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Millennium Development Goals Mask More Serious Health Challenges

The UN just hosted a pledging session for its Millennium Development Goals (MDGs). Of the eight goals, two are for reductions in infant mortality, and maternal and child health rates. An expected refrain from the shortfall in progress toward stated objectives by 2015 is a lack of financial resources. Have donor funds been insufficient; how much of the progress made can be attributed to the MDGs; and what diseases are being ignored?

In April, a research paper published by the University of Washington, funded through the Gates Foundation, found that development aid for health jumped from $8 billion in 1995 to $19 billion in 2006. It also found that health aid to government had a negative effect on domestic government spending, such that for every $1 of health aid to government, government health expenditures from domestic sources were reduced by 0.43 cents.

During the period 2004–2008, Hudson Institute’s “Index of Global Philanthropy and Remittances” documented the contrast between U. S. Official Development Assistance (ODA) and non-governmental resource flows to the developing world via foundations, corporations, religious organizations, etc. The five-year total by 2008 for ODA was $119.4 billion, while non-governmental resource flows were $729.4 billion. In 2004, ODA was 20% of the total, declining to 14% in 2008.

What is the cost of implementing MDGs?  In 2005, an Organization for Economic Co-operation and Development (OECD) report detailed the cost of technical experts hired by the government of the UK to work in three countries. In Tanzania, the average cost was $187,000 per annum; in Jamaica, $200,300; in Bangladesh, $173,600. These costs did not include benefits or overhead, which would have increased each by at least $90,000.

ActionAid, an international charity, conducted a study on consultant wages, calculating that the cost of 740 international advisors in Cambodia exceeded the combined wages of 166,000 civil servants.

Planners for the MDG pledging session are concerned that rich countries are using the global recession as a justification to lower their ODA commitments. Yet this has been going on well before the crisis. In 2005, debt cancellation accounted for more than 20% of ODA from Austria, Germany, Italy, the UK, France, Japan, and Spain, and nearly 70% of Portugal’s ODA in 2004 came from writing off bad loans. Donor countries count the loans and inflated interest, often going back 30 years, as part of their ODA, though there is no real cash transfer to developing countries.

The Gates Foundation-funded research paper found that, on debt forgiveness, it had no detectable effect on governments’ domestic health spending. They were supposed to have increased their health and education budgets by an amount equal to that which was forgiven.

In April, an article in The Lancet documented the fact that maternal mortality had declined from 528,300 in 1980 to 347,900 in 2008. The editor reported that various UN-affiliated groups had called him, asking that the article be delayed: their numbers were much higher than what The Lancet was reporting. The callers thought publication would harm their chances of raising more funds from donors. The editor refused.

In October 2008, UNICEF reported that infant deaths had declined from 20 million annually in 1960 to 9.7 million in 2006. It credited this fall to immunizations and economic development.

A nation’s most vital health indicator is its infant mortality rate, followed by maternal mortality. Both rates began falling well before initiation of the MDGs in 2000 — despite rising population growth rates.

In a September New England Journal of Medicine article, authors reported that non-communicable diseases are among the most severe threats to global economic development. It is projected that in the next ten years, China and India will lose $558 billion and $237 billion, respectively, in national income as a result of chronic diseases.

WHO states that this disease burden will fall heaviest within developing countries. Researchers at Columbia University determined that in Brazil, the number of heart disease deaths in women aged 15-34 is twice that from pregnancy-related causes. This pattern applies in China where there are 61% more heart disease deaths in women aged 15-34 than deaths from maternal conditions. In subsequent decades, three times as many women will die from heart disease as from maternal conditions in the previous decade.

Facts are stubborn things. Fixating on MDG health targets which largely have been met ignores the adult population, the productive sector of any economy. Declines in their health through disease or disability lead to reductions in national development. Adult ill-health is an unfunded liability in a gathering storm, one that will eventually push a tsunami of costly chronic diseases onto the shores of a fragile developing world.

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