Health, development and the Millennium Development
R. DODD and A. CASSELS
Department for Health Policy, Development and Services (EIP/HDS), World Health
Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
Received 17 January 2006, Accepted 20 January 2006
The Millennium Development Goals (MDG), which emerged from the United Nations Millennium Summit in
2000, are increasingly recognized as the over-arching development framework. As such, the MDG are increasingly
guiding the policies of poor countries and aid agencies alike. This article reviews the challenges and opportunities
for health presented by the MDG.
The opportunities include that three of the eight MDG relate to health — a recognition that health is central to
global agenda of reducing poverty, as well as an important measure of human well-being in its own right. A related
point is that the MDG help to focus attention on those health conditions that disproportionally affect the poor
(communicable disease, child health and maternal health), which should, in turn, help to strengthen the equity
focus of health policies in low-income countries. Further, because the MDG are concrete, it is possible to calculate
the cost of achieving them, which in turn strengthens the long-standing calls for higher levels of aid for health.
The challenges include that, while the MDG focus on specific diseases and conditions, they cannot be achieved
without strengthening health systems. Similarly, progress towards the MDG will require health to be prioritized
within overall development and economic policies. In practice, this means applying a health ‘lens’ to processes such
as civil-service reform, decentralization and the drawing-up of frameworks of national expenditure. Finally, the
MDG cannot be met with the resources available in low-income countries. While the MDG framework has created
pressure for donors to commit to higher levels of aid, the challenge remains to turn these commitments into action.
Data are presented to show that, at current rates of progress, the health-related MDG will not be achieved. This
disappointing trend could be reversed, however, if the various challenges outlined are met.
In the year 2000 the global community
made an historic commitment: to eradicate
extreme poverty and improve the health and
welfare of the world’s poorest people within
15 years. The commitment was the United
Nations Millennium Declaration (United
Nations, 2000) and derived from it are eight
time-bound goals, known as the Millennium
Development Goals (MDG).
Table 1) have gained wide-spread accep-
tance in rich and poor countries alike. They
framework for development efforts, and
benchmarks against which to judge success.
International commitment to the MDG was
re-affirmed in September 2005 at the World
endorsed the goals. With the MDG target
date of 2015 just 9 years away, now is the
time to review progress, take stock of the
achievements, and address the challenges.
In its recent publication, Health and the
2005a), the World Health Organization
(WHO) identified five opportunities offered
by the MDG, and five challenges that
are likely to impede progress towards the
opportunities and challenges and explores
one of the challenges in more detail:
namely, the relationship between health
and development policy. It concludes by
Reprint requests to: R. Dodd.
E-mail: email@example.com; fax: z41 22 791 4153.
Annals of Tropical Medicine & Parasitology, Vol. 100, Nos. 5 and 6, 379–387 (2006)
# 2006 The Liverpool School of Tropical Medicine
giving an overview of the WHO’s work on
THE MILLENNIUM DEVELOPMENT
GOALS AND HEALTH
The MDG represent an important set of
opportunities for the health sector.
Firstly, the goals provide a common set of
priorities on how to tackle poverty. This
unprecedented level of agreement between
national governments, international agen-
cies and the United Nations system brings
both political momentum and focus to
development efforts, helping to ensure that
the needs of poor people remain at the top
of the development agenda.
Secondly, health is at the heart of the
MDG,with therecognition that better health
is central to the global agenda of reducing
poverty as well as an important measure of
human well-being in its own right. Health is
represented in three of the eight goals, and
makes an acknowledged contribution to the
achievement of all the others, particularly
those related to education, gender equality
and the eradication of extreme poverty and
hunger. Importantly, the health goals also
focus on problems that disproportionally
affect the poor — communicable disease,
child health and maternal health.
and ambitious targets against which to
measure progress. These provide an indica-
tion of whether efforts to improve health
are on track, and a means of holding
decision-makers to account. Worryingly,
data released in 2005 show that progress
towards the health-related
behind that made towards the other goals
(see Box 1).
Fourthly, it is possible to calculate what it
would probably cost to achieve the MDG,
and this, in turn, draws attention to the
massive funding gap between what is avail-
able and what is needed. This provides
additional support to the long-standing calls
from the health sector for its funding to be
Fifthly and finally, a unique feature of the
MDG is that the eighth goal calls for a
global partnership for development, recog-
nizing that there are certain actions rich
countries must take if poor countries are to
achieve goals 1 to 7. Goal 8 is a reminder
that global security and prosperity depend
on a more equitable world for all.
Importantly, the MDG have also helped to
crystallize the challenges. As developed and
developing countries begin to look seriously
at what it would take to achieve the health-
related MDG, the bottlenecks to progress
have become clearer. These challenges —
again, five have been identified — are
summarized below. They also represent
core elements of the WHO’s strategy for
achieving the MDG, as discussed below.
The first challenge is to strengthen health
systems. Without more efficient and equi-
table health systems, countries will not be
able to scale up the programmes for disease
prevention and control that are required to
meet the specific health goals — of reducing
child and maternal mortality and rolling
back HIV/AIDS, tuberculosis and malaria.
Survival has estimated that universal access
to broad-based health services could, on its
own, meet 60%–70% of the decreases in
decreases in maternal mortality required to
achieve the relevant MDG (Claeson et al.,
2003). In practice, the strengthening of
Group on Child
The eight Millennium Development Goals
Goal 1: Eradicate extreme poverty and 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 sustainability
Goal 8: Develop a global partnership for development
DODD AND CASSELS
health outcomes will not be possible without
major improvements in systems for health-
care delivery, which in turn depend not only
on changes in public-sector management
but also on policies and interventions well
beyond the health sector itself. Moreover,
improvements in health are essential if
progress is to be made with the other,
‘non-health’ MDG, such as the reduction
of absolute poverty.
If current trends continue, most of the
health-related MDG will not be reached in
most parts of the world. Accelerated progress
is, however, possible. It is a matter of political
choice in both the developed and developing
world. It is also apparent that substantial
progress, even if it falls short of the targets set
in 2000, could dramatically transform the
lives of millions of the world’s poorest
people. The MDG are one means of exerting
the leverage that can make this happen.
Anon. (2003). Poverty and Health. DAC Guidelines and
Reference Series. Paris: Organisation for Economic
Co-operation and Development.
Bloom, D. & Sachs, J. (1998). Geography, demography
and economic growth in Africa. Brooking Papers on
Economic Activity, 2, 207–295.
Claeson, M., Gillespie, D., Mshinda, H., Troedsson,
H. &Victoria, C. G. (2003). Knowledge into action
for child survival. Lancet, 362, 323–327.
Gokhale, M. K., Rao, S. S. & Garole, V. R.
(2002). Infant mortality in India: use of maternal
and child health services in relation to literacy status.
Journal of Health, Population and Nutrition, 20, 138–
Michaud, C. (2003). Development Assistance for
Health (DAH): Recent
Allocation. Geneva: World Health Organization.
United Nations (2000). United Nations General Assembly
Resolution 55/2. New York, NY: United Nations.
United Nations (2005). The Millenium Development
Goals Report. New York, NY: United Nations.
Conference Draft. Washington, DC: World Bank.
World Health Organization (2000). The World Health
Report 2000. Health Systems: Improving Performance.
World Health Organization (2001). Macroeconomics and
Health: Investing in Health for Economic Development.
World Health Organization (2005a). Health and the
Millennium Development Goals. Geneva: WHO.
World Health Organization (2005b). World Health
Achievement of the Internationally Agreed Health-related
Development Goals, including those Contained in the
Millennium Declaration. Geneva: WHO.
Trends and Resource
MILLENNIUM DEVELOPMENT GOALS