Global Health Action

REVIEW ARTICLE

The Millennium Development Goals: experiences,

achievements and whats next
Marta Lomazzi1,2*, Bettina Borisch1,2 and Ulrich Laaser1,3
1
World Federation of Public Health Associations, c/o IGH/CMU, University of Geneva, Geneva,
Switzerland; 2Institute of Global Health, University of Geneva, Geneva, Switzerland; 3Faculty of Health
Sciences, University of Bielefeld, Bielefeld, Germany

The Millennium Development Goals (MDGs) are eight international development goals to be achieved
by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender
inequality, environmental damage and the global partnership. Most activities worldwide have focused on
maternal and child health and communicable diseases, while less attention has been paid to environmental
sustainability and the development of a global partnership. Up to now, several targets have been at least
partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200
million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished
and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due
to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015
agenda is now under discussion. The new targets, whatever they will be called, should reflect todays political
situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach
should be adopted.
Keywords: Millennium Development Goals; sustainable development; equity; education; accountability; governments;
post-2015 agenda

*Correspondence to: Marta Lomazzi, World Federation of Public Health Associations & Institute of Global
Health, University of Geneva, rue Michel Servet 1, CH-1211 Geneva, Switzerland, Email: marta.lomazzi@
unige.ch

This paper is part of the Special Issue Facets of Global Health: Globalisation, Equity, Impact, and Action.
More papers from this issue can be found at http://www.globalhealthaction.net.

Received: 5 September 2013; Revised: 28 November 2013; Accepted: 18 December 2013; Published: 13 February 2014

he Millennium Development Goals (MDGs) are empowering women enables not only better conditions for

T the most widely supported and comprehensive

development goals the world has ever established.
These eight goals and 18 targets provide a concrete
women but also improved household management leading
to better health and education for children and to higher
income for the family.
framework for tackling poverty, hunger, maternal and The MDGs find their origins in development ideas and
child mortality, communicable disease, education, gender campaigns of the 1980s and 1990s; they were officially
inequality, environmental damage and the global partner- established following the Millennium Summit of the
ship for development (1) (Table 1). United Nations in 2000, as an output of the United
These targets are both global and local, adapted to each Nations Millennium Declaration (3). All 189 United
country to meet specific needs. They provide a framework Nations member states agreed to achieve these goals on a
for the whole international community to work together voluntary basis by the year 2015. New global health
towards a common goal. If these goals are achieved, world initiatives (such as the Global Fund, the World Bank, the
poverty will be reduced by half, millions of lives will be GAVI Alliance, etc.) and increased financial resources
saved, and billions of people will benefit from the global have advanced the opportunity to deliver MDG-related
economy in a more sustainable environment (2). Further- health programmes worldwide (4).
more, the MDGs are inter-dependent and largely influence From 2000 on, important high-level meetings and
each other. For example, promoting gender equality and summits have been organized to follow up with the

Global Health Action 2014. # 2014 Marta Lomazzi et al. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 1
License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix,
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Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695
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Marta Lomazzi et al.

Table 1. The eight Millennium Development Goals (MDGs) in the Official Development Assistance (ODA) commit-
ments (22). They have provided a framework allowing
MDG1 Eradicating extreme poverty and hunger countries to plan their social and economic development
MDG2 Achieving universal primary education and donors to provide effective support at national and
MDG3 Promoting gender equality and empowering women international level (8). Most activities worldwide have
MDG4 Reducing child mortality rates
targeted MDGs 4, 5 and 6, focusing on maternal and
MDG5 Improving maternal health
child health (MCH) and communicable diseases, espe-
MDG6 Combating HIV/AIDS, malaria and other diseases
cially in the developing countries, while fewer initiatives
MDG7 Ensuring environmental sustainability
have focused on MDGs 1, 2, 3 and 7, which are more
MDG8 Developing a global partnership for development
difficult to influence (14). Some studies have underlined
regional differences in the importance that is attributed
progress in the MDGs and to define action plans for their to specific MDGs. For example, MDGs 4 and 5 have
achievement. In 2008, governments, foundations, busi- been considered most important in the African region,
nesses groups and civil society announced new commit- while MDGs 7 and 8 in the Western Pacific Region. Low-
ments to meet the MDGs, during the high-level event at income countries have attached high relevance to MDG1
the UN Headquarters (5). Two years after, the 2010 when compared to high-income countries (14, 23). Arab
MDG Summit concluded with the adoption of a global countries have not considered MDGs among the top
action plan  Keeping the Promise: United to Achieve priority for the policy makers, academia and social actors
the Millennium Development Goals  and announced a in general mainly due to ethnic, religious, political and
number of initiatives against poverty, hunger and disease, social limitations (18).
with a special focus on womens and childrens health (6). The most recent UN report on progress towards the
In 2013, participants in the Global MDG Conference MDGs has highlighted several achievements in all health
underlined the importance of maintaining the momen- and education areas (21): the hunger reduction goal is
on track; the target of decreasing extreme poverty by
tum for accelerating progress to 2015, while taking lessons
half has been met, as well as the goal of halving the
learned from the MDGs to be used in the development of
proportion of people who lack steady access to drinking
the agenda of the next round of goals beyond 2015 (7).
water; conditions for more than 200 million people living
in favelas have been improved; significant achievements
MDGs achievements and failures have been made in the fight against communicable diseases
To assure an appropriate monitoring and evaluation
such as malaria and tuberculosis and child and maternal
within and among countries and to conceive suitable
mortality have been reduced. Moreover, primary school
policies and interventions, reliable, timely and interna- admission of girls has equalled that of boys and develop-
tionally comparable data on the MDG indicators are of ing countries experienced a reduced debt burden and an
primary importance. They are also essential in encoura- improved climate for trade (20, 21, 24, 25).
ging funding and allocating aid effectively (8). Several However, progress has been highly unequal. The
methodologies and indicators (Table 2) have been devel- reduction in global income poverty is mainly due to the
oped to measure progress towards the MDGs, such as rapid growth of a few countries in Asia, such as China,
the MDG indicators website, the UN Data  and the India, Indonesia and Vietnam. In many other countries,
UNICEF Portal (911). Moreover, progress towards poverty reduction has been quite slow, or poverty has
MDG achievement can be tracked through the MDG even increased (8). Sub-Saharan Africa remains the
Monitor, both globally and at the country level (12). most underdeveloped region (8). Projections indicate
Furthermore, there have been numerous consultations that in 2015 more than 600 million people worldwide
on the MDGs by various organizations. Some of the will still be using unsafe water sources, almost 1 billion
consultations and surveys have had an official character will be living in very poor conditions, mothers will
and others should be considered private initiatives, by continue to die giving birth, and children will die from
organizations such as non-governmental organizations preventable diseases. Also, environmental sustainability
(NGOs) and private foundations (1318). More than a remains a global challenge due to a fast decline of bio-
few official reports have tracked the global assessment diversity and an increase in gas emissions. The goals of
of progress, based on those data (14, 1921). Although primary education and gender equality also remain un-
considerable progress has been made, reliable data and fulfilled, with broad negative consequences, given that
statistics analyses remain poor, especially in many devel- achieving the MDGs deeply relies on education and
oping countries (8). womens empowerment. Moreover, there are severe inequal-
In the last 13 years, the MDGs have managed to focus ities that exist among populations, especially between
world attention and global political consensus on the rural and urban areas, or that affect marginalized people
needs of the poorest and to achieve a significant change (20, 21). MDG8 remains one of the most challenging

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 MDGs: whats next

Table 2. Millennium Development Goals (MDGs) targets and indicators. Adapted from: http://www.unmillenniumproject.org/
goals/gti.htm

MDGs Targets Indicators

MDG1 Target 1. Halve, between 1990 and 2015, the 1. Proportion of population below $1 (1993 PPP) per day
proportion of people whose income is less than (World Bank)
$1 a day 2. Poverty gap ratio [incidence depth of poverty] (World Bank)
3. Share of poorest quintile in national consumption
(World Bank)
Target 2. Halve, between 1990 and 2015, the 4. Prevalence of underweight children under five years of age
proportion of people who suffer from hunger (UNICEFWHO)
5. Proportion of population below minimum level of dietary
energy consumption (FAO)
MDG2 Target 3. Ensure that, by 2015, children everywhere, 6. Net enrolment ratio in primary education (UNESCO)
boys and girls alike, will be able to complete a full 7. Proportion of pupils starting grade 1 who reach grade 5
course of primary schooling (UNESCO)
8. Literacy rate of 1524 year-olds (UNESCO)
MDG3 Target 4. Eliminate gender disparity in primary and 9. Ratio of girls to boys in primary, secondary and tertiary
secondary education, preferably by 2005, and in all education (UNESCO)
levels of education no later than 2015 10. Ratio of literate women to men, 1524 years old (UNESCO)
11. Share of women in wage employment in the
non-agricultural sector (ILO)
12. Proportion of seats held by women in national parliament
(IPU)
MDG4 Target 5. Reduce by two-thirds, between 1990 and 13. Under-five mortality rate (UNICEFWHO)
2015, the under-five mortality rate 14. Infant mortality rate (UNICEFWHO)
15. Proportion of 1 year-old children immunized against
measles (UNICEFWHO)
MDG5 Target 6. Reduce by three-quarters, between 1990 16. Maternal mortality ratio (UNICEFWHO)
and 2015, the maternal mortality ratio 17. Proportion of births attended by skilled health personnel
(UNICEFWHO)
MDG6 Target 7. Have halted by 2015 and begun to reverse 18. HIV prevalence among pregnant women aged 1524 years
the spread of HIV/AIDS (UNAIDSWHOUNICEF)
19. Condom use rate of the contraceptive prevalence rate
(UN Population Division)
19a. Condom use at last high-risk sex (UNICEFWHO)
19b. Percentage of population aged 1524 years with
comprehensive correct knowledge of HIV/AIDS
(UNICEFWHO)
19c. Contraceptive prevalence rate (UN Population Division)
20. Ratio of school attendance of orphans to school attendance
of non-orphans aged 1014 years (UNICEFUNAIDSWHO)
Target 8. Have halted by 2015 and begun to reverse 21. Prevalence and death rates associated with malaria (WHO)
the incidence of malaria and other major diseases 22. Proportion of population in malaria-risk areas using effective
malaria prevention and treatment measures (UNICEFWHO)
23. Prevalence and death rates associated with tuberculosis
(WHO)
24. Proportion of tuberculosis cases detected and cured under
DOTS (internationally recommended TB control strategy)
(WHO)
MDG7 Target 9. Integrate the principles of sustainable 25. Proportion of land area covered by forest (FAO)
development into country policies and programs and 26. Ratio of area protected to maintain biological diversity to
reverse the loss of environmental resources surface area (UNEPWCMC)
27. Energy use (kg oil equivalent) per $1 GDP (PPP) (TEA, World
Bank)

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Table 2 (Continued )

MDGs Targets Indicators

28. Carbon dioxide emissions per capita (UNFCCC, UNSD)

and consumption of ozone-depleting CFCs (ODP tons)
(UNEP-Ozone Secretariat)
29. Proportion of population using solid fuels (WHO)
Target 10. Halve, by 2015, the proportion of people 30. Proportion of population with sustainable access
without sustainable access to safe drinking water and to an improved water source, urban and rural (UNICEFWHO)
basic sanitation 31. Proportion of population with access to improved
sanitation, urban and rural (UNICEFWHO)
Target 11. Have achieved by 2020 a significant 32. Proportion of households with access to secure tenure
improvement in the lives of at least 100 million slum (UNHABITAT)
dwellers
MDG8 Target 12. Develop further an open, rule-based, Official development assistance (ODA)
predictable, non-discriminatory trading and financial 33. Net ODA, total and to LDCs, as percentage of OECD/
system (includes a commitment to good governance, Development Assistance Committee (DAC) donors gross
development and poverty reduction both nationally national income (GNI)(OECD)
and internationally) 34. Proportion of total bilateral, sector-allocable ODA
Target 13. Address the special needs of the least of OECD/DAC donors to basic social services (basic education,
developed countries [includes tariff- and quota-free primary health care, nutrition, safe water and sanitation)
access for least developed countries exports, (OECD)
enhanced program of debt relief for heavily indebted 35. Proportion of bilateral ODA of OECD/DAC donors that is
poor countries (HIPCs) and cancellation of official untied (OECD)
bilateral debt, and more generous official development 36. ODA received in landlocked developing countries as a
assistance for countries committed to poverty reduction] proportion of their GNIs (OECD)
Target 14. Address the special needs of landlocked 37. ODA received in small island developing States as
developing countries and small island developing states proportion of their GNIs (OECD)
(through the Program of Action for the Sustainable Market access
Development of Small Island Developing States and 38. Proportion of total developed country imports
22nd General Assembly provisions) (by value and excluding arms) from developing
Target 15. Deal comprehensively with the debt countries and from LDCs, admitted free of duty (UNCTAD,
problems of developing countries through national WTO, WB)
and international measures in order to make debt 39. Average tariffs imposed by developed countries on
sustainable in the long term agricultural products and textiles and clothing from developing
countries (UNCTAD, WTO, WB)
40. Agricultural support estimate for OECD countries as
percentage of their GDP (OECD)
41. Proportion of ODA provided to help build trade capacity
(OECD, WTO)
Debt sustainability
42. Total number of countries that have reached their
Heavily Indebted Poor Countries Initiative (HIPC) decision
points and number that have reached their HIPC completion
points (cumulative) (IMF  World Bank)
43. Debt relief committed under HIPC initiative
(IMF-World Bank)
44. Debt service as a percentage of exports of goods and
services (IMF-World Bank)
Some of the indicators listed below are monitored separately for the least developed countries, Africa, landlocked developing countries
and small island developing states
Target 16. In cooperation with developing countries, 45. Unemployment rate of young people aged 1524 years,
develop and implement strategies for decent and each sex and total (ILO)
productive work for youth

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 MDGs: whats next

Table 2 (Continued )

MDGs Targets Indicators

Target 17. In cooperation with pharmaceutical 46. Proportion of population with access to affordable essential
companies, provide access to affordable essential drugs on a sustainable basis (WHO)
drugs in developing countries
Target 18. In cooperation with the private sector, 47. Telephone lines and cellular subscribers per 100 population
make available the benefits of new technologies, (ITU)
especially information and communications technologies 48. Personal computers in use per 100 population and Internet
users per 100 population (ITU)

even if of primary importance for the achievement of all goals. MDG3 measures gender equality in education,
MDGs (8). employment and the proportion of women in national
legislatures. MDG5 focuses on maternal mortality and
Discussion on the effectiveness of the MDGs access to reproductive health. This limited explicit inclu-
As reported above, a major part of the MDGs has been at sion in two MDGs is too narrow and clearly indicates
least partially accomplished and many countries are on that the gender issue and its dynamics have not yet been
the way to achieving the MDGs and trying to adopt a fully understood nor integrated in policy dialogues
sustainable path (21). However, in spite of the general (26, 29). Improving equalities will require health system
positive outputs, global targets will not be met in some strengthening, associated with a political and social
regions, particularly sub-Saharan Africa and south Asia. engagement to address all forms of discrimination (30).
Indeed, MDGs have encountered a range of common Fourth, a lack of clear ownership and leadership
challenges (26). internationally and nationally might have partially af-
First, they were not the product of a comprehensive fected the achievement of the MDGs. Even if different
analysis and prioritization of development needs and countries scale up health services and make progress
consequently were sometimes too narrowly focused. The towards the MDGs at very different rates, we have mainly
inconsistent progress partly indicates a trend over time to observed a trend to a global uniform approach. Rather
focus on a subset of specific targets that were easier to than spreading specific technical interventions tested in
achieve, implement and monitor (26). The untied nature one country on large scale, a more specific approach
of many goals has often affected the creation of the as well as the adoption of alternative models such as
synergies that could arise across these targets and in learning by doing engaging key stakeholders and taking
particular between education, health, poverty and gender. advantages from evidence-based data from pilot projects,
Even if acceleration in one goal is likely to improve might be adopted (26, 31). Furthermore, not only
progress in others, these synergies are not always evident, stakeholders but also public health professionals should
and often vary across countries (26, 27). be considered as key actors in the process. Indeed, it has
Second, this framework has not afforded enough been shown that understanding of MDGs among public
consideration to the potential impacts on environmental, health professionals was limited (14, 32). This general
social and economic dimensions. Environmental aspects lack of information and awareness represents an im-
are addressed under goal 7 but only some topics are portant challenge. There is an absolute need for more
covered, neglecting key issues for sustainable develop- elaborate publicity and awareness about the MDGs
ment. Most goals focus on the social dimension of among key players if attaining the MDGs is to be a
development, e.g. MDGs 1, 2 and 6, addressing social reality (33).
problems such as hunger, education, equality, MCH and Fifth, achievement of the MDGs depends much on
communicable diseases. However, these goals are also the fulfilment of MDG8 on global partnership. In
interconnected with environmental and economic factors. his preface to the report, UN Secretary General Ban
While some links are recognized (e.g. the importance Ki-moon said, At the just-concluded Rio20 Confer-
of clean drinking water to health), others such as the ence, commitments were made on an ambitious sustain-
maintenance of environmental resources or the quality of able development agenda. But to keep those pledges
air are not. MDG8 addresses the implementation of credible, we must deliver on previous commitments. As a
sustainable development but does not consider new forms world community, we must make rhetoric a reality and
of financing, technology and capacity building (28). keep our promises to achieve the MDGs (8, 34). As
Third, the issue of equity has represented one of the reported above, almost 200 countries engaged themselves
main challenges to face. A gender focus is clear only in and provided substantial contributions to the cause.
MDGs 3 and 5, while it is missing throughout the other However, these commitments have not been always fully

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Marta Lomazzi et al.

fulfilled. Engagement by governments (and donors in called, should follow the new political situation and
general) has been deeply affected by the global econo- include the emerging countries. The framework adopted
mic and financial crisis that has seriously undermined for the MDGs should be adapted to todays needs: new
progress towards poverty reduction and MDGs achieve- power, new countries, new groups of the poor and new
ment in general, from 2007 on. Furthermore, not only partnerships. The notion of good health is progressing,
governments but also the private sector plays an essential shifting towards a people-centred approach to create and
role in the development of the global partnership. Up to preserve good health and well-being rather than prevent-
now, more than half of the services used for MDGs have ing and treating diseases. Health is now a societal issue of
been provided by private sources and the role of the the global community and should be considered as a global
private sector is intended to be boosted in the next good (43). Health systems should be able to adapt to more
period. Thus, it is of primary importance that govern- complex expectations and new health and environmental
ments and the private sector work together to mobilize challenges. New ways are emerging to improve health: new
more resources to achieve the MDGs and counter the technologies allow unique access to information and
negative effect that the global financial crisis may have on enable civil society worldwide to be connected and take
the targets attained and future achievements (35, 36). part in the decision-making process. In this way, margin-
Those investments should be sustainable over a long alized people can also be integrated in the debate (30). A
period and predictable, and innovative financing mechan- strong emphasis might be placed on the importance of
isms might be taken in account (30). learning and sharing knowledge and experiences of best
Accountability must be an essential part of the frame- practices (30).
work. A few studies have underlined the problem of The post-2015 health agenda should also include
corruption in relation to the use of MDGs resources by specific sustainable health-related targets as well as take
governments and other organizations (14, 18, 37, 38). an all-inclusive approach to preserving peoples health
A health care system in a corrupt environment is weak for the entire lifespan. As a first step, the current MDGs
and unstable, and it will be important for the post-2015 targets should be achieved and new targets should
period to find solutions to address both the health and be adopted for addressing, e.g. the burden of non-
the governance aspects of the development agenda at the communicable diseases (NCDs  such as cardiovascular
same time. Emerging governance models can allow larger diseases, cancers, chronic respiratory diseases and dia-
citizen participation, ownership and influence, as well betes), sexual education, aging, mental illness and other
as intersectoral action. The participation of civil society emerging health challenges such as human mobility and
and its accountability is essential for a strong new policy refugees (13, 30). Equity and education should be con-
development and implementation process (30, 39, 40). sidered as the base of health and incorporated in all targets.
Last but not least, goal measurement is often too The links between health and sustainable development
narrow, or might not identify a clear means of delivery goals (SDGs), as underlined in the Rio  20 report, need
(26). A lack of scientifically valid data on some MDGs, to be strengthened with a rigorous framework and the new
such as MDGs 5 and 6, did not allow the improvement agenda should adopt a social determinant of health
achieved to be measured adequately or to be compared approach (13, 44). Indeed, improving peoples health and
with a baseline (41). Government reports have sometimes quality of life cannot be achieved by focusing only on the
been criticized as false and government-driven, leading health sector, but requires action to address the wider
to a lack of confidence into the official reporting systems socioeconomic issues that influence how people live and
(14, 18, 37, 38). More and better data are definitely get sick, including risk factors, services availability and
needed, especially relating to the poorest and most accessibility, etc. These conditions depend on the distribu-
vulnerable people. However, even the limited data sys- tion of resources and power at local and global levels.
tems available in some developing countries have allowed An integrated health-in-all-policies approach involving
the making of assessable investments in education, different sectors linked to governance, environment, edu-
health, essential infrastructure and environment (42). cation, employment, social security, food, housing, water,
transport and energy are necessary in order to address the
The post-2015 agenda complexity of health inequities (30, 4547). Global health
Despite the positive achievements attained, many see the diplomacy is nowadays focusing on the development of
health MDGs as unfinished business. Indeed, MDGs such a framework, thus incorporating health as a part of all
have not fully addressed the large concept of development policies or, on the other hand, starting from health to drive
included in the Millennium Declaration, which comprises policies to protect national security, free trade and
human rights, equity, democracy and governance (30). economic advancement. Health should be perceived as
A post-2015 slowdown must be avoided. The Millennium an investment and not only as a cost (44, 48).
Declaration is still valid and the work should be finalized. Accountability remains of primary importance. On
To fully address this, the new targets, whatever they will be one hand, better data will be required to allow transpar-

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 MDGs: whats next

ency, proper evaluation and improvements. On the other large (30). Margaret Chan, Director General of the WHO,
hand, governments engagement and partnership dyna- has stated that Universal Health Coverage is the single
mics between all actors should be improved and adapted most powerful concept that public health has to offer and
to the new socio-political context. the Rio  20 conference recognized that UHC has the
The northsouth division is no longer applicable; potential to reduce inequalities, improve economic growth
NCDs such as obesity are affecting all, independently and strengthen social organization (50). To achieve UHC,
of their country income, with a negative impact not only health services and infrastructures as well as coverage
on human well-being but also on national productivity. with financial risk protection should be guaranteed to
Any future health goal must be universally relevant; everyone (51).
however, targets and indicators must be adaptable to a Maximizing HALE could be the other health goal. To
countrys health priorities and needs and regional differ- achieve this aim, we should be able to ensure that people
ences should be considered (14, 30). not only survive but enjoy good health throughout their
The role of governments internationally and at the lifespan (46, 51).
local level, including in areas such as health workforce Both goals are linked and interconnected: an increase
recruitment and supply and production of products for in HALE can be measured as an indicator and out-
health (e.g. vaccines), should be improved. On one side, come of progress towards UHC and the UHC can be
low and lower-middle income countries (23) should be considered as the mechanism to improve HALE (51).
able to mobilize local resources and improve in-country Both UHC and HALE are interesting targets but their
productivity as well as bring innovations and solutions measurement will be challenging.
that are more suitable for emerging countries. On the Debates about post-MDG targets and linkages with
other side, rich countries should contribute more to the SDGs are now on going with in-country and thematic
UN system. MDGs were agreed on a voluntary base by consultations, including, e.g. a UN Task Team, a post-
governments; the new goals should be norms for global 2015 high-level panel established by the UN Secretary
governance and to reinforce the concept of the right to
General, society consultations through social media,
health. These targets should be global social contracts
an Open Working Group provided by the UNSG in
between governances and societies, and the concept of
consultation with governments, etc. (44, 5254).
social responsibility, lacking for the MDGs, should be
Regardless of which overarching targets will be
included.
selected, the goals must be translated into measurable
A more efficient partnership among the different
indicators; accountability and regular reviews of progress
agencies could be envisaged, reducing to a few effective
should be easy to perform, to share and to be understood
organizations the numbers of agencies involved. The
by governments and the general public (13). A multi-
dynamic between the actors should change: publicprivate
sectoral approach will be essential, integrating the social
partnerships are assuming more and more importance.
determinants of health and with a main focus on equity,
The private for-profit (commercial companies) and not-
education and poverty reduction.
for-profit [e.g. Bill and Melinda Gates Foundation (49)]
sector is the only one that can afford the huge cost
associated with this framework: no country, even the Summary and conclusions
very rich, can replace this role. Moreover, the private The MDGs have focused world attention on the needs of
sector should not be considered only as a donor but be the poorest and driven countries and donors commit-
embedded in the path, taking advantages of the capabilities ments to the achievement of common goals.
offered by the sector. Even if a major part of the MDGs has been at
least partially accomplished, many see the MDGs as
The new goals: picking and choosing unfinished business. A post-2015 slowdown must be
Everyone who has a cause wants a goal: however, to prevented. A new round of goals is now under definition,
be successful the new goals should be limited to a few. aiming at fully addressing the large concept of sustainable
Moreover, we are experiencing a sort of goals anxiety development included in the Millennium Declaration.
due to a spasmodic search for fast-defined, effective and A new framework, an intersectoral approach and strong
universal goals able to include all major issues. A careful commitments by governments and donors would be of
consideration of all aspects in the due time would most primary importance to define effective goals and translate
probably lead to better definition of the goals. them into reality.
Most of the discussions are focusing on two types of
comprehensive goals for health: universal health coverage
Conflict of interest and funding
(UHC) and healthy life expectancy (HALE).
UHC and access could represent a successful model The authors have not received any funding or benefits from
to achieve health goals and improve peoples health at industry or elsewhere to conduct this study.

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Marta Lomazzi et al.

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