International Development CommitteeWritten evidence submitted by the Wellcome Trust

Key Points

Health, environmental sustainability and development are highly interdependent. It is vital that health is recognised in the goals as a core component of sustainable development.

The post 2015 goals must be based on robust evidence and a wide range of stakeholders should be engaged during the development process to ensure the goals are tractable and reflect the greatest needs.

Clear baseline data are needed to assess progress against the goals and monitoring procedures should be established at the outset, with support to build local capacity for data collection.

Introduction

1. The Wellcome Trust is committed to achieving extraordinary improvements in human health. A significant and growing proportion of our funding—around £540 million between 2006–07 and 2010–11—is used to support research and research capacity strengthening in low- and middle-income countries (LMICs). We therefore welcome the opportunity to comment on how the post 2015 goals should be established. Our response focuses on the contribution that science can make to the development of the post 2015 goals and the importance of recognising health as a core component of sustainable development.

Lessons Learnt From the Millenium Development Goals

2. Significant progress has been made against some of the Millennium Development Goals (MDGs), for example child mortality. It is difficult to demonstrate a causal link between such progress and the MDGs as development may have occurred for other reasons.1 However, we consider that as aspirational goals, the MDGs have had valuable impact in initiating global efforts to address important development issues including health.

3. There has been some criticism of the development of the MDGs because it did not take a holistic view of issues or involve sufficient engagement with key stakeholders. This has led to unfortunate unintended consequences. For instance, Goal 6: Combat HIV/AIDS, malaria and other diseases2 led to a focus on HIV/AIDS and malaria while anecdotal evidence suggests that tuberculosis and non-communicable diseases have been neglected in comparison. It is vital that goals are meaningfully drafted to avoid unintended consequences of this sort.

4. The MDGs were introduced against a background of limited baseline data from which to measure progress. Further, evaluation procedures were not planned at the outset of the MDGs and many countries lack the capacity to monitor progress against the goals. These factors have made globally-consistent assessment of progress against the goals very difficult and must be addressed in the development of the post 2015 goals.

How should the “sustainable development goals” be established?

Health, sustainability and development

5. Health and development are closely interdependent. This is recognised in the MDGs, which include a number of health indicators. Health and sustainability are also highly interdependent as humans are dependent on the planet for resources, including food, water and materials, and human health is strongly influenced by the environment. Further there are links between addressing environmental challenges and health as modelling has shown that climate change mitigation strategies can have a range of public health benefits that can offset the costs of mitigation.3 For example, changing modes of electricity production to reduce carbon dioxide emissions reduces deaths caused by associated pollutants in India. Similarly introducing low emission cookstoves in India has been shown to have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease and ischaemic heart disease while reducing greenhouse gas emissions. We have recognised the fundamentally important link between health and sustainability in our Strategic Plan 2010–2020, with the introduction of a new strategic challenge, “Connecting Environment, Nutrition and Health”.

6. We were disappointed that health appeared to be a relatively low priority at Rio+20. We hope that this will be rectified in the development of the post 2015 goals, which must recognise health as a core component of sustainable development.

Establishing evidence-based goals

7. It is vital that the selection of post 2015 goals is based on robust evidence about the areas of greatest need and to ensure that the goals are tractable. The UK has a strong research base in science relating to development, including global health, and it is important that the Government capitalises on this strength during the formulation of the goals. We recognise that the evidence base is not the only factor that needs to be considered in development of the goals. Academic analysis suggests that the “most effective policies are those that have recognised and engaged all stakeholders and in particular the poor, in the management of these resources”.4 Development of the post 2015 goals must involve a wide range of stakeholders in the decision making process to ensure that real world needs are reflected.

Embedding monitoring into the goals

8. Science and innovation can make a key contribution to policy in this area by “providing tools for monitoring, measuring and valuing, and in some cases by developing new enabling technologies”.5 The process of evaluating progress must be established as the goals are developed, with appropriate systems put in place to gather baseline data and achieve effective and consistent monitoring. LMICs currently have variable capacity for surveillance and monitoring. Support will be needed to build capacity at a local level to ensure sustainability in consistent and meaningful data collection and monitoring.

9. The Trust provides support to the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH). INDEPTH is an African-led network that provides a model for developing capacity and networking needed to support consistent monitoring of the goals. INDEPTH seeks to add value to individual demographic surveillance system (DSS) sites across LMICs through taking an overview of these sites and coordinating multi-site studies, training and funding. INDEPTH includes 42 DSS sites across Africa, Asia and Oceania. The sites focus on a range of issues including infectious diseases, non-communicable diseases, reproductive health and health systems. The overall vision of INDEPTH is to establish an international platform of sentinel demographic sites that provides health and demographic data and research to enable developing countries to set health priorities and policies based on longitudinal evidence. INDEPTH is currently developing in-country networks in countries where there are more than three INDEPTH member sites with the primary aim of developing comparable indicators for monitoring progress against the MDGs.6

10. The World Health Organization’s Health Metrics Network (HMN) is a global partnership dedicated to strengthening national health information systems. HMN operates as a network of global, regional and country partners that assesses health information systems and seeks to drive sustainable improvements to them.7 It is vital that the HMN and other existing platforms are used to support monitoring of the goals.

The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. We support the brightest minds in biomedical research and the medical humanities. Our breadth of support includes public engagement, education and the application of research to improve health. We are independent of both political and commercial interests.

October 2012