Measles deaths are sharply down according to the recently released Millennium
Development Goals Report 2008. But are they? At a recent conference
at the London International Development Centre (LIDC): No
goals at half time: what next for the millennium development goals,
Professor Kim Mulholland of the London School of Hygiene and Tropical Medicine
took issue with the measles figures.
Mulholland said that original baseline data for measles deaths is
actually wrong, and that there is now agreement that the original figure of
757,000 deaths in 2000 was a big overestimate. The figure is more likely to
be between 200 and 500 thousand. So measles deaths are down but not as much as
some would have you think. This argument about figures illustrates some of the
problems with the millennium development goals that came through for me at the
conference. Dodgy data and 'spin'.
The millennium development goals
(MDGs) were set in 2000 by rich and poor
countries alike at a meeting of the UN. They are:
Goal 1:Eradicate Extreme Poverty & Hunger
Goal 2:Achieve Universal
Primary Education
Goal 3:Promote Gender Equality And Empower Women
Goal 4:Reduce
Child Mortality
Goal 5:Improve Maternal Health
Goal 6:Combat HIV/AIDS, Malaria
And Other Diseases
Goal 7:Ensure Environmental Sustainabilit
Goal 8:Develop A
Global Partnership For Development
The targets are set for 2015.
The general feeling at the conference was some progress has been made in some
areas towards the MDGs but there is much to do. Below are some common threads
from the presentations on progress to each goal.
MDGs country or global goals? The goals are global. But many of the
speakers commented that looking globally obscures the fact that no progress at
all is being made in some areas of the world, often in Africa.
There is a quality of data problem. In the poorest countries there is evidence that the data
needed to track progress on the goals is not being gathered. It is particularly
bad with child mortality. Kim Mulholland showed how child mortality data is
skewed using Eritrea as an example – the lack of data in the poorest groups
means the figures look better than they should. He demonstrated how one can see
what may really be happening by comparing data on mortality with related data
such as that on stunting. According to Mulholland, the data quality problem
looks difficult to solve as there isn't an incentive for countries to improve
data because of the political effect of saying things are worse not better.
Equity issues. The tendency is to go for large scale easy
interventions to get MDG results. As a result the difficult to reach communities
get ignored. Kim Muholland argued that the progress on child mortality has come
at the expense of the marginal population groups. He showed several examples
where Improvements in child mortality occur in the wealthiest quintile of the
population and the gap between rich and poor had increased as a result.
The goals often seem arbitary and limited.
Some examples:
- The target on poverty: Professor
Andrew Dorward showed the focus is on income poverty, which is not always
appropriate. The target is expressed as a proportion but as the world
population is growing,he pointed out, the absolute number of those in
poverty could be increasing while the proportion in poverty remained the
same. - The target for tuberculosis reduction focuses on drug treatment- easily
measured – but in fact poverty, smoking, malnutrition and indoor pollution
are the main drivers of TB deaths, according to Professor John Porter. Cross
sector approaches are needed to address these. - The target to enrol children at primary school. This is easily measurable
but doesn't mean education of children happens. The evidence
suggests enrolment is not followed by attendance or teaching. Worse, the
goal has created a fixation on primary education at the expense of other
education, according to Professor Angela Little - The goal on empowering women does not address one major issue: violence
against women, a major expression of the inequalities in power between the
genders, according to Charlotte Watts.
An interdisciplinary approach is needed. The goals are linked – for
example cleaner water leads to better health and less child mortality. More
links exist between education and health and prevention of
malnutrition. One can't address maternal mortality without addressing poverty
reduction (MDG1), female empowerment (MDG3), child survival (MDG4) and disease
(MDG6). The separation of linked goals can lead to competition rather than
cooperation. A holistic approach is something that the LIDC
itself hopes to foster. The group brings together colleges in London working on
health, education and economics.
Politics gets in the way. For example, the maternal health goals
especially are beset by politics. Family planning and abortion are both
controversial and some countries do not support them. Another way politics
interferes is when there the need to put a positive story as with the measles
figures.
There are fears that after 2015 interest will wane again. This
happened in 1980s with the UNICEF child survival campaign, according to Kim
Mullholland. There were great advances for a while, but then fatigue set in
during the 1990s and progress stopped because UNICEF was looking at other
issues.
The summing up was more positive. The goals are after all an attempt to
improve human wellbeing, and countries all round the world are actually trying
to work together to reach them. That's an achievement in itself.
Download conference materials here: http://lidc.bloomsbury.ac.uk/news_detail.php?news_id=38
I came away thinking how the databases I work on, CAB
Abstracts and Global Health,
together cover research in many of the areas addressed by the Millennium Development Goals:
agriculture, nutrition, economics, human heath, and rural development.