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15 Aug 2016

The limitations of political slogans - the 'privatisation of Medicare' or 'jobs and growth' - are severe. Ideas are shorn of nuance and words stripped of definition. What is meant by 'privitisation' and 'Medicare', and what by 'growth'?

While privatising Medicare may at first blush be the phrase of greatest interest to doctors, I suggest that 'growth' is of deeper concern. Growth - unqualified - could be a curse and not a cure, a health hazard rather than a health promoter, a cancerous thing rather than a positive developmental pathway.

True, decades of free market-based economic growth have achieved remarkable improvements in global health. Whole nations have been lifted from poverty, death and suffering. In economically-advanced nations unimaginable affluence has been achieved with improved average life expectancy.

But with this growth have come unintended side effects. The global challenge of climate change is one such consequence. Inequality is another. In the US, the rich have become disproportionately richer without improvement in economic well-being among workers. This has substantial political effects. Commentators speak of how this inequality, present also in the UK, has contributed to Trump and Brexit.

Growth with attitude

Jeffrey Sachs, an economist at Columbia University with a long-standing passionate interest in sustainable development and health in less developed economies, wrote recently in the Boston Globe about the need for a fresh understanding of what we mean by growth. Sachs played a major part in the development of what are called the Sustainable Development Goals, or SDGs, under the auspices of the United Nations. The goals were agreed upon one year ago by more than 100 nations, including Australia. 

In brief, the SDGs, to quote Sachs, aim at economic growth, but defined in a manner that promotes decency and environmental sustainability. The 17 goals involve the achievement of more than 100 specific objectives. They fall into three groups: those associated with classical economic progress; those that have to do with ensuring environmental sustainability; and those that concern justice and social fairness.

Now, almost a year later, in New York on July 20, ministers and country representatives at the annual UN High-Level Political Forum attended the launch of an index, a measuring device, designed to allow countries to assess how they stand now in relation to the SDGs, and how they can judge their progress. The index is aimed at strengthening the commitment to growth in a way that is consistent with improving human decency and honouring the environment. It provides a current assessment for 149 of the 193 UN member states. It asks each nation to rank itself on indicators of poverty, nutrition, health care, education and pollution - all elements of the SDGs.

The goals include universal education, gender equality, clean water and sanitation, affordable clean energy, decent work and economic growth, reducing inequalities and developing sustainable cities.

Three are of special interest to medical and other health professionals. They concern further efforts to reduce poverty; to do what is needed to promote health and wellbeing; and to ensure food security for all.

In one sense these goals could hardly be disputed. But the real question is whether they have enough grunt to motivate change.

Critics, including The Economist, refer to the goals as “sprawling” and not sufficiently specific, especially when compared with the much fewer (12) Millennium Development Goals that were associated with great progress in infant mortality, HIV and other forms of health promotion and disease control for example.

Nevertheless, despite the ambitious spread of the SDGs, they take account of current urgent global challenges from which Australia cannot hope to remain immune.

Moving Australia toward sustainable growth

The world leaders on the SDG index are the Scandinavian countries, followed by others from Northern Europe. Canada was 13th, Australia 20th and the US 25th. Sweden's homicide rate is around one-seventh of America's, and its incarceration rate one-tenth. Infant and maternal mortality rates are lower, as is income inequality.

In summary, the SDGs are an international expression of an attempt to seek truly global health - for people, the environment and the planet.

While achieving these goals is a lofty ideal, we can only make progress if we use words like 'growth' accurately. If we mean growth that advances the economy while also promoting environmental sustainability and reducing social inequality, then we will be on a solid path to the future.


Published: 15 Aug 2016