Comment

www.thelancet.com Published online April 19, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60765-5 1

What do people want for health in the post-2015 agenda?
With fewer than 1000 days remaining to the target dates
for achievement of the Millennium Development Goals
(MDGs), it is timely to ask: what is the world we want for
health in the post-2015 era? This is the question posed by
a global consultation that we have had the privilege to
coordinate since September, 2012.
There is no shortage of people with an answer.
More than 150 000 people from all regions visited the
consultation website, and more than 100 thoughtful
reports were submitted by a wide range of organisations
and authors. 14 face-to-face consultations attracted
more than 1600 people in places as far-ranging as
La Paz, Dar es Salaam, Abuja, Amsterdam, New York,
Beijing, and Bangkok.
On April, 19, 2013, we launched the nal report of the
con sultation,
1
which aims to do justice to this outpouring
of intellectual and emotional energy. The report follows a
stakeholder meeting to review the rst draft, open review
of the second draft via the website, and a 2 day meeting
in Gaborone, Botswana,
2
which convened 50 participants
(representatives from each of the constituencies that
contributed to the consultation, including UN Member
States, civil society, the private sector, academics, and
heads of global health organisations) to discuss the
penultimate draft. The report will be submitted to the UN
High-level Panel of Eminent Persons on the Post-2015
Development Agenda and to the UN Secretary-General
to help inform the deliberations on the post-2015 agenda
at the UN General Assembly in September, 2013. We also
hope that the report will nd a wide use and readership,
continuing to stimulate debate about how to best
place health in the post-2015 agendawhich is likely to
continue well into 2015.
At the request of the UN Development Group, the
consultation was one of 11 global thematic con-
sultations (the other ten focused on inequalities, edu-
cation, energy, water, food, population, environ ment,
governance, employ ment, and conict) aiming to inform
the for mal and informal discussions now underway on
the post-2015 agenda. The health con sultation was co-
led by WHO and UNICEF, with the collaboration of the
Governments of Sweden and Botswana (who provided
signicant nancial and technical support); together
these four formed the consultation Task Team. Other UN
agencies also contributed support, including UNAIDS,
UNFPA, UN Development Programme, O ce of the High
Commissioner for Human Rights, and UN Department of
Economic and Social Aairs, along with other countries,
foundations, and civil society groups.
We asked for specic inputs around ve questions
(panel 1). Not everyone agreed about the answersin
fact, sometimes people disagreed passionately. But
as the consultation proceeded, there was much more
convergence than might have been imagined, even if
there are some key areas that require further discussion
to move closer towards consensus. The Gaborone meet-
ing was notable for its spirit of constructive engage-
ment,
3
even among partners with very dierent
institu tional interests. There is increasing recognition
within the health community that the place of health in
the post-2015 agenda will be best served by development
of a unied position through com promise, rather than
advancement of several competing proposals.
So what was agreed upon? Almost no one wants to
forget the health MDGs. Where MDGs have not been
achieved, momentum must be maintained to reach
the targets as soon as possible. Where they have been
achieved, revised targets with more ambition should
be set. The new agenda should take heed of the MDGs
lessons about the value of specic, quantied goals and
indicators that are understandable to both politicians
and communities.
At the same time, 2015 is not 2000. The world has
changed and not everything about the MDGs was
perfect. Health is a human right and about more than
disease. Goals need to be relevant to all countries and
have a much greater focus on equity within nations,
disaggregation of data, and setting of targets for closing
gaps, to prioritise the most disadvantaged communities
For the consultation website see
http://www.worldwewant2015.
org/health
Panel 1: Consultation framing questions
1 What lessons have been learned from the health-related
Millennium Development Goals?
2 What is the priority health agenda for the 15 years after
2015?
3 How does health t into the post-2015 development
agenda?
4 What are the best indicators and targets for health?
5 How can it be ensured that the process and outcome are
relevant to the key stakeholders?
Published Online
April 19, 2013
http://dx.doi.org/10.1016/
S0140-6736(13)60765-5
Comment
2 www.thelancet.com Published online April 19, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60765-5
in every country, instead of reaching them last. The
importance of non-communicable diseases and mental
health cannot be ignored. Adolescents also demand and
deserve much greater attention.
Moreover, the health community needs to articulate,
condently but clearly, the contribution of health
to sustainable development,
4
and acknowledge the
crucial importance of the determinants of health by
adopting a health-in-all-policies approach, recognising
the contributions of other sectors and setting health-
related targets under other goals. Ensuring that people
not only survive but enjoy good health throughout
their life courseadding more healthy years to peoples
total life expectancywill be of great importance. While
maintaining goals focused on outcomes which people
value, there also need to be targets for the road to get
there, including ensuring everyone can use accessible
and aordable health services that address their needs.
In panel 2 and the gure, we propose a framework, on
the basis of this shared narrative from the consultation,
for health goals in the post-2015 agenda. But although
the consultation has mostly achieved its aims of
stimulating interest and discussion, and bringing
together proposals for new health goals, its conclusion
marks merely the end of the beginning of this process.
Much remains to be done to continue to make the
case for the importance of health as a cornerstone
of development on the path to the nal post-2015
agenda. An improved understanding is required of
what moving to a sustainable development framework
might mean for health, and there is a need to rise to
the call in Gaborone of Graa Machel, a member of the
High-level Panel, to address the how, and not ignore
implementation, as was done in the MDG framework.
The ndings of the consultation, as with other
proposals beyond health, will now be discussed and
debated in various foraby the High-level Panel as they
conclude their discussions, but also by Member States in
the Open Working Group on Sustainable Development
Goals and at the General Assembly, and by civil
society, academia, and other groups involved in many
other processes. The consultation has laid a strong
foundation for further work on the health goals, as part
of the broader post-2015 process. More discussions, and
particularly country engagement, are needed to develop
specic targets and indicators for the main areas in
panel 2. We urge the health community to continue
Panel 2: Proposed framework for health goals in the post-2015 agenda
Sustainable wellbeing for all could be an overarching goal for the wider post-2015
agenda (gure). This goal would recognise health as an important contributor to,
and outcome of, sustainable development and human wellbeing. This goal would
answer growing calls to look beyond a countrys gross domestic product when
assessing healthy growth and sustainable development, and to address issues of
equity. It also acknowledges that good health is determined, not only by prevention
and treatment of disease, but also by many other aspects of development, including
education; gender equality; sustainable energy and nutrition; water and sanitation;
and climate change adaptation and mitigation. Goals in these areas of the post-2015
agenda could include health-related targets to address the underlying determinants
of health. For example, a goal for the environment could include a target to reduce
indoor air pollution.
Maximising healthy lives could be the specic health goal (gure), in which the health
sector would have a large, but far from exclusive, role. This goal should include:
acceleration of progress on the health Millennium Development Goal (MDG) agenda;
reduction of the burden of non-communicable diseases (NCDs); and ensuring
universal health coverage and access. Achieving improved health at all stages of life
(including crucial phases such as adolescence) is a goal that is relevant for every
country. Interventions from all sectors of society will be required.
Eorts to accelerate progress on the health MDG agenda should build on national and
global eorts that have already resulted in substantial progress in reduction of child
and maternal deaths and control of HIV, tuberculosis, malaria, and neglected tropical
diseases. Rather than pulling back from these goals, the new agenda should be even
more ambitious, and rea rm the targets of ongoing initiatives such as: ending of
preventable maternal and child deaths; elimination of chronic malnutrition and
malaria; provision of universal access to sexual and reproductive health services,
including family planning; increasing of immunisation coverage; and fullment of the
vision of an AIDS-free and tuberculosis-free generation.
Reduction of the burden of major NCDs could focus on cardiovascular diseases, cancers,
chronic respiratory diseases, and diabetes (the four NCDs causing the most deaths), and
mental health. Some targets could be based on the World Health Assembly resolution of
a 25% reduction of deaths due to these four NCDs by 2025. Other targets could be aimed
at reduction of morbidity and disability from NCDs at all ages, including reducing the
prevalence of risk factors.
Ensuring universal health coverage and access is suggested as the key contribution by the
health sector to achieving health goals and targets, but also as a goal in itself, even
though the exact terminology and interpretation of coverage and access remains a
subject of debate. Provision of all people with access to aordable, comprehensive, and
high-quality services that address basic health requirements and country health priorities
is a means to achieve better health outcomes. It is also a desirable goal in its own right
because people value the assurance of access to a health system that prevents and treats
illness eectively and aordably within their homes and their communities, with referral
to clinics and hospitals when required.
Figure: Health and development in the post-2015 agenda
Adapted from Health in the post-2015 agenda. Report of the global thematic consultation on health, 2013.
1

MDG=Millennium Development Goal. NCD=non-communicable disease.
Health
Gender, equity, wealth, education, nutrition, environment,
security, etc
Development goal
Sustainable wellbeing for all
Contributions of other sectors
to health
Accelerate the MDG agenda
Reduce the NCD burden
Ensure universal health coverage and access
Health goal
Maximising healthy lives
Comment
www.thelancet.com Published online April 19, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60765-5 3
to be fully engaged in these debates, to ensure that the
post-2015 agenda rightfully places health at its centre.
Task Team for the Global Thematic Consultation on Health
in the Post-2015 Development Agenda
WHO, Geneva, Switzerland (TB, CC); UNICEF, New York, NY 10017,
USA (MC, KR); Ministry of Health, Gaborone, Botswana (SE-H);
Ministry for Foreign Aairs, Stockholm, Sweden (JL-G, AN);
Consultant to the Ministry of Health, Gaborone, Botswana (TM);
and Independent Expert Review Group, Francistown, Botswana (JP)
[email protected]
Task Team members (in alphabetical order): Ties Boerma, Mickey Chopra,
Clare Creo, Shenaaz El-Halabi, Johanna Lindgren-Garcia, Themba Moeti,
Anders Nordstrm, Joy Phumaphi, *Kumanan Rasanathan
We declare that we have no conicts of interest. We thank all those who
submitted papers, supported and participated in the face-to-face consultations,
contributed comments online, and took part in e-discussions. In particular, we
thank Joanne McManus who prepared the drafts of the report.
1 WHO, UNICEF, Government of Sweden, Government of Botswana. Health
in the post-2015 agenda. Report of the global thematic consultation on
health. April, 2013. http://www.worldwewant2015.org/le/337378/
download/366802 (accessed April 12, 2013).
2 High level dialogue on health in the post-2015 development agenda.
Gaborone, March 46, 2013. Meeting report. http://www.worldwewant2015.
org/le/320271/download/348522 (accessed April 12, 2013).
3 Horton R. O ine: A rainbow on my desolate land. Lancet 2013; 381: 890.
4 Berkley S, Chan M, Dybul M, et al. A healthy perspective: the post-2015
development agenda. Lancet 2013; 381: 107677.