Development goals in the post-2015 world: Whither Canada?
Labonte, Ronald
In 2000 the world's nations committed themselves to eight
Millennium Development Goals (MDGs). Progress has been mixed and not
without controversy, including the lack of ambition with regard to the
extreme poverty goal, the poor quality of data used to measure many of
the targets and the lack of an equity analysis in countries'
achievement of the targets (see Table 1). Although goals 4, 5 and 6 are
generally considered the "health goals", most of the others
exert a powerful influence on the social determinants of health. Slow
progress on goals 4 and 5 led to Canada's leadership on the Muskoka
Initiative on Maternal, Newborn and Child Health, announced during the
2010 G8 summit.
The MDGs expire in 2015, and the past few years have been spent on
numerous intergovernmental, international, Internet and non-governmental
initiatives to define what should be the next set of global development
goals. The starting point for these initiatives is to complete the
unfinished 2000 MDG agenda, but there are efforts to incorporate a more
ambitious and relevant set of development goals. Canada's
North-South Institute has been tracking these post-2015 debates,
enumerating 77 different goal proposals from civil society groups and
international organizations. (4) The objective of this commentary is to
familiarize the Canadian public health community with the state of play
on the post-2015 agenda and the implications for greater global health
equity. It first reviews the positioning of health within two of the key
initiatives (referred to as the Sustainable Development Solutions
Network, or SDSN, and the United Nations [UN] High Level Panel, or HLP),
whose differing goal lists are expected to converge into a final set to
be adopted by UN member states some time later this year. The commentary
then discusses some of the shortcomings of the goals, drawing on the
North-South Institute's monitoring of the less official proposals.
The commentary concludes with a short assessment of how Canada could, or
should, position itself in the post-2015 agenda setting.
Sustainable Development Solutions Network
The SDSN, an international group of researchers reporting to the UN
Secretary-General, engaged in broad consultation in developing its list
of 10 sustainable development goals, most of which are to be achieved by
20 305 (see Table 2). It calls for an elimination of extreme poverty and
hunger, an increase in aggregate national income and a reduction by half
of households living below half the national median income (relative
poverty). It adds early childhood development programs to the MDG
education goal, aspires to a low rate of youth unemployment and aims to
curb violence, especially against women and children. It also calls on
governments to manage their economies so as to live within environmental
limits, end forest and wetland conversion to agriculture (e.g.,
biofuels) and cap greenhouse gas emissions by 2020, with a commitment to
de-carbonize energy. As with the earlier MDGs, these goals address
important determinants of health. The one specific health goal calls for
universal health coverage, with targets for reduction of child,
maternal, infectious and non-communicable disease mortality (thereby
consolidating all of the MDG 2000 health goals into a single one), and
promotion of healthier behaviours (which could be problematic unless
other goals addressing the required resources for people to choose
healthier behaviours are also provided).
UN High Level Panel
The parallel UN High Level Panel comprised 26 "eminent
persons" representing government, the private sector, academia and
civil society. (6) The Panel generated 12 goals, including an end to
extreme poverty and hunger, greater gender rights, better food security
and nutrition, universal access to water and sanitation, and greater
employment opportunities. Many of its goals, although lacking final
target numbers, are more precisely stated than those of the SDSN and
more closely resemble a continuation in style of the MDGs. Many are less
ambitious than the goals developed by the SDSN, particularly those for
environmental, climate change and fossil fuel targets. This may make
them more acceptable to a broader number of UN member nations when time
for a final choice comes about. The health goal calls for an end to
preventable infant and under-5 deaths, and references "priority
non-communicable diseases" but does not mention universal health
coverage.
A big improvement, but ...
Both sets of goals, however they eventually combine, are much
improved over their 2000 millennium predecessors by dint of the range of
complex social determinants of health that they identify, but there are
weaknesses. The post-2015 poverty goal (based on $1.25/day in purchase
power parity) is still much less ambitious than it needs to be. UNCTAD
(the United Nations Committee on Trade and Development) argues that
$5/day in purchase power parity should be considered the minimum for any
modestly comfortable existence. By this metric, in 2030 4% would still
be poor in Europe and Central Asia, 15% in Latin America and the
Caribbean, 30% in East Asia and the Pacific, 50% in the Middle East and
North Africa, and 90% in South Asia and sub-Saharan Africa. (7) Given
the population of South Asia and sub-Saharan Africa, these are sobering
estimates. UNCTAD, along with many civil society organizations and
academics, have urged an "inequality" goal or target to reduce
income and wealth inequalities that have skyrocketed over the past two
decades, rather than a goal based merely on poverty reduction. The
relative poverty target in the SDSN and HLP go part of the distance, but
not far enough.
Another missing piece is social security, provisions for which have
taken a beating in the austerity agenda subsequent to the financial
crisis and recession. By the end of 2015, some 90% of the world's
population (6.3 billion people) are expected to be living under the
contractionary policies of austerity. (8) The International Labor
Organization has been leading a global movement to ensure that there is
a "social protection floor" for all nations, and achieving
social security is one of the most frequently cited issues for those
groups commenting on the post-2015 goals.
There are other limitations. The SDSN, for example, leaves many of
its targets with an asterisk, noting that how these are finally
determined will be up to individual nations. The HLP identifies many of
its targets as candidates for minimum global standards, but most of
these are as yet not fully established or require "further
technical work". More important, as good as both goal sets are in
intent there is little operational guidance offered in how to achieve
them. What methods should be chosen to achieve them may be seen as the
sovereign right of individual nations to determine, yet many of the
goals address inherently global issues (environment, conflict/violence,
employment, poverty). Furthermore, both sets of goals discuss the
importance of establishing some system of global finance (the 0.7% of
gross national income [GNI] target for development assistance, funding
to help developing countries deal with climate change). What is
important is how we move on these goals, which requires an analysis of
why we have these problems in the first place. As an analysis by the
People's Health Movement, an international network of health
activists, points out, none of the models for post-2015 priorities
questions, much less challenges, the prevailing neoliberal paradigm of
economic growth. (9) Instead, there is an assumption that growth can
accommodate environmental limits, with little evidence that it has done
so over the past several decades.
This lack of structural economic and environmental
contextualization is apparent in the targets for global governance. The
MDG global partnership target calling for more trade and investment
liberalization has been somewhat nuanced. The HLP accepts the
conventional argument that "increased trade and access to markets
brings more equitable growth" (6) (p.54) (which is not always the
case), but calls for it to be fairer (whatever that might mean). The
SDSN goes further, urging that rules for "international trade,
finance, taxation, business accounting, and intellectual property are
reformed to be consistent with and support achieving" its list of
sustainable development goals (5) (p. 31). But as the fine details of
this target get worked on, the more powerful countries in the world
continue to push for trade and investment treaties that veer in exactly
the opposite direction. An economy that lives within ecological means, a
global economy that fulfills a social purpose and a financial economy
that is back under capital controls remain the three most pressing goals
now, for the near future. None will be accomplished without systemic
forms of market regulation and resource redistribution.
Whither Canada?
One small means of resource redistribution that the SDSN and HLP
both reiterate (for the 43rd time since it was first promised back in
1970) is achieving the 0.7% of GNI target for development assistance.
Canada here is losing ground already, freezing the level of our
disbursements, restricting contributions to a smaller number of
countries and scoring poorly on the transaction costs of what we do
provide. (10) In 2012/2013, around 10% of Canada's reduced aid
funding was "lapsed" (unspent) and returned to general
revenue, what one commentator calls "budget cuts by stealth".
(11) Canada also shifted its focus from long-standing partnerships in
Africa (where the need is still greatest) to Latin America, where
Canadian companies stand to gain economically. An example of this is a
doubling of aid to Peru in 2012, an upper middle-income country but with
strong Canadian mining interests. Most of Canada's aid to Peru in
2012 and 2013 focused on the private mining sector in promoting local
development, although critics contend that this has more to do with
reducing opposition to the well-documented environmental externalities
of open-pit mining than improving local democracy or health. (12)
While Canada has untied its aid and is contributing more of it
through multilateral agencies (a good thing), linking aid priorities to
foreign trade interests is more controversial. Canada is not alone in
emphasizing "trade not aid" in its development rhetoric.
Ever-larger sums of official development assistance are now being
allocated to "aid for trade" on the assumption that increased
trade inevitably leads to development and trickle-down health. But this
then requires that the rules of trade treaties that Canada negotiates
should provide disproportionate benefits to poorer, aid-recipient
countries. This is not currently the case. This lack of foreign policy
coherence has particular relevance for control of non-communicable
diseases, in that trade and investment treaties are posing risks to
public health regulation. (13)
Environment is the top-rated concern for civil society and
international organizations involved in the post-2015 goal debate. It is
also particularly prominent in the SDSN and less so, but still central
to, the HLP goals. Many developing countries have some concern that they
will be expected to restrain their economic development to sustain the
environment, even as the rich nations continue in their exploitation of
fossil fuels (think shale gas and fracking). Canada scores particularly
poorly on this account, with our exceptional exit in 2011 from the Kyoto
Protocol to the United Nations Framework Convention on Climate Change.
If the post-2015 goals achieve their stated intent of applying to all
countries, and developing countries' anger at rich nations reneging
on their climate change commitments continues to increase, Canada may be
forced back into accountable commitments to a greener future.
Health is the second-ranked concern of civil society and
international organizations, followed by education and
employment/inclusive growth (where social security holds prominence as a
concern). Several of the SDSN and HLP goals deal with key health
determinants, albeit imperfectly. The World Health Organization (WHO)
for its part is calling for completion of the 2000 health MDGs'
unfinished agenda, but it is most keen on a post-2015 health goal of
universal health coverage, which it defines as "ensuring ... health
services ... of sufficient quality to be effective, while also ensuring
that the use of these services does not expose the user to financial
hardship." (14) This sounds reasonable but avoids the contentious
issue of the relationship between public and private sectors in health
care financing and provision. With private insurers and providers eager
to claim a larger piece of the annual $6.5 trillion health care
"market", the risk is that the costly public/private model
dominant in the US will come to define the global default position.
This is a debate in which Canada could play a more aggressive and
healthy role, by elaborating its own experience with a universal,
single-payer, mixed provider system. Canada's system is far from
perfect, with problems of wait times, coverage gaps, inefficiencies and
encroaching privatization. Compared with the US system and the dual
public/private models still dominating Latin America, however, these
imperfections pale to insignificance.
Canada and the aid/trade agenda
Whatever shape the post-2015 development goals take, there are
foreign policy positions that all governments could begin to consider,
especially for goals related to the global economy and global governance
targets. With respect to the aid/trade agenda, for example, Canada could
support much stronger general health exceptions in trade treaties,
starting with the detailed texts of the "agreed in principle"
Comprehensive Economic and Trade Agreement with the European Union and
the still to be completed 12-nation Trans Pacific Partnership Agreement
(TPPA). Another approach would be to ensure that trade and investment
treaties include a provision requiring deference to WHO soft law (e.g.,
the Framework Convention on Tobacco Control) or World Health Assembly
approved global action plans (e.g., on noncommunicable diseases)
whenever a public health policy or regulation is subject to a dispute.
Canada is unlikely to lead in such an initiative. The only new foreign
policy the current government has announced is a "sea change in the
way Canada's diplomatic assets are deployed around the world"
such that all are "harnessed to support the commercial success by
Canadian companies". (15) But it could support initiatives in this
direction when advanced by other trade negotiating partners. Canada has
also been opposing almost every effort by the US to extend patent
protection in the TPPA beyond provisions in the World Trade
Organization's TRIPS (Trade-Related Aspects of Intellectual
Property Rights) Agreement (16) and has used public health arguments to
defend its ban on certain tobacco flavourings in committee meetings at
the World Trade Organization. (17) So there may be some room for a
stronger global public health presence in Canadian trade policy to guide
how the post-2015 goals on trade are implemented.
Canada and the global tax agenda
Aid will continue to be necessary for many low-income countries,
especially in sub-Saharan Africa, where taxation reforms are still years
away from being effectively developed. But aid is no substitute for
domestic economic empowerment. Progressive taxation is fundamental to
that empowerment, and to responsible state building and the social
contract between well-functioning states and their citizens. Many
African countries have been improving their revenue systems, but their
tax rates are still too low to be adequate and still inefficient and
full of exemptions for imports, investors and transnational profits. Why
not aid for progressive taxation reforms rather than (or at least in
addition to) aid for trade? Since Canada has become the Western
world's global mining giant as a result of the domestic tax breaks
we give to mining companies, (18) we also have a potential role to play
in supporting developing countries in their efforts to increase their
low royalty rates, which were largely imposed during structural
adjustment programs in the 1980s and 1990s. Although the current
government is on record as being opposed to a financial transaction tax
(previously known as a "Tobin tax" and initially proposed to
slow down speculative and economically harmful capital flows), 40
countries already have such a tax, and 63 nations support implementing
one globally. At a low rate of 0.05% such a tax would raise over USD 8.6
trillion annually, (19) funding that could be used for global
development, climate change mitigation and "bailouts" for
those who lost employment and homes as a result of the 2008 financial
crisis.
Canada could also take an assertive role in the most recent G20
promise to develop a more transparent international tax identification
system, so that taxes are paid where production profits are earned,
avoiding the toxic practice of transfer pricing through tax haven
countries. (20) In doing so it might also begin to stem illicit capital
flows, especially from Africa, which in the past 40 years topped $1.4
trillion, much of it the result of transnational corporate practices and
more than all of the aid and debt cancellation funds that went to the
continent over the same period. (21)
Actions towards economic and taxation reforms by Canada in the
post-2015 agenda would begin to move us away from a charity model of
intermittent, donor-driven aid to a structural model of global social
solidarity and equitable economic empowerment (see Table 3). Whether we
move in that direction could, and should, be part of next year's
serendipitously timed 2015 federal election campaign.
Received: December 12, 2013
Accepted: May 20, 2014
REFERENCES
(1.) United Nations. Millennium development goals fact sheets.
Geneva and New York: United Nations Publications, 2013. Available at:
http://www.un.org/millenniumgoals/ (Accessed February 18, 2014).
(2.) Labonte R. The austerity agenda: How did we get there and
where do we go next? Critical Public Health 2012;22(3):257-65.
(3.) Labonte R, Ruckert A. The global financial crisis and health
equity: Toward a conceptual framework. Critical Public Health
2012;22(3):267-79.
(4.) Higgins K, Bond R, Kindornay S. Measuring progress post-2015:
An assessment of proposals. Ottawa, ON: The North-South Institute, 2014.
(5.) Sustainable Development Solutions Network. An Action Agenda
for Sustainable Development: Report for the UN Secretary-General. New
York and Geneva: United Nations Publications, 2014.
(6.) High Level Panel on the Post-2015 Development Agenda. A New
Global Partnership: Eradicate Poverty and Transform Economies through
Sustainable Development. New York and Geneva: United Nations
Publications, 2013.
(7.) United Nations Conference on Trade and Development. Growth and
Poverty Eradication: Why Addressing Inequality Matters. New York and
Geneva: United Nations Publications, 2013.
(8.) Ortiz I, Cummins M. The age of austerity: A review of public
expenditures and adjustment measures in 181 Countries. Geneva: South
Centre, 2013.
(9.) People's Health Movement. Health in the post-2015
development agenda. 2012. Available at: http://www.phmovement.org/sites/
www.phmovement.org/files/PHM%20statement%20submitted%20to%20th
e%20WHO.pdf (Accessed December 3, 2013).
(10.) Center for Global Development. Quality of official
development assistance. Available at:
http://www.cgdev.org/page/quality-oda-quoda (Accessed December 3, 2013).
(11.) Montador B. Why is Ottawa accelerating its international aid
budget cuts by stealth? Ottawa: Centre for International Policy Studies,
2014.
(12.) Coumans C. CIDA's partnership with mining companies
fails to acknowledge and address the role of mining in the creation of
development deficits. Ottawa: MiningWatch Canada, 2012. Available at:
http://www.miningwatch.ca/sites/www.miningwatch.ca/files/Mining_and_
Development_FAAE_2012.pdf (Accessed March 5, 2014).
(13.) Friel S, Gleeson D, Thow A-M, Labonte R, Stuckler D, Kay A,
Snowdown W. A new generation of trade policy: Potential risks to
diet-related health from the trans- Pacific Partnership Agreement.
Globalization Health 2013;9(46): 1-7.
(14.) World Health Organization. Health financing for universal
coverage. World Health Organization, 2013. Available at:
http://www.who.int/ health_financing/en/ (Accessed December 3, 2013).
(15.) Department of Foreign Affairs, Trade and Development. Global
Markets Action Plan: The Blueprint for Creating Jobs and Opportunities
for Canadians Through Trade. Ottawa: Government of Canada, 2013.
(16.) Labonte R. Canada must hold firm in opposing US efforts to
expand intellectual property rights. Ottawa: Centre for International
Policy Studies Blog, 2013. Available at:
http://cips.uottawa.ca/canada-must-hold-firm-inopposing-us-efforts-to-expand-intellectual- property-rights/ (Accessed December 3, 2013).
(17.) Drope J, Lencucha R. Evolving norms at the intersection of
health and trade. J Health PolitPolic (in press).
(18.) Denault A, Sacher W. Imperial Canada Inc. Legal Haven of
Choice for the World's Mining Industries. Vancouver, BC:
Talonbooks, 2012.
(19.) McCulloch N, Pacillo G. The Tobin tax: A review of the
evidence. Brighton, UK: Institute of Development Studies, 2011.
(20.) BBC News. G20 to share tax information by 2015. September 6,
2013. Available at: http://www.bbc.co.uk/news/business-23994488
(Accessed December 3, 2013).
(21.) African Development Bank and Global Financial Integrity.
Illicit Financial Flows and the Problem of Net Resource Transfers from
Africa: 1980-2009. Tunisia and Washington: African Development Bank and
Global Financial Integrity, 2013.
Ronald Labonte
Author's Affiliation
Canada Research Chair, Globalization/Health Equity, Professor,
Faculty of Medicine, Institute of Population Health, Ottawa, ON
Correspondence: Ronald Labonte, Faculty of Medicine, Institute of
Population Health, 1 Stewart St, Ottawa, ON K1N 6N5, Tel: 613-562-5800,
ext. 2288, E-mail:
[email protected]
Conflict of Interest: None to declare.
Table 1. Mixed progress on the Millennium Development Goals1-3
Goal Comment
1. Eradicate The goal of halving the proportion living in
extreme poverty extreme poverty has been reached, although the
and hunger number in the world living in precarious and
still poor conditions has increased. The hunger
goal is within reach. A target associated with
achieving full employment has been derailed by
the financial crisis, which has led to the
highest ever recorded number of global
unemployed.
2. Ensure by 2015 Global primary school enrolment stands at 90%,
all children but 250 million leave primary school illiterate,
are able to early school leaving remains persistent, and
complete gender inequities have not been eliminated.
primary
schooling
3. Promote gender Gender disparity in primary and secondary
equality and education, the key target, has narrowed but
empower women persists. More women now work but often in
insecure, poorly paid and hazardous conditions.
4. Reduce child Under-5 mortality has dropped by almost 50% but
mortality is below the two thirds decline set by the goal.
5. Improve Maternal mortality has dropped by almost 50% but
maternal is below the three quarters decline set by the
mortality goal. Over half of women do not receive the
and universal minimum four antenatal visits.
access to
reproductive
health care
6. Combat HIV/ HIV incidence is declining in most regions,
AIDS, malaria malaria deaths have fallen by 26% and the TB
and other mortality rate by 41%. Concern exists with post-
diseases financial crisis declines in development aid for
these diseases, a rise in extensively drug-
resistant strains of TB and the failure of the
goal to address non-communicable diseases.
7. Ensure Progress on sanitation has been made but is one
environmental third below the target; the target of improving
sustainability dwellings and water/sanitation access for slum
dwellers was achieved but was set at only 100
million people, whereas just shy of a billion
people live in slums; biodiversity loss has
increased rather than reversed; and greenhouse
gas emissions continue to rise rather than
decline.
8. Develop a Trade and investment liberalization has expanded,
global although the benefits remain inequitably shared
partnership and the liberalized financial system created the
for development financial crisis and subsequent recession;
development assistance increased annually until
the financial crisis and fell in real terms in
2011 and 2012; essential drugs have become more
affordable, but new trade treaties continue to
erode the progress made on the rights of
countries to access lower-cost generic medicines.
Table 2. Some progress on post-2015 Millennium Development Goals (5)
SDSN goals HLP goals Comment
End extreme poverty End poverty By 2030 many will
including hunger still be living in
not-quite-extreme
poverty, with only
minimal social
protection.
Achieve development Manage natural SDSN includes a
within planetary resource assets target for reducing
means sustainably population growth.
Ensure effective Provide quality SDSN adds early
learning for all education and child development
lifelong learning programs, HLP
includes pre primary
education and adds
learning outcomes,
not just access.
Achieve gender Empower girls and SDSN includes a
equality, social women and achieve relative poverty
inclusion and human gender equality measure for social
rights inclusion; neither
SDSN nor HLP
includes sexual
orientation in its
list of goals to end
discrimination.
Achieve health and Ensure healthy lives Both continue
wellbeing at all targets for maternal
ages child health from
the MDGs and
reference non-
communicable
diseases; neither
refers to universal
health coverage.
Improve agricultural Ensure food security SDSN emphasizes
systems and raise and good nutrition agriculture and
rural prosperity rural livelihoods
more generally, HLP
focuses on hunger,
nutrition and food
security.
Empower inclusive, Achieve universal SDSN includes
productive and access to water and employment targets
resilient cities sanitation and improved living
standards in slums;
both include targets
for water and
sanitation access
and water
conservation.
Curb human-induced Secure sustainable SDSN calls for
climate change and energy "pricing greenhouse
ensure sustainable gas emissions"
energy (carbon tax) and de-
carbonizing the
economy; HLP is less
ambitious with the
goal of doubling
renewable energy and
ending fossil fuel
subsidies.
Secure ecosystem Manage natural SDSN calls for
services and resource assets "polluter pay"
biodiversity, good sustainably (including
management of water government pay) for
and natural th< social cost of
resources pollution and use of
environmental
services.
Transform governance Ensure good SDSN calls for
and sustainable governance and trade, finance,
development effective taxation, business
institutions accounting and
intellectual
property rules to be
reformed to be
consistent with
sustainable
development goals;
HLP emphasizes civil
and political
rights.
Ensure stable and HLP targets a
peaceful societies reduction in
violence, similar
targets embedded in
other SDSN goals.
Create a global HLP target for trade
enabling environment is less precise and
and catalyze long- ambitious than
term finance SDSN's but does call
for an end to
illicit (capital)
flows and tax
evasion and for the
0.7% target of GNI
for development;
this is also
embedded in other
SDSN goals, although
neither references
financial
transaction taxes as
a development
financing strategy.
Recent minor revisions to the sustainable development goals have been
made; an up-to-date list can be found here:
http://sustainabledevelopment.un.org/content/documents/
3686WorkingDoc_0205_additionalsupporters.pdf
SDSN=Sustainable Development Solutions Network; HLP=High Level Panel;
MDG=Millennium Development Goals.
Table 3. Canada in a post-2015 agenda
* Strengthen our commitments to maternal/child health.
* Promote our publicly funded universal health system as an important
model for expanding universal health coverage.
* Ensure that health concerns (present and future) are fully protected
in trade and investment treaties.
* Aid for trade--if trade treaties actually disproportionately benefit
poorer people and countries.
* Aid for tax reform--to build the transparent and progressive tax
systems developing countries need to establish effective states and
mobilize domestic revenues for health.
* Join and promote global systems of taxation to foster global
development (including the post-2015 goals) and climate change
mitigation.
* Work with the G20 to reform global taxation systems in order to
prevent tax evasion and illicit capital flight.
* Work with developing countries to improve their royalties on
extractive industries, notably mining.
