I would like to talk with you today about a topic encompasses much that you may remember about Georgetown from your time there. The University’s focus on the world – a very international focus – and on the individual. In the two sessions I’m offering here today, we’ll talk first about the international issues .. Specifically the Millennium Development Goals. In the second session, I will share with you a few of the ways Georgetown is addressing these goals, using the Jesuit concept of CURA PERSONALIS, or “care for the whole person”. Through it all – the theme will be health. As you can see, I’m in the medical center – I have been there for over two decades as director of the Institute for Reproductive Health. This afternoon I’ll tell you a bit about some of our work in that addresses the MDGs, but for now it may be helpful just for you to know that the Institute is supported primarily by the U.S. Agency for International Development, which funds a large, multi-faceted program that supports integrated development in the world’s poorest countries. We are pleased to be part of that, and will get to that point later.
These are all interrelated. People living in extreme poverty are most likely to have insufficient food, to lack opportunities to go to school, to live in conditions that are harmful to their health and to have inadequate access to health care. At the same time, people who are illiterate are less prepared to protect themselves from disease, are less prepared to benefit from job opportunities, etc. So the MDGs also are interrelated, as we’ll see this morning.
The MDGs were agreed to by 189 nations of the world in September of 2000 in a summit organized by the United Nations. They are few in number – only 8. But the challenge of meeting these goals by the agreed-upon target date of 2015 is enormous. They are complex – in some cases almost intractable. And the world doesn’t stand still. The global economic downturn, increased food prices, civil unrest, storms, etc., take their toll. But at least they represent the firm aspiration of the international community to take specific actions in an effort to create a better world.
In September 2000, 147 heads of State and Government – and 191 nations in total – met here in New York at UN headquarters and after lengthy discussion and debate, adopted the Millennium Declaration. The Declaration outlines peace, security and development concerns and mainstreams a set of inter-connected and mutually reinforcing development goals into a global agenda. As part of the preparation of the Road Map report on the implementation of the Millennium Declaration, discussions were held with the UN, IMF, OECD and the World Bank with a view to develop a comprehensive set of indicators for the Millennium Development Goals (MDGs). [MDG toolkit]
There have been many previous attempts to address international development concerns. “Health for all by the Year 2000” for example. But the MDGs are different in a number of critical ways. With only 8 goals, each with a specific target, and with targets adapted to what can realistically be achieved in each region of the world in just 15 years – from 2000 to 2015 – it makes it possible to measure progress, or lack of progress, along the way and take corrective actions when things are going well. It is easier to communicate these goals to international organizations, governments at all levels, communities – and all this has resulted in unprecedented political commitment and agreement that these are indeed what we need to achieve to make a better world.
MDGs are an important tool of political mobilization. They also provide a useful framework of accountability for national governments, bilateral and multilateral donors, and many other actors that have a role in development such as local NGOs, international NGO networks, women's’ groups, trade unions, private businesses, global corporations, the media, the judiciary ….indeed all of us who are global citizens. [MDG toolkit]
Health-related improvements are arguably central to all 8 development goals. For the sake of time, we won’t address the 8 th goal today. And in looking at goals 1-7, we will focus on the connecting theme of HEALTH. What is it about each of these goals that involves health, health disparities, and within each goal, what are the challenges and strategies for reaching the goal.
Let’s look first just very generally at progress. Indeed, at least until the global economic crisis, we’ve been making significant progress in reducing the percent of the world’s population that live in extreme poverty – often defined as less than $1 a day – to approximately ½ of what it was in 1990. Today, ONLY 1 in 4 people are at the extreme poverty level, though of course that varies considerably by region. Improvements have been made in enrollment in primary education – a critical factor in improving the quality of life of future generations. Again, progress is uneven, and in some regions the percent of girls enrolled in school is significantly lower than the percent of boys – which is an indicator of inequality and has important consequences for girls and their future children. Progress also has been made in infant and child mortality – though again uneven. We will look in more detail at progress on the MDGs and consider the implications for health.
Most of the slides I’ll show you over the next several minutes are coded the same way – so let’s look first at what the bars and colors mean. These bars are for all developing regions, 1990-2002, 2004-2006, and 2008. MDG target is marked by the yellow bar. These bars represent world regions, with lighter blue being 1990-1992, then 2004-2006, and finally 2008. No targets have been met as of 2008. The declining trend in the rate of undernourishment in developing countries since 1990-1992 was reversed in 2008, largely due to escalating food prices. In the developing world, the proportion of children under five years of age who were underweight declined by only five percentage points from 1990 to 2007 — from 31 per cent to 26 per cent. This rate of progress is insufficient to meet the goal of reducing underweight prevalence by half — even without taking into account higher food prices and the economic crisis that developed in the meantime. This target is measured by -Prevalence of underweight children under-five years of age -Proportion of population below minimum level of dietary energy consumption As you can see, it is quite different by region. Sub-saharan Africa has the highest percentage of undernourished people, although it has improved slightly. Southern Asia, including India, has improved – and given the size of the population, that accounts for a significant portion of the reduction of undernourished people. Oceania and East Asia are actually getting worse. Why is this so difficult? And why would a region actually get worse rather than better?
Graph: The number of pupils of the theoretical school age for primary education enrolled either in primary or secondary school, expressed as a percentage of the total population in that age group. Demographic trends can affect achievement of this goal, since population growth usually puts increased pressure on the resources allotted to education. An increase in the share of mothers with a primary or secondary education is associated with a reduction in the child mortality rate, and that educated parents have better nourished children. Education has been shown to have a positive effect on the success of HIV prevention. (fertility decline can improve education and education can improve other health indicators) [MDG Report 2009]
A foundation we have worked with on a health project in northern India is also involved in education. In one of the villages they work in, they were concerned that almost half of the girls did not attend the primary school, even after fees were covered by the foundation. They found that the girls – and their parents – were concerned that there was no appropriate place for the girls to use the bathroom … something simple to fix (particularly by the standards of northern India!), that dramatically increased school enrollment for girls as soon as accommodations were made.
A foundation we have worked with on a health project in northern India is also involved in education. In one of the villages they work in, they were concerned that almost half of the girls did not attend the primary school, even after fees were covered by the foundation. They found that the girls – and their parents – were concerned that there was no appropriate place for the girls to use the bathroom … something simple to fix (particularly by the standards of northern India!), that dramatically increased school enrollment for girls as soon as accommodations were made. UNICEF “big sister” program in Madagascar The UNICEF-supported big-sisters program in Madagascar is another example of a local solution to the problem of girls not attending school. Teachers identify first-grade girls who appear to be most at risk of dropping out – the ‘little sisters’ – and pair them with ‘big sisters’ from the fourth and fifth grades. The older girls sign pledges to support their younger peers. In addition to walking their ‘little sisters’ to school and helping with homework, the ‘big sisters’ advise the younger girls on hygiene and social skills, and work on building their confidence in the classroom. “ There are far fewer drop-outs amongst the little girls of this programme,” says UNICEF Education Officer Noro-Rakoto Joseph. “And even the bigger girls are far more motivated. It gives them a real sense of responsibility because the big girl takes the lead. She has to help the little girl, and it gives her real pride and joy.”
As you can see, Goal 2 is closely related to Goal 3 – promoting gender equality and empowering women. Gaps in education equality are seen most in rural areas and among the poor. This target is measured by -Ratios of girls to boys in primary, secondary and tertiary education -Share of women in wage employment in the non-agricultural sector -Proportion of seats held by women in national parliament [MDG Report 2009]
Intersection of gender equity and health: There is a growing consensus on the broader economic and social gains to be made from promoting the health of women. The World Bank in particular has argued for investment in women’s health as a rational use of resources especially in the poorest communities. In response to these pressures, international organizations and national governments have prepared gender action plans which include health-related objectives. These have focused mainly on reproductive issues but there is a growing acceptance of the need to integrate gender concerns into all aspects of health care. Gender divisions have a direct impact on the health needs of women and affect: -women’s access to care/care-seeking behavior -the quality of health services they receive -political investment in “female” health interventions (i.e. FP, maternity care, etc.) -domestic violence -nutrition (http://www.eurohealth.ie/gender/section3.htm) [MDG Report 2009]
Research shows investing in girls provides the best overall outcome - both for girls as well as the economies of communities and of nations. A girl who has an opportunity to participate will be better educated and have better economic prospects. She'll be healthier, marry later and her future children will be healthier. This is important for a girl and her family, but it also addresses issues like slowing population growth, which has a broad impact on everything from health to climate change to economic viability. Safe Spaces program in Tanzania, Uganda, Bangladesh (part of Girl Effect by Nike) [http://www.brac.net/usa/adolescents.php] BRAC is demonstrating the value of an adolescent girl as an economic actor instead of as a child-bride. They've pioneered a microfinance program in which 40,000 adolescent girls have gained the confidence, skills and capital to run their own businesses and manage their own resources. These entrepreneurs pay their own school fees and often pay their siblings' tuition. They also delay marriage - both because parents begin to recognize it's not the best option and because girls themselves are empowered to decline an illegal marriage (which is any marriage before 18).
For the developing regions as a whole, the under-five mortality rate dropped from 103 in 1990 to 74 in 2007. Still, many countries, particularly in sub-Saharan Africa and Southern Asia, have made little or no progress at all. Why? -Fragile health infrastructure -Lack of trained providers -limited access to appropriate foods, medicines, vaccinations, etc. -Lack of awareness at the community level of the importance of exclusive breastfeeding and weaning practices, clean water, etc. This target is measured by -Under-five mortality rate -Infant mortality rate -Proportion of 1 year-old children immunized against measles
Look at how many of these deaths should be easily preventable with known, available interventions. First – see deaths to children under 5 NOT during the first month of life. Diarrhoea is preventable by feeding the baby nothing but breastmilk, preferably through the first 6 months – conferring appropriate nutrition and protection not only from the bacteria that cause diarrhea but also from other diseases through the natural substances in breastmilk. HIV/AIDS transmission to infants from their mothers can be reduced by primary prevention of HIV/AIDS among women of childbearing age, testing all pregnant women to ascertain their HIV status and treating them with aggressive antiretroviral therapy, especially in the 3 rd trimester of pregnancy if they test positive. Children under 5 are particularly susceptible to malaria and to dying when they contract it – I’ll share with you this afternoon some very interesting progress being made in this area by a researcher at Georgetown. Improvements have been made through promotion of insecticide treated bednets … Vaccinations against measles, prevention and prompt treatment of pneumonia and other upper respiratory infections can also make a difference. Focusing on the significant % of deaths to children under 5 that occur during the first month of life – we see that most of them are associated with delivery. Preterm births, which are more frequent when the mother is very young – especially if she is under 18 – or when pregnancies are too closely spaced. More on this when we look at the next goal. Severe infections, tetanus, and asphyxia are directly related to whether or not the birth is attended by a skilled, trained attendant – not necessarily a doctor or even a nurse, but someone who has been properly trained and has access to clean water and a basic ‘birthing’ kit. For the developing regions as a whole, the under-five mortality rate dropped from 103 in 1990 to 74 in 2007. Still, many countries, particularly in sub-Saharan Africa and Southern Asia, have made little or no progress at all. This target is measured by -Under-five mortality rate -Infant mortality rate -Proportion of 1 year-old children immunized against measles
As you can see, significant progress has been made in reduction of child mortality in all but a few areas – notably sub-saharan Africa and Oceania. What’s holding them back? Poverty, lack of access to food, cultural practices, weak health infrastructure, lack of trained birth attendants. But there are successes as well.
Save the Children’s programs in Ethiopia are of note. Ethiopia has 75 million people, 85% of them living in rural areas, and the majority lack access to health care. 120,000 Ethiopian newborns die every year – mostly from those very preventable causes we saw a moment ago, with the largest percentage being infection, including tetanus. Only 6% of Ethiopian deliveries are with a skilled birth attendant, and most occur at home. Traditional practices include cutting the umbilical cord with a sharp knife, usually unsterilized, and rubbing cow dung and button on the umbilical stump. A campaign to encourage pregnant women to get a tetanus toxoid vaccination, training traditional birth attendants and government health extension workers in safe delivery procedures and how/when to seek higher level care.. Definitely making a difference, and definitely a long way to go. All of this is related, of course, to the MDGs we’ve already discussed – poverty, lack of education, poor nutrition, a low status of women that puts safe motherhood practices fairly low on the priority list.
This goal is one that is of particular interest to me – because of the nature of my work, which I’ll talk more about this afternoon, and because it’s an area in which our progress has been relatively slow, and because the interventions needed to make progress are well known and closely interrelated with other MDGs. Look here at regional disparities in maternal mortality. Again, sub-saharan Africa is the most problematic, but in virtually no developing region are we close to our targets.
Again, a significant portion of these causes can be addressed by improvements in attended births – the same things that kill infants kill their mothers. Infection, obstructed labor, which is related to haemorrhage. Better prenatal care for management of hypertension, better nutrition – all easier said than done.
The use of family planning has improved impressively during the past two decades in many regions. However, the unmet need for family planning is still unacceptably high in low- and middle-income countries. This target is measured by -Contraceptive prevalence rate -Adolescent birth rate -Antenatal care coverage (at least one visit and at least four visits) -Unmet need for family planning
Underlying the challenges to accomplishing this?
Worldwide, the number of people newly infected with HIV peaked in 1996 and has since declined. However, in some regions, especially Eastern Europe and Central Asia, infection rates continue to rise. This target is measured by -HIV prevalence among population aged 15-24 years – this is the most direct indicator, but also one that is difficult to measure. Why? Stigma, discrimination, fear, lack of access to testing … figures are mostly extrapolation from specific populations … such as pregnant women in pre-natal clinics … which can render the figures very questionable. But data from several sources suggests that indeed, other than in Eastern Europe and Central Asia. -
As you know, work continues in the search for a vaccine against HIV. There have been a number of promising starts, but to date, there have been no vaccines that have proven in trials to provide even modest protection against HIV. So the second line of attach is treatment to lower the “viral load”, basically the amount of strength of the virus, amont those who test positive for HIV. Loweriing the viral load does 2 things – it slows the progress of the disease, and it makes those who have it less likely to infect others. There are many issues to be faced in the effort to get everyone who needs treatment on these medications. One is the cost of the medications themselves – they are the result of expensive and extensive research by pharmaceutical companies – but there have been recent successful negotiations that have resulted in generic medications being available for developing countries. But health systems in these countries are often fragile – meaning medications may not be available, health care may not know how to instruct people to take them, and they can be complex to take – although regimens have been much simplified in the current generation of treatment options. As a result, of the approximately 33 million people living with HIV/AIDS, only about 3 million people in the developing world are actually receiving treatment. That too, as you may imagine, is uneven, with people in poor countries, rural areas, less educated people … less likely to receive treatment. Prevention efforts through education, promotion of behaviors that reduce the potential for infection (not having sex with an infected person, using condoms, etc.), voluntary counseling and testing, prevention of mother to child transmission, etc. – continue. The good news is, these efforts are having a positive effect in most of the world – though we stil have a very long way to go and are unlikely to meet the MDG by 2015.
This target is measured by -Incidence and death rates associated with malaria -Proportion of children under 5 sleeping under insecticide-treated bednets -Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs -Incidence, prevalence and death rates associated with tuberculosis -Proportion of tuberculosis cases detected and cured under directly observed treatment short course Again – look at the geographic distribution of these diseases. Subsaharan Africa is always bright red (in the case of malaria) and at the top (in the case of TB). MORE TO COME.
WILL ADD NOTES LATER.
Certainly there are a number of issues associated with environmental sustainability, but the particular focus on the MDG is on safe drinking water and basic sanitation. Unsanitary conditions and a lack of clean drinking water lead to diarrheal disease (one of the most deadly diseases for children under 5) and parasitic infections, including a number that are called “neglected tropical diseases”, such as river blindness, guinea worm, and other diseases that are considered “diseases of poverty” in that they tend to affect the poorest of the poor, causing sickness, disability, compromised physical and mental development, blindness and disfigurement. This target is measured by -Proportion of population using an improved drinking water source -Proportion of population using an improved sanitation facility These two indicators are related, in that people who lack sanitation facilities use the same water source as where they get water for drinking and cooking for bathing, washing, for animals, and they use it as a latrine. You’ll notice that in this area, southern and eastern Asia are not doing particularly well, and even Latin America, which has shown significant progress in other areas, still has a long way to go in this area.
Safe water sources are lacking in many areas, primarily rural areas and urban slums. Building safe, piped in water systems as we have in developed countries would be impossibly expensive and is not anticipated as the solution to safe water. Instead, community water sources from bored wells and water filtration systems that can be used at the household or village level are being promoted. Some households purchase bottled water – usually safer than water from rivers or other contaminated sources – but it is expensive and out of the reach of many.
I hope you’ve found this presentation hopeful – not depressing. Much has been accomplished – when you think of how we’re doing in the world compared to where we were just a few decades ago, we’re much better off. And with the MDGs, we now have a set of agreed-upon, measurable, interrelated intervention that are being addressed by national and local governments and communities, NGOs, international donors, foundations, and others. We almost certainly won’t meet these goals by the target date of 2015, but we’ll be close on some and making progress on others. This afternoon I will be sharing with you some of the work Georgetown faculty are doing to address some of the specific health issues we’ve discussed this morning. I look forward to seeing you.
The Millennium Development Goals and cura personalis: Addressing global health challenges from research to practice
The Third Century of AchievementGeorgetown UNIVERSITY
Session 1The Millennium Development Goals and cura personalis:Addressing global health challenges from research to practice Dr. Victoria Jennings, Professor in the Department of Obstetrics and Gynecology and Director, Institute for Reproductive Health 2
Why the Millennium Development Goals (MDG)?A major portion ofhumanity suffers fromextreme poverty,hunger, illiteracy anddisease. 3
About the MDGs• 8 goals to be achieved by 2015 that respond to the worlds main development challenges• Targets adopted by 189 nations during the UN Millennium Summit in September 2000• International commitment to a blueprint for a better world 4
2000 Millennium Summit• ‘The United Nations Millennium Declaration is a landmark document for a new century …….(we are) initiating a Millennium Campaign to make the commitments better known throughout the world….• As part of this, the United Nations system will work with national governments, civil society, the international financial institutions and other partners to produce a series of regular national reports…to measure and monitor progress towards achieving the MDGs on a country by country basis. Our hope is that, in this age of democracy, annual reporting will force action. …..• It is not at the United Nations, or by the work of the organizations officials, that the goals could be achieved. They have to be achieved in each of its Member States, by the efforts of their Governments and peoples.’ Kofi Annan UN Secretary General
About the MDGsWhat makes the MDGs different from other international goals? • Limited number (8 goals,18 targets, 40 indicators) • Quantitative specific targets • Time bound • Indicators to measure progress • Easy to communicate • Unprecedented political commitment and agreement 6
Premise of the MDGsThey will: • trigger action and foster alliances; • provide a framework of accountability for national governments, international donors, and many other actors that have a role in development.
By 2015 all 191 UN Member States have pledged to:• Goal 1: Eradicate extreme poverty and hunger• Goal 2: Achieve universal primary education• Goal 3: Promote gender equality and empower women• Goal 4: Reduce child mortality• Goal 5: Improve maternal health• Goal 6: Combat HIV/AIDS, malaria and other diseases• Goal 7: Ensure environmental sustainability• Goal 8: Develop a global partnership for development 8
What progress have we made?• From 1990 to 2005, those living in extreme poverty have decreased from ½ to ¼ in the developing regions.• In sub-Saharan Africa and Southern Asia, enrollment in primary education increased by 15 percentage points and 11 percentage points, respectively, from 2000 to 2007.• Since 1990, deaths of children under five declined steadily worldwide from 12.6 million to 9 million. 9
Progress Goal 1: Eradicate extreme poverty and hungerTarget: Halve, between 1990 and 2015, theproportion of people who suffer fromhunger. Proportion of undernourished population, 1990-1992, 2004-2006, 2008 (Percentage) 10
Progress Goal 1: Eradicate extreme poverty and hungerNo Progress or deterioration. Already met the target or very close to meeting the target.Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Initiate breastfeeding within 1 hour of birth• Exclusive breastfeeding for first 6 months• Appropriate complementary feeding from 6m with continued breastfeeding up to 2y• Develop policies and norms that encourage delayed marriage• Improve programs to encourage healthy timing and spacing of pregnancies• Strengthen social policies that address negative effects of high food prices 12
Progress Goal 2:Achieve universal primary educationTarget: Ensure that, by 2015, children everywhere, boys andgirls alike, will be able to complete a full course of primaryschooling Adjusted net enrolment ratio in primary education, 1999/2000 and 2006/2007 (Percentage) 13
Progress Goal 2:Achieve universal primary education No Progress or deterioration. Already met the target or very close to meeting the target. Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Increase investment in education• Improve local capacity of teachers• Improve access by eliminating school fees, constructing schools in underserved areas, and encouraging recruitment of teachers• Ensure that girls have equal access 14
Progress Goal 3:Promote gender equality and empower womenTarget: Eliminategender disparity inprimary and secondaryeducation by 2005, andin all levels of educationno later than 2015 16
Progress Goal 3:Promote gender equality and empower women 17
Progress Goal 3:Promote gender equality and empower women No Progress or deterioration. Already met the target or very close to meeting the target. Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Increase primary school enrolment and completion for girls• Adopt and enforce laws promoting women’s rights,protection from violence/abuse, employment, political engagement• Ensure that health services are accessible to women and address their needs 18
Progress Goal 3:Promote gender equality and empower womenBRAC creates “safe spaces” for adolescents VideoBRAC 19
Progress Goal 4: Reduce child mortalityTarget: Reduce by 2/3, between 1990and 2015, the under-5 mortality rate Under-5 mortality rate per 1,000 live births, 1990 and 2007 20
Progress Goal 4: Reduce child mortality Causes of death for children under-5 Causes of death for infants in the first 28 daysUNICEF Progress for Children 2007 21
Progress Goal 4: Reduce child mortalityNo Progress or deterioration. Already met the target or very close to meeting the target.Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist. How can progress be made? • Exclusive breastfeeding to 6 months • Appropriate nutrition with Vitamin A supplementation • Use of insecticide-treated bed nets • Immunizations • Skilled birth attendants 22
Progress Goal 4: Reduce child mortalityImproving Newborn Health in Ethiopia Save the Children, Guy Calaf BBC News BBC News 23
Progress Goal 5: Improve maternal healthTarget: Reduce by 3/4, between 1990 and 2015, the maternal mortality ratio Maternal deaths per 100,000 live births, 1990 and 2005 24
Progress Goal 5:Improve maternal health Causes of maternal deaths UNICEF Progress for Children 2007 25
Progress Goal 5: Improve maternal healthTarget: Achieve, by 2015, universal access to reproductive health Percentage of women aged 15-49 married or in union using any method of contraception UNICEF Progress for Children 2007 26
Progress Goal 5: Improve maternal health No Progress or deterioration. Already met the target or very close to meeting the target. Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Reduce adolescent pregnancy• Increase access to safe, effective and acceptable family planning• Emphasis on healthy timing and spacing of pregnancies• Increase access to prenatal care• Increase attendance at birth by a skilled professional• Improve access to emergency obstetric care 27
Progress Goal 6: Combat HIV/AIDS, malaria and other diseases Target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS Number of people living with HIV, number of people newly infected with HIV and number of AIDS deaths in the world (Millions), 28BBC World News
Progress Goal 6: Combat HIV/AIDS, malaria and other diseasesTarget: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it Number of people receiving antiretroviral drugs in low- and middle income countries, 2002−2007 3.0 Millions 2.8 North Africa and the Middle East 2.6 2.4 Eastern Europe and Central Asia 2.2 2.0 East, South and South-East Asia 1.8 1.6 Latin America and the Caribbean 1.4 1.2 Sub-Saharan Africa 1.0 0.8 0.6 0.4 0.2 0.0 2002 2003 2004 2005 2006 2007 Year Source: Data provided by UNAIDS & WHO, 2008. 29
Progress Goal 6: Combat HIV/AIDS, malaria and other diseases Target: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Estimated incidence of clinical malaria episodes, 2005 Number of new tuberculosis cases per 100,000 population (excluding people that are HIV- positive),1990-2007World Malaria Report 2005 30
Progress Goal 6: Combat HIV/AIDS, malaria and other diseases No Progress or deterioration. Already met the target or very close to meeting the target. Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Access to pharmaceuticals which treat AIDS, malaria and TB• Gender-sensitive and age-appropriate information on preventing HIV• Care for orphans and vulnerable children• Insecticide-treated bed nets 31
Progress Goal 7: Ensure Environmental SustainabilityTarget: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation Left: Population that gained access to an improved sanitation facility 1990-2006 (Millions) Right: Population that needs to gain access to an improved sanitation facility to meet the MDG target, 2006-2015 (Millions) 32
Progress Goal 7: Ensure Environmental Sustainability No Progress or deterioration. Already met the target or very close to meeting the target. Progress insufficient to reach the target if prevailing trends persist. Progress sufficient to reach the target if prevailing trends persist.How can progress be made?• Increase access to latrines and safe water sources• Improve knowledge and practice of good hygiene 33
Where is progress still needed?• Providing productive and decent employment for all, including women and young people• Addressing hunger, especially in the interests of our youngest citizens• Eliminating inequalities in education based on gender and ethnicity, and among linguistic and religious minorities• Reducing maternal mortality• Improving sanitation, including living conditions of people in rural areas and the urban poor 34