September 20, 2010 Liz Borkowski, MPH 8Comment

If you’re working on a major global problem like poverty, it’s important to have goals to work towards. Back in 2000, world leaders came together and adopted the United Nations Millennium Declaration, which commits to reducing extreme poverty and sets out a series of goals to be reached by 2015. Each of the eight Millennium Development Goals, as they’ve come to be known, has between one and five specific targets, many of which involve reducing the proportion (by half, two-thirds, etc.) of people who suffer from a particular condition or lack access to an essential resource like clean drinking water or basic sanitation. The goals are:

Goal 1: Eradicate extreme poverty and hunger

Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day
Target 2: Achieve full and productive employment and decent work for all, including women and young people
Target 3: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Goal 2: Achieve universal primary education

Target 1: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

Goal 3: Promote gender equality and empower women

Target 1: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

Goal 4: Reduce child mortality

Target 1: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

Goal 5: Improve maternal health

Target 1: Reduce by three quarters the maternal mortality ratio
Target 2: Achieve universal access to reproductive health

Goal 6: Combat HIV/AIDS, malaria and other diseases

Target 1: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 2: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
Target 3: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Goal 7: Ensure Environmental Sustainability

Target 1: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources
Target 2: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss
Target 3: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation
Target 4: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

Goal 8: Develop a global partnership for development

Target 1: Address the special needs of least developed countries, landlocked countries and small island developing states
Target 2: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system
Target 3: Deal comprehensively with developing countries’ debt
Target 4:In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries
Target 5: In cooperation with the private sector, make available benefits of new technologies, especially information and communications

Uneven Progress
This week, a UN summit on the MDGs is taking place in New York. The New York Times’ Neil McFarquhar reports that there hasn’t been enough progress to put the world on track to achieving the targets:

Yet despite broad if sporadic progress, the United Nations acknowledges that only two of the many targets might actually be met: cutting in half the number of people who lack safe drinking water and halving the number of people who live on $1.25 or less daily.

Any progress is widely welcomed, of course, but experts warn that even those achievements may disguise the fact that some of the poorest countries are making considerably less headway, or even becoming worse off.

Because the goals concentrate on global averages, China skews the statistics on earnings because its roaring economy has lifted millions out of poverty since 1990, the baseline year on which all the goals are set.

Looking at nations individually makes for a much more complicated portrait. In Nigeria, the ranks of people living on less than $1.25 a day jumped to 77 percent of the population in 2008 from 49 percent in 1990, for example, while in Ethiopia it was reduced to 16 percent from 60 percent, according to a new report from the Overseas Development Institute, a British research group.

Similarly, Ghana cut hunger by 75 percent by 2004, but the problem more than doubled in the Democratic Republic of Congo in the same period.

A UN Development Programme assessment published in June puts more emphasis on what’s been achieved, but also describes the unevenness of progress:

There have been noticeable reductions in poverty globally. Significant improvements have been made in enrolment and gender parity in schools. Progress is evident in reducing child and maternal mortality; increasing HIV treatments and ensuring environmental sustainability. While there are welcome developments in the global partnership, where some countries have met their commitments, others can do more.

At the same time that the share of poor people is declining, the absolute number of the poor in South Asia and sub-Saharan Africa is increasing. Countries that achieved rapid reductions in income poverty are not necessarily making the same progress in gender equality and environmental sustainability. Lack of progress in reducing HIV is curtailing improvements in both maternal and child mortality. Moreover, attention to the quality of education and health services may have suffered in the rush to extend coverage.

One of the benefits of measuring global progress toward specific MDG targets is that it allows for comparisons between countries’ strategies and results. (Although the assessments aren’t as rigorous as some would wish – McFarquhar quotes MIT’s Esther Duflo criticizing a lack of understanding of what works.) The UNDP assessment highlights some successful strategies, including large-scale immunization campaigns and conditional cash transfer programs (see this recent Economist report for more on CCTs). It also notes that locally developed strategies that are based on a broad national consensus and take into account the voices of the poorest and most marginalized are most likely to lead to sustainable achievements.

At the same time, the assessment suggests that progress on hunger will remain inadequate if we can’t improve global agricultural productivity and address (Der Spiegel has a special report on this topic), and we urgently need to strengthen climate-change adaptation and risk-reduction capacities in countries exposed to national disasters.

The Importance of Equality
While all of the targets interact with one another to some degree, the UNDP assessment reports that improving gender equality has a strong multiplier effect. While the world hasn’t managed to eliminate gender disparity in education in primary and secondary schools (the sole target for Goal 3), by 2008 there were 96 girls per 100 boys enrolled in schools, up from 91 in 1999. This is likely to have a positive impact on several other MDG targets:

Ensuring girls have unfettered access to health, education and productive assets helps progress across the MDGs. Increased female school enrolment is associated with better health and nutritional intake of families. Enhancing reproductive and maternal health contributes across the MDG goals. Equitable provision of land and agricultural inputs significantly increases output and ensures food security. Constitutional and legal reforms enhance women’s empowerment and increase their political participation. Providing infrastructure to households with energy sources and water reduces the burden of domestic activities and frees girls to attend school, engage in self employment or participate in labour markets.


In many countries, transactional sex, social norms that disempower women and domestic violence are among the causes of HIV infection. Birth rates are likely to be lower in households where women are empowered, which, in turn, is associated with better health and education for children.

The push for gender equality may get a boost with the recent creation of the UN Entity for Gender Equality and the Empowerment of Women; last week, UN Secretary-General Ban Ki-moon announced the appointment of Michelle Bachelet, former president of Chile, to head it.

Gender isn’t the only source of inequality, of course, and UNICEF has urged a greater focus on the most disadvantaged children over the next five years. In their Narrowing the Gap to Meet the Goals report, UNICEF provides evidence that such a focus is not only right in principle, but could allow for more lives to be saved per million spent. UNICEF’s equity-focused approach model includes three key measures: upgrading selected facilities (especially for maternal and newborn care), and expanding maternity services; overcoming barriers (like user charges) that prevent the poorest from using already-available services; and increasing the use of community outreach and involvement, such as using more community health workers to deliver basic services outside of facilities.

Financial Commitments
Earlier today, Secretary-General Ban urged heads of state attending the UN summit to “provide the necessary investment, aid and political will to end extreme poverty.” From the news release, it looks like he focused on urging countries to honor their previous commitments on development assistance, rather than asking for increased commitments. French President Nicolas Sarkozy, however, has already announced that his country will boost its aid contributions by 20% over the next three years (France currently donates 10 billion euros per year), and he also proposed a small international tax on financial transactions to fund development efforts.

I can’t find anything recent on the White House website about the US involvement in the summit or the broader MDG effort, but I hope President Obama will soon make an announcement about how the US will support the global effort to meet MDG targets.

8 thoughts on “Global Health 101: Millennium Development Goals

  1. While your goals may indeed be noble I’m afraid you will never achieve them unless we find a way to tackle the thorny dilemma of population growth on a resource limited and finite planet. Unfortunately it seems that humans are not much smarter than yeast nor do they have a very good grasp as to the consequences of the exponential function.

    We are currently in population and ecological overshoot due to the easy access we have had to fossil fuel over the last 200 hundred or so years. This has been the basis of our entire civilization and it fueled the so called green revolution, possibly one of the worst things that ever happened to humanity. We are now at or very near peak oil and the piper will need to be paid.

    I could cite many areas of study and the works of myriad scholars as to why I think this, but perhaps this relatively short paper might help to clarify the fundamental problem.


  2. As women’s education level increases, fertility rates tend to decrease – so, achieving the MDG of promoting gender equality and empowering women will likely help slow the rate of population growth.

    Since resource strains aren’t just a function of how many people there are but how much we’re each consuming, it’s also essential to reduce the kind of excessive consumption we have here in the US.

  3. “Since resource strains aren’t just a function of how many people there are but how much we’re each consuming, it’s also essential to reduce the kind of excessive consumption we have here in the US.”

    I agree completely with that statement, I just spent some time traveling in Germany, Austria and Hungary… I’m quite convinced that it is possible to live quite well with significantly reduced consumption as compared to US standards.

    “As women’s education level increases, fertility rates tend to decrease – so, achieving the MDG of promoting gender equality and empowering women will likely help slow the rate of population growth.”

    While this is something that is often stated, whether or not it is actually a significant factor in actually reducing global population is something on which the scientific jury still seems to be out.

    “There is a need for more research on the relationship between various aspects of women’s status and fertility rates. In his 1991 study of comparative reproductive preferences, Charles Westoff of Princeton University’s Office of Population Research found,

    “The relationship between education and the percentage of women who want no more children is positive in several of the countries, but weak or non-existent in many others. In fact, [the data] give the general impression that the intention to terminate childbearing is similar across educational levels…There is little evidence to support any strong pattern of diffusion or differential penetration of norms of family limitation across educational levels or from urban to rural areas. (pp. 5-6)

    Abernethy (1993 correspondence) raises some interesting issues:

    “Raising women’s legal, health, and social status, and providing women with educational opportunity are very worthwhile objectives in themselves. Nevertheless, only correlational data link these factors to fertility decline. On the contrary, participation in the labor market, particularly if a woman’s earnings make a significant contribution to family income, appears to significantly affect family size targets: Penn Handwerker and Diane Macunovich have found in Third World countries and the United States, respectively, that women prefer and have fewer children when child rearing carries an opportunity cost.”

  4. The ‘population growth’ canard is what it is … a canard … and is used to stop all reasonable discussion or to be counterproductive in the “Apollo Moon Hoax” sense. Population growth is a carefully phrased synonym for making “those people” (whoever they are, but mostly brown skinned) to stop existing.

  5. I’m sure some people use the population growth argument in a counterproductive way, but that doesn’t mean finite natural resources aren’t a legitimate concern. The important thing to remember is that resource use per person is part of the equation – so those of us who are using more than we need are making it harder for the planet to support a growing population.

  6. @ Douglas Watts,

    I’m sure the airborne brown yeast floating in from the sky into a vat already populated by a blooming population of white yeast will both suffer exactly the same consequences of population crash. This will happen either because their food, sugar, is all consumed or the amount of alcohol they produce will rise to a point where it becomes toxic and poisons them.

    Population growth follows natural laws, it is no more a ‘canard’ than the laws of thermodynamics or gravity.

    For the record, I understand your reaction to my comment. This topic is taboo in polite company, unfortunately it doesn’t change reality just because we choose to ignore it.

    What we need is deeper understanding of the issues involved based on dispassionate scientific analysis.

  7. All these wonderfull objectives are great. No one can be against virtue.

    But we do have a core problem, us who are the richest countries in the worlds and the mightiest military in action all over the world.

    We are loosing year after year our Morality.

    The Indispensable People?
    The Collapse of Western Morality

    Yes, I know, as many readers will be quick to inform me, the West never had any morality. Nevertheless things have gotten worse.

    In hopes that I will be permitted to make a point, permit me to acknowledge that the US dropped nuclear bombs on two Japanese cities, fire-bombed Tokyo, that Great Britain and the US fire-bombed Dresden and a number of other German cities, expending more destructive force, according to some historians, against the civilian German population than against the German armies, that President Grant and his Civil War war criminals, Generals Sherman and Sheridan, committed genocide against the Plains Indians, that the US today enables Israel’s genocidal policies against the Palestinians, policies that one Israeli official has compared to 19th century US genocidal policies against the American Indians, that the US in the new 21st century invaded Iraq and Afghanistan on contrived pretenses, murdering countless numbers of civilians, and that British prime minister Tony Blair lent the British army to his American masters, as did other NATO countries, all of whom find themselves committing war crimes under the Nuremberg standard in lands in which they have no national interests, but for which they receive an American pay check.

    I don’t mean these few examples to be exhaustive. I know the list goes on and on. Still, despite the long list of horrors, moral degradation is reaching new lows. The US now routinely tortures prisoners, despite its strict illegality under US and international law, and a recent poll shows that the percentage of Americans who approve of torture is rising. Indeed, it is quite high, though still just below a majority.

    And we have what appears to be a new thrill: American soldiers using the cover of war to murder civilians. Recently American troops were arrested for murdering Afghan civilians for fun and collecting trophies such as fingers and skulls.

    more at

    Lets fix this problem, let regulate these behavior either individuals or collectives, lets put our armies to the service of virtue and we should succeed.

    Thank you

    Snowy Owl

  8. I agree completely with that statement, I just spent some time traveling in Germany, Austria and Hungary… I’m quite convinced that it is possible to live quite well with significantly reduced consumption as compared to US standards.

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