The Role of the Sustainable Development Goals
The United Nations voted unanimously to enact the Sustainable Development Goals (SDGs) on 25 September. “Transforming our world: the 2030 Agenda for Sustainable Development” officially comes into effect on 1 January 2016, essentially replacing the Millennium Development Goals that expire this year. These news SDGs provide countries with a comprehensive development framework that includes older development goals, such as ending poverty and inequality, as well as new ones, such as reversing environmental degradation. In the coming months and years, governments will discuss how to interpret the provisions domestically and create effective progress indicators.
The third Sustainable Development Goal (SDG 3) focuses on “[ensuring] healthy lives and [promoting] well-being for all at all ages.” The goal itself has thirteen key targets that create a diverse and interdisciplinary approach to address health issues. Some of them tackle maternal and child health by reducing the number of preventable deaths for newborns and children under five. Others look at road traffic injuries, which requires considering both infrastructure and emergency response procedures.
One important target is SDG 3.4, which aims to “reduce by one third premature mortality from non-communicable diseases [NCDs] through prevention and treatment and promote mental health and well-being [by 2030].” This article considers the role of mental health and well-being within the SDGs, and what countries may consider to be appropriate indicators for mental health.
The WHO has recognized mental health and well-being as an important sustainable development issue since the initial formulation of the SDGs. Their 2010 report, “Mental Health and Development: Targeting people with mental health conditions as a vulnerable group,” states clearly that people with mental health conditions are a vulnerable group of people. This group is often subject to stigma and discrimination, to physical and sexual victimization, and to barriers in attaining education and employment. Given these factors, they often experience significant health issues that need to be addressed through the sustainable development of health care systems and community-level service programs.
Other health actors, including physicians, researchers, and health organizations, have also supported the inclusion of mental health as part of the SDGs. These actors often draw upon their experiences working with this population in order to further strengthen the urgency of including mental health support in the development agenda.
Given the widespread recognition of mental health’s importance in sustainable development, it is interesting to see its inclusion as part of SDG 3.4 rather than having its own target. NCDs include a wide variety of health risk factors that contribute to premature mortality other than poor mental health, such as physical inactivity, obesity, and cancer. Indeed, over half of the deaths from NCDs in the global north are caused by pulmonary heart disease and diabetes. In principle, it is possible to reduce premature mortality from NCDs through “prevention and treatment” alone without meaningfully promoting “mental health and well-being.”
Despite this issue, it is significant that the WHO and other stakeholders are considering different mental health indicators because it reflects their interest in including mental health interventions within their SDG 3.4 strategies. An important consideration for policymakers is to look at international working papers. One of the most prominent attempts comes from the WHO’s “2013 – 2020 Mental Action Plan,” which outlines broad objectives and indicators to addressing this issue. These include: strengthening global governance for mental health by ensuring that eighty percent of countries have developed their mental health policies to reflect international human rights instruments, and providing responsive mental health and social care services for communities by increasing coverage by twenty percent. The suggestions are broad and are meant to capture global goals for mental health. As such, countries are expected to apply these goals to their country’s particular health needs.
Another important consideration when implementing indicators is the aggregation of data. That is, when a country reports its health outcomes, the data often reviews the country as a whole without considering the health outcomes of particular communities. Aggregate data can unintentionally mask significant health inequalities between populations. A population as a whole might see great improvements in mental health coverage, but vulnerable communities might still face significant barriers to these services. Requiring particular methods of reporting that include researching the health outcomes of vulnerable populations has been suggested by a number of different global health and international development researchers.
There is little controversy when it comes to including issues of mental health into the SDGs. However, given the ambiguity of SDG 3.4 and the issues of generating particular health indicators for mental health, creating policies on how domestic policy can include and report on these goals is difficult. Time will tell if mental health will be meaningfully addressed, or if it is simply a well-meaning addition to the SDGs.