Accelerating progress towards better public health and sustainable development in fragile settings

Résumé

In 2015, all countries in the world agreed on a framework for sustainable development: the 2030 Agenda. 1 A bold vision of how countries together can achieve sustainable development across three dimensions: environment, economic and social. To make the vision come to life, 17 Sustainable Development Goals (SDGs), 169 targets and 231 unique indicators aligned across the three dimensions were agreed. The SDGs and their targets are directly and indirectly connected. Although these interactions are made explicit in the preamble of the 2030 Agenda, this recognition is not reflected in the formulation of the SDG targets and indicators.2 While the health-related SDG targets, such as child mortality, have continued to show impressive reductions, the world is not on track to meet around half of the SDG targets, and one-third have not shown any improvements or even regressed since 2015.3 Fragile and conflict-affected countries have lagged behind in the progress towards the SDGs. Indeed, many countries are experiencing polycrisis with conflicts, political instability, climate change and the lingering impact of the COVID-19 pandemic, making progress difficult. Fragile and conflict-affected countries will house an increasing proportion of populations who face several overlapping deprivations across the SDGs outside of the traditional public health sphere, from a lack of proper infrastructure development to climate change pressures.4 This is also true for health outcomes, with, for instance, maternal and child mortality being considerably higher in fragile or conflict settings, which also face a larger burden of infectious diseases.5 6 If the world is to live up to the 2030 Agenda of not leaving anyone behind, there is an urgent need to focus efforts on promoting sustainable development in these countries. The cuts in funding from major sources and lack of geopolitical stability over the last months have already been felt in these countries and threaten to significantly undermine or even reverse improvements made. In an increasingly complex landscape of policy priorities at the country level and constrained resources, it becomes ever more relevant to understand how progress in one sector (health or non-health sector) might lead to positive impacts in another.

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