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PLOS BLOGS Speaking of Medicine and Health

The MDGs should be replaced with something better

Dr Rhona MacDonald, freelance editor, (

The MDG Review Summit, or more precisely, The High level Plenary Meeting of the General Assembly, is currently ongoing (Sept 20-22) and with at least 140 Heads of State and Governments in attendance at the UN headquarters in New York. With only five years to go until the 2015 deadline to achieve the MDGs,  participants will be reviewing progress towards the MDGs, and are expected to pledge to take accelerative action if necessary. But they will not be acting in a vacuum. There has been a plethora of publications in the lead up to the Summit which have critically appraised progress so far.

At the Summit launch, worthy statements and platitudes from world leaders were in abundance and Ban Ki Moon, the Secretary General of the UN said, “There is no global project more worthwhile.” He continued, “Let us send a strong message of hope. Let us keep the promise.”

But are the MDGs worthy of our hopes? Rising from the ashes of the dismal failure of last century’s “health for all by the year 2000” initiative,  the MDGs have helped to focus international attention and galvanise action in key development and global health areas. For many, the MDGs are the equivalent of some sort of Holy Grail—a quest of utter importance that surpasses everything else. Yet, for all their merits, the main one in my view being, “something is better than nothing”, the MDGs also have some serious faults. With the benefit of hindsight, if transported back ten years, I believe that the MDGs, and their accompanying targets, which are now so familiar, would not only be vastly different, but also be constructed differently—and hopefully, much better.

First, the MDG targets seem to be at odds with a human rights framework. Most MDG targets are in terms of proportions of people, for example, to reduce child deaths by two thirds and halve the proportion of people without access to improved sanitation. From a human rights perspective, with the current situation in which there are no plans for what happens after 2015, adopting a goal in which a third of children will still die and in which 50% of people who need access to improved sanitation will not have it, is unacceptable.

Second, the MDGs were formed and negotiated with little reference to equality and participation. As usual, the most powerful had the largest say, and as a consequence, the MDGs are not based on ethical development principles.

Maybe because of the point above, the third fault is the narrow scope of the MDGs. Many crucially important areas, such as chronic diseases, disability, sexual and reproductive health, violence, and injury have been omitted. Given that in the quest to meet targets, the international community is blinkered to all but the MDGs, these omissions are serious. If an area, even one as massive as chronic diseases, has not been included in the MDG list, there is very little hope of it gaining the priority, attention, and action it needs—and deserves.

But even if an area is fortunate enough to make it into the MDGs,that does not necessarily mean that it will get much attention. The obvious hierarchy of MDGs is now, in my opinion, overtly explicit with the so-called “health” MDGs (4, 5 & 6 ) receiving the most attention.  Taking such a narrow view can be damaging, especially as the result is that other MDGs which directly relate to health (such as MDG 1 and the water and sanitation targets in MDG 7 are largely neglected. Furthermore, ALL of the MDGs relate to health. For example, how can MDG 5 be achieved without reference to MDG 3 ?

Relating to the point above is the “siloed” nature of the MDGs. Work towards each goal is usually in isolation which seems counterproductive. How can MDG 4 be achieved for example, without reaching the targets of MDG 1 and MDG 7 ?

Next, the language used in some of the MDGs is vague making their associated targets inappropriate. For example, what is the definition of “hunger” in MDG 1 ? Should this term not be “undernourished” instead? And exactly what is involved in the “empowerment” referred to in MDG 3? Empowerment of women should be at every level in every area of the community and society. So how does the associated target of the number of “female politicians” relate to the universal empowerment of women? And MDG 8 is so vague that it is usually ignored.

Finally, it is very unlikely that any of the MDGs will be reached by 2015. All the faults of the MDGs could be forgiven if at least the world could move onto something better once the MDG targets were achieved. But as it stands, as the prevailing pragmatic view is to continue with what we have, given all the energy, resources, and time that has been invested into them, tearing up the MDGs and starting again with something better, will simply not happen, even though it probably should.


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