Achieving the health related SDGs — why we need major shifts in thinking
Real momentum is building around the Sustainable Development Goals (SDGs) as national governments integrate the 2030 Agenda with their own policy processes. Recognition of the multi-sectoral nature of the SDGs is encouraging different stakeholders to get involved in many national contexts and in a wide range of actions. Health in particular is acting as a strong driver for positive change.
However, progress on putting in place the mechanisms needed to support efforts towards the SDGs is very uneven across the world. Growing inequalities are often leading to some citizens being excluded from the gains that others will experience; and an unhealthy fixation with indicator measurement is inhibiting efforts to put good policies in place and implement them, in order to make a real difference to health outcomes.
These challenges highlight the need for good governance of global health and strong institutions that can help shape and provide that governance. They also reveal the contribution of high quality knowledge, analysis, and data to inform policymaking and implementation, and the important role that think tanks and academic institutions can play as sources of knowledge, and as conveners and mediators of different stakeholders in public policy processes.
Recent exchanges have highlighted some very significant changes in practice that could really help catalyze progress towards the health-related SDGs. At a recent THINK_SDGs meeting we discussed seven major “shifts” in thinking that are needed in order to achieve this.
Firstly, while methods, instruments, and mechanisms are all important to support progress, real change will not happen unless the challenges provided by the SDGs are seen as inherently political (but not partisan). Innovative and politically savvy ways of working will be needed to engage with different societal actors.
Currently the focus of the SDGs seems to be moving too far towards obsession with measurement, tracking indicators, and targets. Important as these are, the real prizes are the outcomes which show improvements in the health and wellbeing of all citizens. Once change is clearly identified, measurement must follow.
There are too many incidences of surveys, censuses, and information gathering exercises which are viewed as simply extracting information from respondents who then lose control over the information they have provided. Those who provide the data usually have no idea what happens to it, nor any say in the decisions that are subsequently made on the basis of that information. To really leave no-one behind, citizens need to be included in the knowledge generation and sense-making processes that move things forward; and they need to be able to access the data again if real accountability is to be achieved in policymaking and implementation.
Too often, the multi-national and bilateral bodies that are so influential in the field of global health are the drivers of what happens in a local context, and seek to control what happens locally even though they may be the least equipped to do so. Locally generated solutions and practices often generate the best way forward, and in turn inform the efforts of global bodies who can then target their support, and create global governance mechanisms that are shaped by realities on the ground.
All stakeholders have their own particular interests in health outcomes, not least the private sector who can be a force for both positive and negative change. It’s important to recognize these interests and expectations, and to address explicitly the ethics of partnership and collaboration, especially when the private sector is involved.
Different actors bring their particular competences, interests, and needs to knowledge generation. The old adage that “knowledge is power” remains true — when shared and jointly owned it is truly empowering, but when it remains unshared in the hands of select groups, this serves only to reinforce power imbalances.
Finally, think tanks and academic institutions have a very significant contribution to make in catalyzing progress towards the SDGs. However, rather than being seen as elite “founts of knowledge” increasingly removed from their local context, they can use their credibility and independence in moderating, bridging, convening, and sense-making with the knowledge of multiple societal actors to identify ways to make real progress.
It won’t be easy to make to make these shifts happen in practice, but by combining efforts, pooling expertise and insights, and helping to build capacity where it is currently limited, think tanks and academic institutions are in a strong position to help establish transformative communities, and to work together for improved health and well-being.
This post was first published on The bmjopinion blog on December 21, 2017.
Peter Taylor is the director of the Inclusive Economies program at IDRC.
Photo: Dominic Chavez / World Bank