Health is fundamental to human development. All people, regardless of social status, consistently rank good health as a top priority, (1) and healthy people are critical to sustaining societies. It is therefore not surprising that four of the eight Millennium Development Goals (MDGs) directly relate to health. (2)
The MDGs were successful at focusing global attention and resources on specific, pressing world challenges, including hunger, maternal and child health, HI V/AIDS and malaria. These issues were placed at the top of the global agenda, inviting international agencies, Governments, non-governmental organizations and civil society, private firms, and other stakeholders to come together in order to achieve the goals. As a result, extreme poverty fell by half, there has been significant progress in the fight against malaria and tuberculosis, and over 2 billion people gained access to safer drinking water.
Nonetheless, as with many other global targets, alongside strengths and successes there are also challenges and weaknesses. Progress has been uneven, both within and across countries. Although chronic undemutrition, child and maternal mortality have fallen significantly, there is still much to be done. Public education and rapid diagnostic testing for HIV/ AIDS has reduced the number of new cases, and more effective treatments allow HIV-positive people to live longer. Yet access to treatment needs to become more widespread, new cases need to be prevented, and stigma and discrimination reduced.
The MDGs encouraged specific interventions benefitting subpopulations, namely pregnant women and children under 5 years of age, rather than all people. Some countries, however, sought to improve indicators through investments in their health systems to support the entire population, which resulted in dramatic progress in the health of all people at all ages. Other countries focused interventions on delivering health services largely to pregnant women and young children, and saw fewer improvements in the overall health of the general population. A new agenda is needed to prioritize equity in outcomes, and address health systems in addition to targeting specific diseases.
Further, the global burden of disease has shifted greatly in the past 30 years, increasing the need for a focus on health systems. Non-communicable diseases such as stroke, cancer and diabetes are responsible for a growing share of both mortality and morbidity in both developed...