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The Sustainable Development Goals: The Role of Ethics.

  • World Health Organisation; Academy of Science of South Africa; University of Toronto; University of KwaZulu-Natal
Jerome Amir Singh
Centre for the AIDS Programme of Research
in South Aica (CAPRISA), University of
KwaZulu-Natal, Durban, South Aica and
Dalla Lana School of Public Health, University of
Toronto, Toronto, Canada
The Suainable
Development Goals
For the SDGs to elicit public u
and condence, ethics mu be
cenal to their realizaon
The nature of the SDGs
The SDGs represent collective aspirational goals of the interna-
tional community and are intended to be integrated and indi-
visible, global in nature, and universally applicable. Although
the SDGs are grounded in human rights norms and are intended
to be universally applicable, they are not a negotiated treaty.
Therefore, at best, the SDGs will nction as a form of “so law”.
To this end, the UN is developing a global reporting mechanism
that will call on countries to voluntarily submit data to track pro-
gress in light of the SDGs indicators. The UN’s high-level political
forum under the auspices of the General Assembly and the Eco-
nomic and Social Council will have the central role in overseeing
follow-up and country review at the global level. The eective
implementation of the SDGs will thus depend on a mutually sup-
portive relationship between the SDGs and international law.
Despite the need for such symbiosis, only three conventions are
explicitly included in the SDGs:
. The UN Framework Convention on Climate Change (Goal 13);
. The Framework Convention on Tobacco Control (Target 3.a);
. The UN Convention on the Law of the Sea (Target 14.c).
Neither the UN Charter – which speaks about, among other is-
sues, promoting “higher standards of living” (UN Charter Article
55a), solutions to health and related problems (UN Charter arti-
cle 55b) – nor human rights instruments (including the Universal
Declaration of Human Rights) have been included in the SDGs.
The SGDs allude to “World Trade Organization agreements” (Tar-
get 10.a) but only in relation to special and dierential treatment
for developing countries. None of the 31 targets of the “justice”
and “implementation” goals (Goals 16 & 17) make any reference
to international law.
The Sustainable Development Goals (SDGs) were adopted by
global leaders at the United Nations (UN) headquarters in Sep-
tember 2015. The 17 Sustainable Development Goals and 169
targets represent a bold transformational economic, social and
environmental agenda relating to ture international develop-
ment. The SDGs set priorities and benchmarks for, among other
issues, ending poverty and improving nutrition globally by 2030.
Seeking to build on their predecessors, the Millennium Develop-
ment Goals – which expired at the end of 2015 – the SDGs apply
universally to all UN member states. However, while movement
towards sustainable development, global eradication of poverty,
and improved global nutrition is to be welcomed, the SDGs lack
legal status and explicit enforcement mechanisms. They also
add to an array of existing international nutrition-centered ini-
tiatives which, to date, have had mixed results in pursuit of their
respective agendas. For the SDGs to elicit public trust and con-
dence, ethics must be central to their realization.
The role of ethics
59SIGHT AN D L IFE | VOL .  |  
targets. This will be challenging, given that the international
nutrition arena is already a crowded space with a bewildering
array of UN agencies and bodies involved in nutrition-related
initiatives. These include the activities of the ve UN agencies
with a mandate in nutrition (FAO, IFAD, UNICEF, WFP and WHO),
as well as intra-UN initiatives, such as REACH (Renewed Eorts
Against Child Hunger and Undernutrition), which collectively
work toward realizing the UN Global Nutrition Agenda. The UN
Global Nutrition Agenda describes the vision and guiding prin-
ciples for UN work on nutrition and outlines the broad aims that
these ve UN agencies will pursue collectively over the next ve
years. The activities of the above ve agencies occur in addi-
tion to the activities of several other UN bodies, including IAEA,
UNEP, UNHCR, UN Women, UNFPA, and the World Bank, which
also address nutrition at the global level to some degree. The
work of all these players occurs in addition to the work of the
UN Standing Committee on Nutrition (UNSCN), whose mandate
includes monitoring and promoting cooperation among UN agen-
cies and partner organizations in support of community, national,
regional, and international eorts to end malnutrition in all of its
forms in this generation. This mandate is carried out by UNSCN
Task Forces and Working Groups. Adding to the crowded inter-
national nutrition arena are the activities of the Committee on
World Food Security and the World Health Assembly (WHA), the
latter of which, in 2012, endorsed the comprehensive implemen-
tation plan on maternal, infant and young child nutrition, which
included six global targets focusing on stunting, anemia, low
birth weight, childhood overweight, breastfeeding, and wasting
to be achieved by 2025, and ve corresponding actions (spelt
out in resolution WHA65.6). Furthermore, a Global Monitor-
ing Framework on Maternal, Infant and Young Child Nutrition,
which comprises 14 core indicators, was adopted by the WHA in
May 2015. While these indicators have been aligned with cor-
responding SDG indicators, they will require adjustment. Simi-
larly, to avoid duplication and redundancy, the SDG monitoring
system in relation to health and nutrition must synergize with the
WHA Global Monitoring Framework, as well similar monitoring
initiatives, such as the UNICEF – WHO – World Bank Group joint
child malnutrition estimates, the Global Nutrition Report (GNR),
the Global database on the Implementation of Nutrition Action
(GINA), the International Food Aid Information System (INTER-
FAIS), the Food Security Information Network (FSIN), and the
United Nations Statistics Division’s Global Indicator Database
and Statistical Yearbook, which includes collated data on, among
other indicators, health and nutrition. Several regional initiatives
(such as the Aican Union’s Aican Regional Nutrition Strategy
for the period 2016–2025) and global health initiatives (such as
those under the auspices of the International Food Policy Re-
search Institute [IFPRI], Coverage Monitoring Network [CMN],
Save the Children, the Scaling Up Nutrition [SUN] Movement and
Outside the actual SDGs, the preceding SDGs Agenda’s dec-
laration makes reference to international instruments. This
includes the UN Charter, the Convention on the Rights of the
Child, the Universal Declaration of Human Rights, and “other in-
ternational instruments relating to human rights.” Neither the
International Covenant on Civil and Political Rights nor the In-
ternational Covenant on Cultural, Social and Economic Rights
are referred to explicitly in any part of the Agenda. The Agenda
makes only vague reference to “ll respect for” and “commit-
ment to” international law. This governance gap has led com-
mentators to note that the SDGs “will represent a rhetorical tool
that every government ocial and international aid worker will
have to pay homage to while failing to hold accountable the ap-
propriate actors in international development.” The lack of rm
accountability and enforcement mechanisms in the SDGs raises
questions about the distinction between the SDGs and similar
nutrition-related aspirational ameworks which have had lim-
ited impact, to date.
The la of rm accountabili
and enforcement meanisms in
the SDGs raises queions
Crowded space: SDGs and existing
global nutritional initiatives
While all the SDGs are intended to be integrated and indivis-
ible, the following SDGs are of particular relevance to health and
End poverty in all its forms everywhere (Goal 1);
End hunger, achieve food security and improved nutrition,
and promote sustainable agriculture (Goal 2);
Ensure healthy lives and promote well-being for all at all
ages (Goal 3); and
Ensure availability and sustainable management of water
and sanitation for all (Goal 6).
Compliance with the SDGs will
depend on rong moral leaderip
om naonal authories
and suained pressure om the
internaonal communi
To achieve these goals, it will be essential to unite the global
nutrition community around a common set of values, goals, and
Box : Proposed set of ethics principles
to guide decision-making in relation to achieving
the Sustainable Development Goals
. Stewardship and responsibility
Authorities, nanciers, the private sector, civil society,
and the public at large have a responsibility to protect and
develop limited resources, and to ensure ecological integrity
and human well-being. Initiatives should be implemented
in a manner that most impacts on poverty reduction, ending
hunger, achieving food security, improving nutrition, promot-
ing sustainable agriculture, and improving human health.
. Respect for persons
Authorities, nanciers, the private sector, civil society,
and the public at large have a duty to act responsibly and
prudently towards each other, and towards future genera-
tions, in relation to resources and in respect of initiatives that
most impact on poverty reduction, ending hunger, achieving
food security, improving nutrition, promoting sustainable
agriculture, and improving human health.
. Non-malecence
Authorities, nanciers, the private sector, civil society, and the
public at large have a moral obligation not to harm, facilitate
harm, or be complicit in the harm of others in relation to
initiatives that could have an impact on poverty reduction and
human health.
. Risk-benet analysis and burden identication
The implications of initiatives that have an impact on poverty
and human health must be identied in a timely manner,
preferably prospectively.
. Reasonableness and relevance
The rationale that underpins initiatives which impact, or could
impact, poverty and human health must appeal to relevant
evidence, values, and principles.
. Collaboration
Authorities, the private sector, the international community,
civil society, and the public at large should engage in col-
laborations to mitigate the impact of initiatives that could
exacerbate poverty and the adverse human health outcomes
associated therewith.
. Least harm
If an existing or proposed project or policy that actually or
potentially detrimentally impacts on poverty and human
health can be realized by feasible alternatives that are less
adverse to poverty and human health, these alternatives
ought to be pursued as a rst resort.
. Solidarity, duty of rescue, justice, and reciprocity
Humans have a moral responsibility to ensure the common
welfare of humankind, particularly that of the poor and
marginalized, who are experiencing or could experience det-
rimental health outcomes related to poverty. This necessitates
providing aid and support to these individuals.
. Transparency, publicity, and engagement
The rationales and potential health implications of existing or
proposed initiatives that have an impact on, or could have an
impact on, poverty and human health must be publicly dis-
closed and made accessible to aected stakeholders by means
of meaningful engagement processes.
. Accountability, appeal, and enforcement
Stakeholders who are being, or who stand to be, aected by
initiatives that are impacting, or could impact, poverty and hu-
man health, must be given a fair opportunity to appeal against
such initiatives, and to have their appeal upheld.
the Global Alliance for Improved Nutrition [GAIN]) – are also in-
volved in nutrition-related strategies and monitoring activities.
While synergy with concurrent health and nutrition initia-
tives will be key to realizing the SDGs, because of the fact that
the SDGs lack an enforcement mechanism if countries fail to
reach their goals or to submit data for review, compliance will
largely depend on strong moral leadership on the part of nation-
al authorities and sustained pressure on the part of the interna-
tional community. The failure of existing so-law instruments to
inspire nutrition-related policy reform in many settings globally
– despite the open endorsement of several WHA Resolutions on
nutrition on the part of national health authorities serving on
the WHA – highlight the fact that political rhetoric alone will be
inadequate to realize the SDGs, and they underpin why the eld
of ethics must be central to realizing the SDGs.
How the eld of ethics can facilitate
the realization of the SDGs
Ethics, also known as moral philosophy, involves systematiz-
ing, defending, and recommending concepts of right and wrong
behavior. Ethics has been described as the branch of philoso-
phy that denes what is good for the individual and for society,
and establishes the nature of obligations, or duties, that people
owe themselves and one another. It may be said that ethics of-
fers a normative guidance amework on what should be done
to ensure good for the individual and society, regardless of the
absence or applicability of a legal obligation. Put dierently,
an ethical/moral duty is a duty which one owes and ought to
perform, but which one is not legally bound to ll. Seen in
this context, the omission of key international law instruments
and enforcement mechanisms in the SDGs will necessitate a
problem-solving mindset based on ethics to deliver on SDG
promises. To this end, adherence to ethics norms (see B ox )
could facilitate the realization of the SDGs.
In the absence of legally binding compliance and accountability
mechanisms, realizing the SDGs will require a mindset shi on
the part of authorities – om empty political rhetoric that has
generally characterized the realization of other so-law interna-
tional instruments, to a problem-solving mindset based on ad-
herence to explicit ethical benchmarks. Such an approach could
help engender public trust and condence in national authori-
ties, transnational organizations, and so-law instruments, and
could facilitate the realization of the SDGs.
Correspondence: Jerome Amir Singh,
Head of Ethics and Law, Center for the AIDS Programme
of Research in South Aica (CPRISA), University of
KwaZulu-Natal, Durban, South Aica
Funding: The author is supported by the Centre for the AIDS
Programme of Research in South Aica (CAPRISA), Durban, South
Aica, which forms part of the Comprehensive International
Program on AIDS, nded by the US National Institute of Allergy
and Infectious Diseases. The author is also supported by the HIV
Prevention Trial Network. No specic nding was received for
writing this article. The nders had no role in study design, data
collection and analysis, decision to publish, or preparation of the
The panel who discussed the theme "Dening obligations and taking responsibility for stakeholder actions" at the Micronutrient Forum
2014 (le to right): Jerome Singh (UKZN), Thiago Luchesi (WVI), Purnima Mennon (IFPRI), Rachel Toku-Appiah (GMT), Martin Bloem (WFP).
manuscript. The views of the writer do not necessarily reect the
views of his nders or employers.
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... 41 See: (consulted on September 27, 2021). 42 Singh (2015), p. 58. 43 Visser et al. (2019), 10.3390. ...
Iran is a vulnerable country to desertification and soil degradation and to respond to this problem, some laws and regulations such as Act on Soil Protection Act, as well as institutional arrangements for environmental protection and soil preservation, have been initiated. However, the efficiency of these instruments in building an effective soil governance system is disputable. This chapter intends to exercise the legal challenges of Iran in soil protection governance. To do so it firstly considers the state of soil degradation and protection in Iran and then examines the development of soil protection governance in its legal system. This chapter, emphasizing on the contribution of institutional efficiency and legal enforcement in soil governance, concludes that Iran’s legal system faces with a body of legal, institutional and social obstacles in development and improvement of soil protection governance pillars, i.e. integrated instruments and cross-sectoral collaboration in multilevel protection.
... 7 According to (Klimska and Leźnicki, 2017) the global ethics consistent with the goals of sustainable development consists of such values as the right to life and health, justice, responsibility, solidarity, and moderation. In turn, according to ( Singh, 2015), the ethical foundations of the sustainable development goals include: management and responsibility, However, an element of such a global ethic may already be the social solidarity shown in protecting all people at risk of humanitarian disaster. ...
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Objective To explore the impact of the Coronavirus disease 2019 (COVID-19) pandemic on the quality of medical products in Zimbabwe, including market risks for substandard and falsified products and impacts on quality assurance activities. Design Qualitative study based on in-depth key informant interviews. Setting Health system stakeholders across the medical product supply chain in Zimbabwe. Participants 36 key informants were interviewed between April and June 2021. Results We found that the COVID-19 pandemic disrupted quality assurance and regulatory activities of medical products in Zimbabwe, resulted in observations of poor-quality personal protective equipment (PPE) and other COVID-19-related products and led to increased risks to quality. Risks to quality due to COVID-19-related disruptions included increased layers of agents in the supply chain and an influx of non-traditional suppliers. COVID-19-related movement restrictions reduced access to health facilities and thus may have increased the usage of the informal market where smuggled and unregistered medical products are sold with less oversight by the regulator. Most reports of poor-quality medical products were for PPE, such as masks and infrared thermometers, used for the COVID-19 response. Besides these reports, many participants stated that the quality of essential medicines in the formal sector, not related to COVID-19, had largely been maintained during the pandemic due to the regulator’s stringent quality assurance process. Incentives for suppliers to maintain quality to retain large donor-funded contracts, and the need for local wholesalers and distributors to comply with quality-related aspects of distribution agreements with global manufacturers of brand-name medical products, mitigated threats to quality. Conclusions The COVID-19 pandemic presented opportunities and market risks for circulation of substandard and falsified medical products in Zimbabwe. There is a need for policymakers to invest in measures to safeguard the quality of medical products during emergencies and to build resiliency against future supply chain shocks.
Background: The high incidence of mental illness worldwide is a substantial economic burden on society. Temperature and the occurrence of mental and behavioral disorders (MDs) seem to have a relationship, but this has not been widely researched. Therefore, this study aimed to investigate the effect of temperature on the hospitalization rate of patients with MDs in a temperate monsoon climate region of northern China. Methods: Patients with MDs hospitalized in the Mental Health Center of Hebei Medical University, China, from January 2014 to December 2019 were included in the study. The delayed exposure-response relationship between temperature and the number of hospitalized MDs patients was analyzed using a quasi-Poisson generalized additive model combined with a distributed lag nonlinear model. Results: With the reference of 15.3℃ (temperature with the minimum hospitalizations), the single lag effect of low temperature (-2°C, 10th percentile) increased the hospitalization of patients with MDs, while the cumulative effect decreased the risk of hospitalization for some MD subtypes; it was an acute protective effect. The single and cumulative lag effect of high temperature statistically increased the hospitalization rates of patients with MDs. The optimum temperature for each subtype was different, and the males and the younger age group were more susceptible to high temperatures. Conclusions: Low temperature has an acute protective effect on the hospitalization of patients with MDs. In comparison, high temperature increases hospitalization rates. Men and younger people are more affected by temperature, which provides early warning and health intervention measures for patients with corresponding temperature changes.
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Jerome Singh argues that health ethics principles must be afforded equal status to economics principles in climate change deliberations, and that the health community must play more of a leadership role.
Lessons for the design of the Sustainable Development Goals
  • M Miller-Dawkins
Miller-Dawkins M. Global goals and international agreements. Lessons for the design of the Sustainable Development Goals. Accessed October 1, 2015.
The Impending Failure of the Sustainable Development Goals
  • S Wisor
Wisor S. The Impending Failure of the Sustainable Development Goals. September 30, 2014. www.ethicsandinternationalaffairs.
United Nations Global Nutrition Agenda (UNGNA v.1.0)
  • M Mclachlan
McLachlan M. United Nations Global Nutrition Agenda (UNGNA v.1.0).
WHA65/6: Comprehensive implementation plan on maternal
World Health Assembly. WHA65/6: Comprehensive implementation plan on maternal, infant and young child nutrition, 21-26 May 2012.
WHA 68/9. Maternal, infant and young child nutrition. Development of the core set of indicators
World Health Assembly. WHA 68/9. Maternal, infant and young child nutrition. Development of the core set of indicators, 15 May 2015.