Volume 10 Issue 1
Peer reviewed article
If there’s one quality the United Nations cannot possibly be accused of lacking, it’s ambition. The Millennium Development Goals stand as one such product of the UN’s idealism, eight limited and yet very well intentioned targets for global health progress by the year 2015. And now that 2015 has finally rolled around, how close have we actually come to meeting any of those goals?
The unfortunate reality is that while many nations have made remarkable health and social progress, a minority of countries will fail to meet any of the goals at all. Many of the most heavily affected constituencies lack the political will to strive for such changes, perhaps because it is the louder voices of developed nations that drives dialogue surrounding the MDGs.
However, regardless of the apparent naivety of such ambitious targets, the Millennium Development Goals have been necessary because they provide exactly what its name suggests: a goal that we have to continually keep striving for. It hasn’t been fifteen years without significant and measurable progress, and perhaps that is more important than whether or not the UN is aiming too high.
If there’s one quality the United Nations cannot possibly be accused of lacking, it’s ambition. The Millennium Development Goals stand as one such product of the UN’s idealism, eight limited and yet very well intentioned targets for global health progress by the year 2015. Adopted in September 2000, the MDGs have aimed to address many of the indisputably pressing health and environmental issues of the 21st century, and have been described by the University of Manchester’s Professor David Hulme as ‘the world’s biggest promise.’ The eight MDGs are as follows:
1. To eradicate extreme poverty and hunger 2. To achieve universal primary education
3. To promote gender equality and empower women
4. To reduce child mortality
5. To improve maternal health
6. To combat HIV/AIDS, malaria, and other diseases
7. To ensure environmental sustainability
8. To develop a global partnership for development
The nature of the goals being set wasn’t exactly unprecedented, but the international community’s financial commitment to attempting to meet them has been; in 2005, the G8 nations agreed to cancel US$40 to $55 billion in debt owed by some of the world’s poorest countries.  The UN’s secretary-general Ban Ki-Moon has hailed the MDGs as ‘the most successful global anti-poverty push in history’, though some would argue otherwise; some view the MDGs as a warm, fluffy and ultimately hollow gesture with good intentions, while other more radical critics feel the MDGs actively distract the international community from more effective measures and issues of greater importance, such as finding working alternatives to capitalism. So now that 2015 has finally rolled around, maybe we can be- gin to put the debate to rest when we finally have some more concrete statistical evidence.
But therein lies one of the biggest problems with assessing the effectiveness of the MDGs. The reality is that it’s very difficult to track the exact extent of progress in many countries where data is limited, or entirely absent – countries that are often the ones most desperate for change. And it hasn’t always been a straightforward fifteen years for governments and humanitarian organisations. Since the turn of the millennium, we have seen Timor-Leste become a sovereign state following years of occupation, a war-torn Sudan splintered into two separate nations, and the Arab’s world’s pursuit of democracy leave a steadily growing trail of death and destruction in its wake. Much of India and Southeast Asia was left to pick up the pieces following the catastrophic 2004 Boxing Day tsunami, while Haiti is still recovering from the devastation of the 2010 earthquake. Accord- ing to UN data, the number of newly displaced persons has tripled since 2010, with developing nations shouldering the greatest burden. There have been setbacks, some manmade and others natural, and ones that truly highlight that we can’t possibly achieve the MDGs without peace and international cooperation. So in spite of these shortcomings, how close have we actually come to meeting any of these goals?
There has legitimately been some remarkable, if uneven, change over the last fifteen years. According to the UN’s 2014 MDG progress report, as well as the African Development Bank and Center for Global Development, a number of their targets have indeed been met, while others still face significant challenges.
While ‘eradicate’ might not be the right word, UN data suggests that we have actually met the first component of goal 1: to halve the proportion of people living in ‘extreme poverty’, defined as those living on an income
of less than US$1.25 a day, between 1990 and 2015. In 1990, 36% of the world lived under such conditions, in comparison to the 18% in 2010. It’s an extraordinary statistic at first glance, though much of the apparent success is owed to China, a country that has witnessed a veritable social revolution over the last two and a half decades. Today, 12% of its 1.35 billion inhabitants live in extreme poverty, in contrast to the 60% of China in 1990. Certainly, the numbers overlook those that aren’t necessarily living in extreme poverty, but regardless, it is significant change. However, the statistics don’t look nearly so good in other parts of the globe; the UN’s most recent estimate of the proportion of people living on less than $1.25 a day in Sub-Saharan Africa remains at 48%, just 8% down from the corresponding figure in 1990., With Africa’s dramatic population growth, the number of people living in extreme poverty has actually increased, rising to 410 million in 2010 from 290 million in 1990 (excluding North Africa). Even worse is knowledge that the proportion of people living in extreme poverty has worsened in eight African nations: Central African Republic, Nigeria, Madagascar, Zambia, Kenya, Guinea Bissau and Côte d’Ivoire. It may be some improvement in terms of percentage, but it’s evidence that the international community’s current approach to tackling poverty in many parts of Africa isn’t working well enough.
The second MDG has aimed to address the less than complete rates of primary education throughout the world, particularly aiming to reduce the gap in education between that of males and females. The last fifteen years have marked some dramatic increases in enrolment rates throughout the developing world, with an average improvement of 7%. Most significant is the improvement in Sub-Saharan Africa, increasing to 78% in 2012 from 60% in 2000, though there are still significant disparities between individual countries, with eleven countries having net enrolment rates of less than 75%. Once again, however, the apparent improvement in the numbers somewhat obscures a less favourable reality; with booming birth rates worldwide, the 60 million children out of school in 2007 stood at a similar 58 million in 2012. A disproportionate 50% of these children live in conflict-affected areas, feeding that vortex of poverty and violence much of the developing world knows too well.
It’s too easy to think of the MDGs as being only applicable to developing nations, but reducing in- equality between women and men stands as equally critical in the developed world. It’s another area where progress is being made, but the disparity is still apparent. Women still remain underemployed in comparison to men in non-agricultural sectors, modestly improving worldwide from a 35% share to a 40% share of paid positions. The global time-related underemployment rate, a measure of those willing and able to work more hours, stands significantly higher amongst women in most regions of the world, including developed countries. Wage disparity is also a significant problem in much of the world, and particularly Africa; of the 54 African countries, only in Egypt, Uganda, The Gambia, Ghana, Malawi, Zambia Burundi, Botswana and Benin do women earn at least 75% of what men in similar positions are paid.
Women’s political involvement still remains poor worldwide, though some parts of the world have shown dramatic improvement. As of 2014, women hold 24% of political seats in national parliaments in North Africa, in stark contrast to 3% in 2000. Five countries still remain with no female representation whatsoever: Palau, Qatar, Tonga, Vanuatu and Yemen. Of all the seats in the developing world, 21% are now occupied by women, only 4% behind the alarming 25% of seats in developed nations. It may be the 21st century, but the glass ceiling remains firmly in place for many women worldwide.
The sad reality is that the MDGs’ target to reduce the under-five mortality rate from 1990 to 2015 by two-thirds has appeared to fall short. It hasn’t been without significant progress, however; the global under-five mortality rate dropped to 48 per 1,000 in 2012 from 90 per 1,000 in 1990. This improvement has coincided with far higher rates of measles vaccination worldwide, although recent progress appears to be stagnating. Most regions, barring Sub-Saharan Africa and Oceania, reduced mortality rates by at least half, resulting in 17,000 fewer under-five children dying everyday. Interestingly, improvements have been noted at all income levels and in both developed and developing nations. It’s no small consolation, but there is still so much more to be done.
Going hand in hand with goal 4, goal 5’s aim to reduce maternal mortality rates by three-quarters has also failed to be met. In spite of this, as of 2012 we have seen a 45% reduction worldwide since 1990, with 68% of births in the developing world being assisted by a trained professional, in contrast to only 56% in 1990. Sub-Saharan Africa remains the most heavily affected region
in the world, accounting for 62% of maternal deaths in 2013. Sierra Leone is the most heavily burdened country in the world, with a stagger- ing 1,100 deaths per 100,000 live births – in plain terms, more than one in a hundred live births results in the death of the mother. This stands in contrast to Belarus, Israel and the Scandinavian nations, countries that have amongst the lowest rates worldwide at between 1 and 4 deaths per 100,000 live births. Few of the goals so well illustrate the shocking disparity between developed and the most disadvantaged nations.
While HIV incidence has declined significantly since 2001, many parts of Africa remain crippled by devastating infection rates. As of 2012, a record 35.3 million people are living with HIV worldwide, with new infection rates continuing to exceed AIDS-related deaths.  Condom use amongst males and females engaging in higher-risk sex in Sub-Saharan Af- rica remains very poor, at an estimated 57%, in contrast to the 95% target set by the UN General Assembly in 2001. However, access to antiretroviral therapy has been dramatically improv- ing annually, with an unprecedented 1.6 million additional patients receiving treatment in 2012. The UN estimates that, given current trends, the target 15 million patients receiving ART by 2015 could be a reality.
Closely tied to HIV/AIDS prevalence, reducing rates of tuberculosis has been another significant MDG target. 1.1 million of the 8.8 million patients diagnosed in 2013 were also HIV-positive, and 75% of the 8.8 million from Africa. Despite this, worldwide, the number of new cases of TB per 100,000 is dropping, with 87% of newly diagnosed patients in 2011 being treated successfully. Whether or not these trends can be maintained in the face of the rising threat of multi- drug-resistant tuberculosis remains to be seen.
With increased use of anti-malarial interventions, the world has seen a 42% decline in malaria mortality rates between 2000 and 2012. Over that period, an approximate 700 million insecticide-treated bed nets were distributed throughout Sub-Saharan Africa, once again the most heavily affected region in the world. How- ever, only an estimated 36% of the inhabitants of these countries have access to a bed net, highlighting the enormous gap that still needs to be bridged.
In terms of progress, Goal 7 arguably stands as the most disappointing of
the MDGs. It’s 2015, and millions of hectares of forest continue to be destroyed annually, while carbon emissions continue to rise dramatically as parts of the developing world begin to industrialise. Though developed regions have observed a slight reduction in carbon emissions, dropping from 14.9 billions of metric tons in 1990 to 13.3 billions of metric tons in 2011, emissions in the developing world have spiked, now contributing more emissions than the developed world with 18.9 billions of metric tons in 2011. Perhaps it’s one of those things that have to get worse before it can get better, but it’s still a pressing concern being entirely overlooked by too many countries, Australia included.
Goal 7 also includes the specific target to halve the proportion of the population without consistent access to basic sanitation and clean drink- ing water, and there has been some remarkable global progress made in that field. In 1990, an estimated 24% of people worldwide did not have access to clean water, in comparison to 11% in 2012, achieving the target before schedule.  Despite this, 45 countries will still fail to meet those targets, twenty of which are from Africa, again emphasising the considerable disparity between different countries and regions of the world. Moreover, the sanitation target will fail to be met, 2.5 billion people worldwide still without access to adequate facilities, a very modest 7% improvement from the 2.7 billion in 1990.
The final MDG focuses on maintaining strong and functional ties between nations, and admittedly suffers from some of the MDGs’ most poorly defined targets; target 8A is a prime example of this, supposedly aiming to ‘[d]evelop further an open, rule-based, predict- able, non-discriminatory trading and financial system’.
The Organisation for Economic Co-operation and Development (OECD) states that as of 2013, developed countries net ‘official development assistance’ sat at an all-time high of US$134.8 billion, or a combined 0.9% of the developed world’s gross national income. Impressive figures, perhaps, but equally ones that remind us of the MDG’s dependence on foreign aid that can only reach so far. A more enduring change is the significantly decreased debt burden on developing countries; in 2000, 12% of exports from developing nations were external debt payments, in contrast to 3.1% in 2012.
On another positive note, the UN notes that In- ternet access throughout the developing world is rapidly increasing, with two-thirds of the world’s Internet users living in developing regions. An es- timated 20% of Africa’s population are online, as of 2014, up from 10% in 2010. Even still, more than four billion people worldwide are yet to use the Internet, a likely consequence of insufficient access and affordability for many individuals.
2015 and beyond
So the results are in – or at least as much of it as we’re going to get with incomplete data – and the findings are somewhat mixed. The unfortunate reality is that while many nations have made remarkable health and social progress, as we can see, at the opposite end are nations such
as the Democratic Republic of Congo and Côte d’Ivoire, countries that will fail to meet any targets at all. The MDGs may be eight undoubtedly worthwhile targets, but they also fail to address the root causes of poverty and social inequality. Moreover, many of the most heavily affected constituencies lack the political will to strive for such changes, perhaps because it is the louder voices of developed nations that drives dialogue surrounding the MDGs.
Another question that stands is whether or not these positive trends will be able to continue in the face of fluctuating foreign aid, although 2013 marked a rebound from two years of diminishing volumes. The Guardian’s Liz Ford has de- scribed the MDGs as essentially ‘targets for poor countries to achieve, with finance from wealthy states’, while the Center for Global Development called them ‘overly-ambitious goals’ with ‘unrealistic expectations’ on foreign aid. It’s very easy to be a cynic, and maybe understand- ably so; even the UN have acknowledged the ‘gaps and disparities’ between their idealised vision of 2015 and the projected reality. But it hasn’t been failure without measurable progress, and perhaps that is more important than whether or not the UN is aiming too high.
In September of this year, the United Nations will aim to finalise the specifics of the Sustainable Development Goals, the proposed successors to the MDGs. The SDGs will purportedly aim to ‘[b]uild upon commitments already made’ by the MDGs, but with an additional focus on implementing ‘action-oriented’ strategies that support long-term, sustainable development. It’s a topic that cannot possibly be explored in an ad- equate level of detail here, and certainly warrants an essay of its own. Perhaps the SDGs will be able to address the shortcomings of the MDGs’ programs and 2030 will be the year we eliminate inequality for good – or at least we’ll be closer to making that dream a reality. Regardless of the apparent naivety of such ambitious targets, the Millennium Development Goals have been necessary because they provide exactly what its name suggests: a goal that we have to continually keep striving for. We’ve needed the MDGs to continually remind us of the promise we’ve made ourselves and the fact that we are determined to keep it.
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