Can epidemiology inform global health and development targets?

In 2015, the global health and development community will collectively assess the progress of nations towards achieving the Millennium Development Goals (MDGs), an ambitious framework for human development based on broad principles of equity, solidarity and poverty reduction. Of the 12 goals established to measure social and economic progress, three (MDG4, MDG5 and MDG6) relate directly to health development; reduction of child mortality , reduction of maternal mortality; and progress against the global epidemics of HIV/AIDS, malaria and tuberculosis , respectively. 1 There has been much debate about whether global goals with explicit targets are useful or not in stimulating action by countries and donors to improve health. Whereas broad development goals are likely to receive strong endorsement by countries, the addition of specific targets might well be unwelcome, particularly if they are perceived as being too ambitious. Worse, the global focus on targets for the MDGs has driven a culture of accountability with an almost singular focus on whether a country is likely to achieve the specified targets or not, to the detriment of other important measures of progress. The political imperative that countries have no doubt felt to accelerate progress with health development because of the existence of the MDGs is laudable, and real, but it has not necessarily been the ideal policy environment to do so, for five principal reasons. First, recent global assessments have suggested that only about one-quarter of all countries, and less than one in five developing countries, will achieve MDGs 4 and 5, obscuring the very substantial progress in reducing child mortality , for example, that has occurred in sub-Saharan Africa, India and much of eastern Europe since 2000. 2–4 In many countries, these accelerated declines have been due to the success of bold public policies, and financing, to scale-up and ensure delivery of bed nets and effective treatments to control diarrhoea and vaccine-preventable diseases, to manage HIV infection through antiretroviral therapy (ART) and prevent mother-to-child transmission of the virus. 5–9 Yet, there is comparatively little awareness or focus on these impressive gains in reducing child mortality since they are, in most cases, unlikely to lead to countries achieving the global target. Arguably, the policy intelligence that can be gleaned from the success stories of the past 12–15 years ought to be the principal concern of the global health development community, and not whether a country might, or might not achieve some arbitrary …