped and crowded working conditions can create a wide range of
environmental risks. Bad sanitation may lead to contaminated groundwater and faeces finding their
way into the solid waste, onto the open land, into the drainage ditches, and generally into contact with
people. Flies may breed in the human and other waste, and contaminate the food. Solid waste may
find its way into the drains, causing accumulations of water in which mosquitoes breed. Microbial
food contamination makes thorough cooking important, but cooking with smoky fuels may expose
women and children to hazardous pollutants. The mosquito coils and pesticides used to combat
mosquitoes may add to the air pollution and chemical hazards. Crowding and poor housing can
exacerbate most of these problems. In low-income settlements therefore, local environmental
problems are a major cause of disease and death. Inadequate household water and sanitation, smoky
cooking fuels, waste accumulation in the neighbourhood, disease-carrying pests – all are major
contributors to ill-health and mortality, especially among children, and all involve closely interrelated
local environmental processes. Virtually everyone living, working and socialising in the
neighbourhood is at risk, but particularly women and children. Low-income settlements may also
come to be the worst affected by global environmental damage, but they have immediate concerns
that are, and ought to be, the priority for local action. (Adapted from McGranahan 2001) 4.3 Ill-
Health and Development The links between health, poverty reduction and long-term economic
growth are powerful - much stronger than is generally understood. The burden of disease in some
low-income regions, especially sub-Saharan Africa, stands as a stark barrier to economic growth and
therefore must be addressed as a central component of any comprehensive development strategy.
Malaria alone is estimated to slow economic growth in Africa by up to 1.3 per cent each year.
Africa’s GDP would probably be about US $100 billion higher if malaria had been tackled 30 years
ago, when effective control measures first became available. Even today, half a billion cases of
malaria each year lead to the loss of several billion days of productive work. The HIV/AIDS
pandemic represents a unique challenge of unprecedented urgency and intensity. This single epidemic
has the potential to undermine Africa’s entire development process over the next generation.
HIV/AIDS is estimated to slow economic growth in Africa by up to 2.6% in high prevalence
countries. Through its widespread impact on demography, households, communities, sectors and the
economy, HIV/AIDS is now seen as more than a health crisis; it is recognised as a threat to
development and security throughout the world. (Adapted from Buch 2001) Health in the Context of
Sust • Low-wage jobs often expose workers to a range of environmental hazards that threaten their
health and well-being. Thus street vendors are exposed to high levels of vehicular pollution, waste
pickers are exposed to hazardous materials, and cramped and crowded working conditions can create
a wide range of environmental risks. Bad sanitation may lead to contaminated groundwater and
faeces finding their way into the solid waste, onto the open land, into the drainage ditches, and
generally into contact with people. Flies may breed in the human and other waste, and contaminate
the food. Solid waste may find its way into the drains, causing accumulations of water in which
mosquitoes breed. Microbial food contamination makes thorough cooking important, but cooking
with smoky fuels may expose women and children to hazardous pollutants. The mosquito coils and
pesticides used to combat mosquitoes may add to the air pollution and chemical hazards. Crowding
and poor housing can exacerbate most of these problems. In low-income settlements therefore, local
environmental problems are a major cause of disease and death. Inadequate household water and
sanitation, smoky cooking fuels, waste accumulation in the neighbourhood, disease-carrying pests –
all are major contributors to ill-health and mortality, especially among children, and all involve
closely interrelated local environmental processes. Virtually everyone living, working and socialising
in the neighbourhood is at risk, but particularly women and children. Low-income settlements may
also come to be the worst affected by global environmental damage, but they have immediate
concerns that are, and ought to be, the priority for local action. 14
A Simple Model for Assessing Pathways Linking Globalization and Health It is difficult to link
directly health outcomes to globalization processes. Other phenomena may affect health status
dramatically in the short-term (e.g. infectious diseases such as HIV/AIDS, or large-scale
immunization programs) largely independent of globalization processes. Changes in physical
environmental conditions, such as increasing the size of a nation’s or population group’s “ecological
footprint” may improve health outcomes in the short-term, but not over the longer-term. Changes in
international trade and investment flows are recent, and present-day health outcomes, at least for
older populations, may reflect social and environmental conditions of an earlier period characterised
by greater trade protectionism and strong state welfare programs. Perhaps most importantly,
globalization may improve peoples’ health in some circumstances but damage it in others, especially
when liberalisation has been rapid and without government support to liberalisation-effected sectors
and populations. For example liberalised trade in agricultural products may provide short-term
economic benefit to less developed countries. This can improve peoples’ health, dependent on how
equitably those benefits are allocated amongst all citizens. But food exports in poorer countries can
also increase fossil-fuel based transportation, creating short and longer-term health- and environment-
damaging effects, and commodity-led export produces lower long-term economic growth than
manufactured (“value-added”) export. Protectionist policies, including subsidies, in turn, may
preserve rural life and livelihoods, arguments frequently advanced by the European Union and Japan.
This benefits the health and quality of life of rural people. But such policies can also support
ecologically unsustainable forms of production and increase oligopolistic corporate control over
global food production. Trade openness might also increase women’s share of paid employment,
which is an important element of gender empowerment. But, at the same time, public caring supports
for young children have been declining in many trade-opened countries, portending future health
inequalities; and much of women’s employment remains low-paid, unhealthy and insecure. What is
the gain? What is the loss?15

14
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 24-25. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
15
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 32-33. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
There are four broad categories for understanding better how economic globalization impacts on
pathways to health. These are: 1. Regulations governing social and environmental health-determining
conditions, in particular the legal constraints on national/sub-national regulatory powers imposed by
various trade and investment agreements. 2. Social and environmental health-determining conditions
themselves, such as economic growth, poverty, income distribution, physical environment, food
access/security, employment, social capital/cohesion and gender equity. 3. Exposure to health
damaging products, such as tobacco, toxic waste and/or products containing hazardous or potentially
hazardous substances. 4. Access to health care and other health promoting public services, such as
education and housing, through increased privatization and user fees, or reductions in service levels
and access.16
To sustain disease control programmes, health systems must be able to respond to the health
and social needs of people over their life span. Building on primary health care, sustainable health
systems are necessary that guarantee equity of access to essential health functions. These functions
include:
• Making quality care available across the life span; • Preventing and controlling disease, and
protecting health; • Promoting legislation and regulations in support of health systems; • Developing
health information systems and ensuring active surveillance; • Fostering the use of, and innovation in,
health-related science and technology; • Building and maintaining human resources for health; and •
Securing adequate and sustainable financing.17

3. Health indicators.
The health of a country’s population is often monitored using two statistical indicators: life
expectancy at birth and the under-5 mortality rate. These indicators are also often cited among
broader measures of a population’s quality of life because they indirectly reflect many aspects of
people’s welfare, including their levels of income and nutrition, the quality of their environment, and
their access to health care, safe water, and sanitation.18

16
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 33. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
17
Health in the Context of Sustainable Development Background Document Prepared by Y. von Schirnding and C.
Mulholland for WHO Meeting: “Making Health Central to Sustainable Development: Planning the Health Agenda for the
World Summit on Sustainable Development” Hosted by the Government of Norway Oslo, Norway 29 November-1
December 2001. p. 61. https://www.who.int/mediacentre/events/HSD_Plaq_02.6_def1.pdf
18
Soubbotina Tatyana P. Beyond Economic Growth. An Introduction to Sustainable Development. Second Edition. 2004.
p. 53. https://www.gfdrr.org/sites/default/files/publication/Beyond%20Economic%20Growth_0.pdf
 An indicator acts like a flag that draws our attention to something that’s going on and makes
us to ask questions like: What does this number mean? Are we getting better over time? How are we
doing compare to benchmark?
An indicator provides a standard way of measuring and comparing a problem of area of focus.
This standard and comparable information helps you understand how well you’re doing and were you
could improve.
In the health sector, indictors can tell us about the quality and effectiveness of various
interventions or treatments. They can tell us about health outcomes, quality of care, and even how
well public money is being spent. Health indicators are vital tools to help anyone who monitors and
manages the health of a population and how services are being used. Health indicators do not provide
solutions; rather they give clues to what’s behind of performance. They are just are a starting point
for further investigation.
Health indicators are measurable characteristic that describes:
– the health of a population (e.g., life expectancy, mortality, disease incidence or prevalence,
or other health states);
– determinants of health (e.g., health behaviors, health risk factors, physical environments,
and socioeconomic environments);
– health care access, cost, quality, and use.
Indicators of Health
1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social & mental health
8. Environmental indicators
9. Socio‐economic indicators
10. Healthy policy indicators
11. Indicators of quality of life.
12. Other indicators.
These indicators are expressed in quantitative terms and help you measure things like safety,
quality and appropriateness of care and efficiency and to give us a basis for comparison.
 Mortality Indicators include: Crude Death Rate, Expectation of Life, Maternal Mortality
Rate, Infant Mortality Rate, Child Mortality Rate, Under 5 proportionate mortality rate, Disease
Specific Mortality, Proportional Mortality Rate.

Morbidity Indicators are used to supplement mortality data. Morbidity rates used for
assessing ill health in community are: Incidence, Prevalence, Notification rate, Attendance rate at
OPDs, health centres etc., Admission, readmission and discharge rates, Spells of sickness.
Disability Rates are based on premises or portion that health implies a full range of daily
activities.
Two groups:
Event type indicators: Number of days of restricted activity, Bed disability days, Work‐loss
days within a specified period
Person‐type indicators: Limitation of mobility, Limitation of activity (ADL)
Sullivan’s Index – Expectation of life free of disability • HALE (Health Adjusted Life
Expectancy) – The equivalent number of years in full health that a newborn can expect to live based
on current rates of ill‐health and mortality. • DALY (Disability Adjusted Life Year) – Number of
years lost due to ill‐health, disability or ill‐ health. • QALY (Quality adjusted life year) – Number of
years of life that would be added by a medical intervention
Nutritional Status Indicators It includes :‐ • Anthropometric measurement of pre‐ school
children. • Height of children at school entry. • Prevalence of low birth weight

Health indicators have a big importance when analyzing the functioning of a certain health
organization.
For instance: A particular hospital has a high death rate amongst its patients. This is
important and needs investigating. It may be because it is a specialist hospital and admits many very
ill patients from other hospitals, or it may be because there is room for improvement in the way the
hospital treats and cares for patients. Lesson: indicators rarely give definitive answers but they nearly
always suggest the next best question to ask that ultimately WILL give the answer required.19
Example:
Full anatomy of an indicator.

19
The Good Indicators Guide: Understanding how to use and choose indicators. p, 5.
https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/The-Good-Indicators-Guide.pdf
 The ‘people with diabetes’ indicator is taken from the 2007 Association of Public Health
Observatories (APHO) Health Profiles for England.
This is just one example of several indicators featured in the Health Profiles. Like all the other
indicators in this resource, it has been chosen specifically for its potential positive. impact on the
health of the population, but also because it is:
• valid – it measures what it says it measures
• meaningful – it allows comparison of time, place and or people
• possible to communicate – to a wide audience.
Indicator name
Prevalence of recorded diabetes (“People with diabetes”).
Indicator definition
Diabetes prevalence (from Quality and Outcomes Framework), persons, all ages, June 2006,
per 100 resident population.
Geography
England, Region, Local Authority: Counties, County Districts, Metropolitan County
Districts, Unitary Authorities, London Boroughs.
Timeliness
Data is extracted from the QMAS system annually in June and published in QPID (Quality
and Prevalence Indicators Database) in September-October each year.
What this indicator purports to measure
Prevalence of diabetes.
Why this indicator is important (rationale)
Diabetes is a serious disease with serious consequences. It is the fifth leading cause of death
globally and accounts for about 10% of NHS costs. The burden falls disproportionately on elderly
and ethnic populations. We use the indicator in this context as a proxy for healthcare need and
demand (a high prevalence of diabetes can indicate a less healthy population with higher service
utilisation). The sequelae of diabetes include blindness, amputation, neuropathy, renal disease, heart
disease and other complications such as amputation. It is treatable and preventable. Important
modifiable risk factors are obesity, diet and lack of physical activity.
Reason to include this particular indicator
To encourage better collection of the primary data to give more accurate estimates of disease
prevalence. To monitor diabetes prevalence. To emphasise the burden of disease. To encourage
preventative action.
 Policy relevance
Diabetes National Service Framework.
Interpretation: What a high / low level of the indicator value means
A high value can indicate genuinely high prevalence and/or better detection and recording.
Conversely a low value may indicate genuinely low prevalence or poor detection and recording.
There is some evidence (by comparing QOF data between 2004-5 and 2005-6), of all these i.e. there
were large increases in prevalence in some practice and slight falls in others, though the national
average increased marginally and most practices had reasonably stable estimates suggesting that by
and large recording rates had stabilised. In many areas the levels of recorded diabetes were close to
those predicted by the PBS model i.e. we believe the indicator to be a good estimate of actual
prevalence. (See the PBS diabetes prevalence model http://www.yhpho.org.uk/viewResource.aspx?
id=7).
Interpretation: Potential for error due to the measurement method
See above. Also because recording is rewarded through QOF points there may be potential for
“gaming”. There are a large number of codes used to record diabetes on GP systems which may lead
to counting errors depending on how the data is extracted (see the QOF definitions for the codes
used). There may also be potential biases in the attribution of practice populations to local authority
areas but these are probably small.
Interpretation: Potential for error due to bias and confounding
There may be undersampling of young people, ethnic populations and other vulnerable
groups e.g. the homeless and travellers in the numerator.
Confidence intervals: Definition and purpose
A confidence interval is a range of values that is normally used to describe the uncertainty
around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors
influencing the indicator which are subject to chance occurrences that are inherent in the world
around us. These occurrences result in random fluctuations in the indicator value between different
areas and time periods. In the case of indicators based on a sample of the population, uncertainty also
arises from random differences between the sample and the population itself. The stated value should
therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals
quantify the uncertainty in this estimate and, generally speaking, describe how different the point
estimate could have been if the underlying conditions stayed the same, but chance had led to a
different set of data. The wider the confidence interval the greater the uncertainty in the estimate.
Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%,
and so it is said that there is a 95% probability that the interval covers the true value. The use of 95%
is arbitrary but is conventional practice in medicine and public health. The confidence intervals have
also been used to make comparisons against the national value. For this purpose the national value
has been treated as an exact reference value rather than as an estimate and, under these conditions, the
interval can be used to test whether the value is statistically significantly different to the national. If
the interval includes the national value, the difference is not statistically significant and the value is
shown on the health summary chart with a white symbol. If the interval does not include the national
value, the difference is statistically significant and the value is shown on the health summary chart
with a red or amber symbol depending on whether it is worse or better than the national value
respectively.20

20
The Good Indicators Guide: Understanding how to use and choose indicators. p, 35-36.
https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/The-Good-Indicators-Guide.pdf
From: https://www.researchgate.net/figure/Global-Reference-List-of-100-Core-Health-Indicators-by-
results-chain-Source-Reprinted_fig4_296687556
4. Life expectancy at birth - a basic indicator of sustainable development.
POLICY RELEVANCE
a) Purpose: The indicator measures how many years a new-born baby is expected to live on
average given current age-specific mortality rates. Life expectancy at birth is an indicator of mortality
conditions and, by proxy, of health conditions.
b) Relevance to Sustainable/Unsustainable Development (theme/sub-theme): Mortality,
with fertility and migration, determines the size of human populations, their composition by age and
sex, and the population’s potential for future growth. Life expectancy, a basic indicator, is closely
connected with health conditions, which are in turn an integral part of development. The Programme
of Action of the International Conference on Population and Development (ICPD) notes that the
unprecedented increase in human longevity reflects gains in public health and in access to primary
health-care services (paragraphs 8.1 and 8.2), which Agenda 21 recognizes as an integral part of
sustainable development and primary environmental care (paragraph 6.1). The ICPD Programme of
Action highlights the need to reduce disparities in mortality and morbidity among countries and
between socio-economic and ethnic groups. It identifies the health effects of environmental
degradation and exposure to hazardous substances in the work-place as issues of increasing concern.
Life expectancy is included as a basic indicator of health and social development in, among others,
the Minimum National Social Data Set endorsed by the United Nations Statistical Commission at its
29th session in 1997, the Human Development Index, the UNDG-CCA indicator set and the
OECD/DAC core indicators.
(c) International Conventions and Agreements: The Declaration of Alma Ata (1978) set a
target of life expectancy greater than 60 years by the year 2000; the World Summit for Social
Development (WSSD) also included this goal. The ICPD Programme of Action specified that: life
expectancy should be greater than 65 years by 2005 and 70 years by 2015 for countries that currently
have the highest levels of mortality; and 70 years and 75 years, respectively, for the other countries
(ICPD Programme of Action, paragraph 8.5).
(d) International Targets/Recommended Standards: See above.
(e) Linkages to Other Indicators: This indicator reflects many social, economic, and
environmental influences. It is closely related to other demographic variables and is related to human
health and the environment as well as to economic indicators. 21
METHODOLOGICAL DESCRIPTION

21
https://www.un.org/esa/sustdev/natlinfo/indicators/methodology_sheets/health/life_expectancy.pdf
(a) Underlying Definitions and Concepts: Calculation of life expectancy at birth is based on age-
specific mortality rates for a particular calendar period. Mortality rates are commonly tabulated for
age groups 0 to1, 1 to 5 years and for five-year age groups thereafter until an open-ended interval
starting at age 80 or above. (b) Measurement Methods: Several steps are needed to derive life
expectancy from age-specific mortality rates; details on the methodology to follow can be found in
demographic or actuarial references that describe the construction of life tables including Pressat
(1972) or Shryock and Siegel (1980). For a description of the methodology implemented in computer
programs, see United Nations (2003).
(c) Limitations of the Indicator: Where data on deaths by age are of good quality, or adjustments
for age misstatement and incompleteness can be made, the life expectancy at birth can be calculated
directly from registered deaths and population counts, which are usually based on census
enumerations. When data on deaths by age are not available because vital registration is deficient, the
life expectancy at birth can be estimated using methods that derive indicators of mortality from
indirect information on the risks of death obtained from special questions included in censuses or
demographic surveys. For information on these indirect methods, see United Nations (1983 and
2003).
(d) Status of the Methodology: Well developed and widely employed.
(e) Alternative Definitions/ Indicators: Another indicator of general mortality in common use is the
Crude Death Rate (CDR), which is the number of deaths in a period (commonly a one-year period)
divided by the mid-period population; it is usually expressed in deaths per 1,000 population. The
CDR can be calculated from data that have less detail than those needed to calculate the life
expectancy at birth, but it has the drawback of being influenced to a substantial degree by age
structure of the population. That is, two populations with the same CDR could be subject to markedly
different mortality risks at each age. Life expectancy may be calculated separately for males and
females, or for both sexes combined. If the underlying data permit, life expectancy may also be
calculated for subnational populations. Life expectancy can also be presented for particular ages after
birth. For instance, life expectancy at age 60 represents the number of additional years a person aged
60 would expect to live, on average, given current age-specific mortality rates for ages 60 and over. 22
ASSESSMENT OF DATA
(a) Data Needed to Compile the Indicator: Age-specific death rates are the basic information for
the calculation of the indicator. Some data sources yield estimates of age-specific mortality for only
some age groups, so that it may be necessary to employ data from different sources, each adjusted

22
https://www.un.org/esa/sustdev/natlinfo/indicators/methodology_sheets/health/life_expectancy.pdf
independently, to arrive at a complete and consistent set of rates for a given period. Countries may
tabulate data derived from death registration systems at the sub-national level. The under-five
mortality rate is more readily available for sub-national populations than life expectancy at birth.
(b) National and International Data Availability and Sources: Data on deaths classified by age
are compiled by the Statistics Division of the Department of Economic and Social Affairs (DESA) of
the United Nations Secretariat on a regular basis but they are reported only by countries with
functioning civil registration systems. For all countries, data allowing the estimation of mortality,
including those derived from vital registration systems, censuses or demographic surveys are
evaluated and, if necessary, adjusted by the Population Division of the Department of Economic and
Social Affairs (DESA) as part of the preparation of the United Nations population estimates and
projections.
(c) Data References: Past, current and projected estimates of life expectancy at birth are prepared for
all countries by the Population Division, DESA, and appear in the biennial World Population
Prospects reports.

5. Health and longevity as a premise and consequence of sustainable development.

Healthy life expectancy is increasing most in countries lagging behind the longevity front
runners, currently led by Japan. This may simply be due to the fact that countries that have the
highest life expectancies also enjoy the highest healthy life expectancies. In this case, the observation
of a strong increase in healthy life expectancy in the former countries would be part of their caching
up. It was impossible to explore this kind of question until very recently because of an almost
complete absence of comparable data on the functional health status of various national older
populations. However, thanks to the development of the European Health Surveys System, it is now
possible to examine such a question, at least within the European Union (EU). Thus, we examined the
correlation between life expectancy at age 65 and the number of healthy life years (HLY) in 2006 for
the 24 EU member states having comparable disability data (EHEMU, 2009). Healthy life years
(HLY) is a European structural indicator that has been selected to assess the quality of the years lived
by European citizens and to answer the question whether the additional years of life expectancy are
years in good health. HLY is conceptually a disability-free life expectancy and is computed annually
with data from EUROSTAT surveys on limitations in activities people usually do. The 2005 HLY
values allowed the first pan-European study of health inequalities to be carried out (Jagger et al,
2008). As shown by the scatter plot (Figure 1), there is a positive correlation between the value of life
expectancy at age 65 and the number of HLYs that people can expect to live, although the correlation
coefficient is not excessively high, especially for females (R2 equals 0.62 for males and 0.42 for
females), suggesting that other factors are at play in determining the value of the healthy life years.
For instance, the Swedish leading position in terms of HLYs at age 65 is a reminder of the north-
south gradient observed about the functional health status of centenarians.23
We explored three avenues to examine the relationship between longevity and healthy life
expectancy. At the individual level, we looked at the most recent studies of centenarians. At the
national level, we reviewed all existing time series on health expectancies; and at a more global level,
we explored the correlation between life expectancy at age 65 and the number of healthy life years
(HLY) within the European Union. Firstly, we saw that centenarians are a strongly selected group.
The phenomenal increase in their numbers, currently observed in Japan and in most Western
European countries, is essentially due to the fall of mortality above the age of 80 years and it seems
that this decrease in mortality selection has been accompanied by a parallel decline in the functional
health status of the successive cohorts of new centenarians, at least in Japan. Secondly, we explored
the relationship between the increase in healthy life expectancy and the increase in total life
expectancy, at the country level, to assess whether increase in life expectancy is always accompanied
by a compression of morbidity. We concluded from this section that it seems that healthy life
expectancy increased most in the countries that lagged behind in terms of life expectancy at age 65.
Indeed, with the exception of Switzerland, there is no strong evidence of compression of morbidity in
the countries with the lowest mortality. Finally, we examined the correlation between life expectancy
at age 65 and the number of healthy life years (HLY) for 24 European countries having comparable
data on activity limitations in activities people usually do. We found a positive relationship, though
not an extremely strong one, between the quantity and the quality of the years lived. Altogether, these
three results suggest that the strong increase in healthy life expectancy is more a feature of countries
that are catching up with the best countries in terms of population health, rather than a characteristic
of countries leading the longevity revolution. However, there is a clear trend showing that the higher
the life expectancy, the higher the healthy life expectancy. Low mortality countries may not display
obvious compression of disability, although they tend to enjoy the highest healthy life expectancies.
For them, the fast accumulation of centenarians seems to be accompanied by a parallel decline in
their functional health status. Although other factors, such as the initial level of disability in the
various countries (Robine, 2006), may explain the empirical observations we report here, it seems

23
Robine Jean-Marie, Saito Yasuhiko and Jagger Carol. The relationship between longevity and healthy life expectancy.
p. 9. http://www.eurohex.eu/bibliography/pdf/Robine_QIA_2009-3113069825/Robine_QIA_2009.pdf
sensible to conclude that there is no strong evidence today of compression of morbidity and disability
in the countries that lead the longevity revolution.24
The dramatic increase in average life expectancy during the 20th century ranks as one of society’s
greatest achievement. Although most babies born in 1900 did not live past age 50, life expectancy at
birth now exceeds 83 years in Japan—the current leader—and is at least 81 years in several other
countries. Less developed regions of the world have experienced a steady increase in life expectancy
since World War II, although not all regions have shared in these improvements. (One notable
exception is the fall in life expectancy in many parts of Africa because of deaths caused by the HIV/
AIDS epidemic.) The most dramatic and rapid gains have occurred in East Asia, where life
expectancy at birth increased from less than 45 years in 1950 to more than 74 years today.25

6. Impact of COVID-19 on the Sustainable Development 

The Burden of Infectious Disease In sharp contrast to successes in controlling some of the most
dangerous killers of children such as diarrhea and worm infections, other infectious diseases persist
into the 21st century. For example, the average rate of measles immunization worldwide is only about
80 percent, and every year more than 1 million children die of the disease. Many of those children are
in Sub-Saharan Africa, where the rate of measles immunization is the lowest—under 60 percent.
About half of all infectious disease mortality in developing countries—more than 5 million deaths a
year—can be attributed to just three diseases: HIV/AIDS, tuberculosis (TB), and malaria. None of the
three has an effective vaccine, but there are proven and cost-effective ways to prevent these diseases.
Prevention, however, is complicated by the fact that infections occur primarily in the poorest
countries and among the poorest people, perpetuating their poverty even further.26
Achieving the SDGs was proving a challenge for many developing countries before COVID-19 for
the following reasons:
(i) Massive amounts of financing needed. The UN has estimated that annual financing of $5 trillion
to $7 trillion globally will be needed to meet the SDGs.27

24
Robine Jean-Marie, Saito Yasuhiko and Jagger Carol. The relationship between longevity and healthy life expectancy.
p. 9-10. http://www.eurohex.eu/bibliography/pdf/Robine_QIA_2009-3113069825/Robine_QIA_2009.pdf
25
Global Health and Aging. p. 4. https://www.who.int/ageing/publications/global_health.pdf
26
Soubbotina Tatyana P. Beyond Economic Growth. An Introduction to Sustainable Development. Second Edition. 2004.
p. 58. https://www.gfdrr.org/sites/default/files/publication/Beyond%20Economic%20Growth_0.pdf
27
Accelerating Sustainable Development after Covid-19. The Role of SDG BONDS. July 2021. p. 2.
https://www.adb.org/sites/default/files/publication/712591/sustainable-development-after-covid-19-sdg-
bonds.pdf
(ii) Limited integration. The limited integration of the SDGs into infrastructure planning due to
systemic lack of capacity, political will, and other challenges results in a lack of substantial national
SDG project pipelines.
(iii) Substantial private finance required. The private finance share required is over 50% in most
countries and made worse because government budgets have been diverted to COVID-19 emergency
relief and recovery work.
(iv) Countries’ limited capacity. The limited capacity in countries to create bankable SDG projects
that can attract commercial lending and/or private capital.
(v) Complexity of applying SDG indicators and frameworks at project levels. This results in
deviations or inaccuracies which expose issuers to potential legal action, reputational damage, and
eventual economic costs. Solutions to the above challenges, especially those that can be applied to
project development, for those that promote the SDGs and are bankable enough to attract private
capital at scale, require institutional capacity building, along with national project funds. Several
countries are undertaking such measures.28
The COVID-19 pandemic is impacting many sectors of society, such as health, education,
economy, which are related to thematic issues covered by the SDG3 (Health & Well-Being), SDG4
(Quality Education), SDG8 (Decent Work & Economic Growth), SDG12 (Consumption &
Production), SDG13 (Climate Action), etc.
Global Human development, (containing education, health and living standards) experienced
a decline in 2020, especially related to an increase in woman’s violence and food insecurity. UN
report of the Secretary-General, “Progress towards the Sustainable Development Goals” (2021),
states that, as a result of the pandemic an additional 83-132 million people can suffer hunger and
different forms of malnutrition in 2020 (SDG2). Furthermore, about 90% of countries, suffered
disruption of health services (SDG3). Regarding climate (SDG13), despite a temporary reduction of
emissions in 2020 due to the lock-down measures, overall in 2020, the Greenhouse Gases (GHG)
increased around the world.29
Although difficulties were foreseen even before pandemic for SDG1, (baseline projections
suggested that 6 per cent of the global population would still be living in extreme poverty in 2030),
due to the pandemic it is expected an increased by 110 million of people living in poverty. The
pandemic impact is bigger among the vulnerable groups (women, youth, low wage workers, small
and medium enterprises, informal sector). It is expected that economic crisis will have a stronger
28
Accelerating Sustainable Development after Covid-19. The Role of SDG BONDS. July 2021. p. 2.
https://www.adb.org/sites/default/files/publication/712591/sustainable-development-after-covid-19-sdg-bonds.pdf
29
https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2021/05/Shulla_paper1.pdf
impact for the developing countries, which can deepen the inequalities between countries, thus,
compromising the achievement of SDG 10 (reduced inequalities).
In the education sector, according to UNESCO, more than 1.5 billion learners are affected,
thus challenging the Goal 4 implementation. This can influence the long-term implementation of the
entire 2030 Agenda, as Goal 4, and especially Target 4.7, on Education for Sustainable Development
(which evolves along with sustainability issues), are strongly interconnected with the other goals.
On the other, hand, unprecedented global crisis enhanced the pressure for multilateral system
cooperation (“which needs functioning institutions, and a level of political leadership to drive those
institutions towards an outcome”). Thus, highlighting the importance of the SDG17 “Partnerships for
the Goals” for global cooperation processes. Another negative effect of COVID-19 pandemic for the
SDGs, is that data production, which is crucial to the achievement of SDGs is being disrupted.
In addition, the unusual circumstances created by the COVID-19 pandemic have intensified
the interdependencies between the SDGs. Intersection between health and sustainability challenges
was made clearer by the pandemic. The regress on the implementation of the immediately most
affected SDGs, can influence the achievement of other SDGs, in short or long-term, creating a new
pattern of interconnectedness between them, which can be related to consequences pf the COVID-19
pandemic.
For post-pandemic recovery and resilience towards future challenges, it is important to
understand the consequences of the COVID-19 pandemic for the SDGs, not only because the SDGs
framework can serve as a useful tool if properly incorporated in the post-pandemic actions and
recovery plans, but also because it can be a good opportunity to synergise the world different agendas
for a sustainable future. Furthermore, the encompassing nature of the SDGs which enables addressing
multiple global challenges (e.g., climate change, poverty, water, peace) emphasises their importance
for the efficiency of the recovery processes.
The post-pandemic recovery process can be directed towards sustainability. The 2030
Agenda for Sustainable Development can be a useful tool for the post-pandemic recovery processes
and future resilience. Although several SDGs are affected more than others by the pandemic, their
interconnectedness influence the progress on others, thus compromising the overall progress of the
2030 Agenda.
There are negative consequences associated with non-achieving the SDGs, which can be
related to degradation of environmental problems, poverty and hunger, economic growth and well-
being. But due to the unexpected crisis, there is a shift of countries’ priorities, which is diminishing
their efforts to reach the SDGs. Countries as main responsible for SDGs implementation, can use the
crisis as an opportunity to strengthen their commitment for the 2030 Agenda for Sustainable
Development, by placing sustainability at the core of recovery plans.
Interconnections between the SDGs.
The 2030 Agenda for Sustainable Development is indivisible, where Goals have positive or
negative synergies between them. The global pandemic has highlighted the indivisible character of
the 2030 Agenda and intensified the interconnection between the SDGs. Understanding these
interactions can play a role for consistent policy actions. The SDGs interconnections can take place in
different ways such as through: (1) goal–goal interactions; (2) target-target interactions; (3) indicator-
indicator interactions; (4) policy-policy interactions; (5) goal/target/indicator and/or policy
interactions; (6) external entities and (7) geographic location18. Also these interactions can be more
visible through real case observations.
Findings (based on literature and observations) related to the consequences of COVID-19
pandemic for several SDGs, as presented in the publication “Effects of COVID-19 for the Sustainable
Development Goals (SDGs)” by Shulla et al (2021), emphasise that due to the global pandemic, the
linkages between the most effected SDGs are intensified and their impact on other Goals is increased.
Current emerging challenges for the implementation of SDG3 (Health & Well-Being), SDG4
(Quality Education), SDG8 (Decent Work & Economic Growth), SDG12 (Consumption &
Production) and SDG13 (Climate Action), can aggravate further implementation of the SDG5
(Gender Equality), SDG9 (Infrastructure & Innovation) and SDG10 (Reducing Inequalities), SDG17
(partnerships for the goals) and SDG11 (sustainable cities).30

30
https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2021/05/Shulla_paper1.pdf