Linking Sustainable Good Health and Well-Being to the Sustainable Development Goals: An Historical Perspective

Abstract

The aim of this chapter is to provide an overview of the UN Sustainable Development Goals and their relevance for good health and well-being. Sustainable development is defined and then presented within three pillars: social, environmental and economic. The chapter examines these pillars and how they intersect with health.

In 2000, out of the eight Millennium goals launched, six were directed at improving peoples’ health whilst the other two focused on environmental sustainability and partnership for development. The 17 SDGs launched in 2015 had 169 targets for 2030: often organised in the so-called Wedding Cake Model, which is examined in this chapter. Environmental issues are basic elements in this model, represented by the SDGs 6, 13, 14 and 15. Social issues are tackled through SDGs 1, 2, 3, 4 and 5. All these represent health issues as they relate to goals for “no hunger, education, healthy bodies and gender equality”. They are grouped together with SDGs 7, 11 and 16 with focus on access to clean energy, good housing, and strong institutions. The rest of the SDGs (SDGs 8, 9, 10 and 12) are defined as important for the economy (decent work, innovation and infrastructure, equity, responsible consumption and production). Partnership, SDG 17, is the overarching most important SDG, with its main focus on collaboration as a means for achieving a sustainable future. The chapter explores the SDGs for eradicating poverty, combatting inequality and stopping climate change by 2030, all of which impact sustainable good health and well-being.

In conclusion, it addresses the need to take a transdiciplinary approach and forge cross-sectoral and institutional collaboration in order to achieve these SDGs.

1 Placing the Sustainable Development Goals in Context

The concept of sustainability has developed over time. Over short periods of time, it is difficult to notice specific changes that have taken place, but looking back, we can see that there have been very distinct, and different, eras of change. In the period from the 1850s to the 1960s, pollution and smoke from factory chimneys symbolised industrial growth and prosperity. People flocked from the countryside to the cities to work. Factories were built in ever-increasing numbers across the United Kingdom. In the late 1800s, the impact on the environment magnified. Air quality was affected by smoke, resulting in bodies of water and water sources being polluted. Acidification, fish death and a reduction in biodiversity ensued. As there was a total lack of regulation, emissions quickly spiralled out of control. Populations living in close proximity to provide human resources for industrialisation also resulted in outbreaks of diseases not experienced before, such as the cholera epidemic of 1848 across the United Kingdom. It is difficult to determine how many people died; however, estimates suggest it could have been as high as 50 to 60,000. Poor air quality resulting in “smog” had become commonplace in large cities, such as London, over several hundred years. As industrialization took hold, factories belched out their emissions and people continued to heat their homes with open fires in close quarters, both using cheap coal. The “Great Smog” in 1952 in London lasted 5 days and killed an estimated 12,000 people. This was then followed by the Clean Air Act of 1956, which endeavoured to control domestic sources of air pollution. The Clean Air Act of 1968 was next: it regulated the minimum heights of chimneys, requiring them to be built taller when located nearer to towns. It is clear now that these must have had devastating impacts on peoples’ health and well-being, but at the time, it is interesting that factory emissions were not considered significant air polluters.

The focus initially was more on environmental impacts. Environmentalists began to speak out in different ways as time progressed, and the effects on nature were more apparent. For many, Rachel Carson’s seminal work, Silent Spring (1962), is well known as a catalyst for the environmental movement. It described the use of DDT as a pesticide over large areas in the USA, and how insects and birds were being decimated. Theories about nature’s resource limitations were increasingly debated. It was feared that the lack of regulation would lead to resource collapse if the situation was ignored. The period between 1970 and 2000 featured new regulations, standards and practice. Hardin’s Tragedy of the commons (1968) pointed out the increasing usage of natural resources by industries and the creation of value for industry while the burden of dealing with any environmental issues was left to society and governments. It discussed the importance of joint responsibility for cleaning up damage caused to the environment. Limits to growth (Meadows et al. 1972) raised questions about nature’s tolerance limit in relation to the extraction of natural resources and pollution. The conclusion was that at least four planets would be needed if we were to continue at the same rate of “progress”. The links were clearly made between humans’ use of resources, the lack/destruction of them, potential famines and general health and well-being. The inextricable links between human health and ecosystem health are/were there for all to see. The foundation of the environmental movement was built out of concern about the effects of pollution not only on nature, but also on human health.

In 1972, the United Nations Conference on the Human Environment (UNCHE) took place. This conference directed politicians’ attention for the very first time to the rising problem of pollution, pesticides and other issues faced on a global scale. There were 113 countries and 400 NGOs present. The Stockholm Declaration on the Human Environment declared that “the natural resources of the earth… must be safeguarded for the benefit of present and future generations” (Principle 3, Environmental Law Guidelines and Principles, The Stockholm Declaration (UNEP 1972).

The United Nations Environmental Program (UNEP) was established at this conference, which signalled the beginning of efforts to protect the global environment. Fifty years of environmental action followed before the celebration in 2022 with examples of action not only globally but also locally (UNCC 2022). In Finland (STUK – Radiation and Nuclear Safety Authority), a division of the Ministry for Social Affairs and Health, for example, had been monitoring the impact of radiation and in particular its use in hospitals since 1958: it was not alone in monitoring nuclear safety.¹ In the USA, the Environmental Protection Agency (EPA²) was established in 1970, while in Norway, the Ministry of the Environment was established on 8 May 1972 as the first ministry of its kind in the world, and in 1974, Gro Harlem Brundtland became Minister of the Environment. Denmark quickly followed suit. One of the central tasks was to clean up the pollution problems that the industry had created. It was obvious that water and air were being polluted. Several international conventions were adopted in regard to the environment, for example, the Acid Precipitation Convention in 1979 and the Bern Convention for the Conservation of Biodiversity in 1982. In the early 1980s, the “ozone hole” over Antarctica was discovered and the impact of greenhouse gases and chemical on the atmosphere was assessed, which gave rise to the Montreal Protocol for the Reduction of Ozone-Depleting Gases in 1987. Other examples are the North Sea Declarations for Limiting Emissions in the North Sea in 1988, and the Basel Convention against dumping of toxic waste in the Third World in 1989.

The Brundtland Report Our common future (1987) defined the concept of sustainability as follows: “Today’s generations must align themselves so that the needs of today’s people are met without weakening the basis for future generations to have their needs met”. It is recognised as possibly the most quoted definition across the globe. The three pillars, environment, economy and society – also referred to as “people, planet and profit”, and part of the definition, were the starting point for discussions at the 1992 Rio Conference. The Rio Declaration on Environment and Development (UN 1992) presented 27 principles for a sustainable future, and the meeting resulted in five different documents, amongst which were the UN Framework Convention on Climate Change, the Convention on Biological Diversity and in Agenda 21. Agenda 21 comprised a comprehensive plan of action to be taken globally, nationally and locally for the twenty-first century. Agenda 21 and the Commitments to the Rio principles were strongly reaffirmed at the United Nations Conference on Sustainable Development (WSSD) in Johannesburg, South Africa, in 2002, called Rio+10. Hundreds of Heads of State and government and tens of thousands of government representatives and NGOs gathered at this summit.

The United Nations Conference on Sustainable Development (UNCSD) in 2012 (Rio+20) was attended by multinational companies and world leaders. Countries were largely not represented. The ensuing report entitled The Future We Want covered broader sustainability topics such as poverty eradication, food security and sustainable agriculture, energy, sustainable transport, sustainable cities, health and population and promoting full and productive employment (UN 2012).

2 Sustainable Development Goals and the 2030 Agenda

The current Sustainable Development Goals (SDGs) are officially known as Transforming Our World: the 2030 Agenda for Sustainable Development. They include the agreed set of 17 goals and 169 targets from the UN Sustainable Development Summit (2015). The 2030 Agenda for Sustainable Development is “a plan of action for people, planet, prosperity, partnership and peace”.

The wedding cake model (Fig. 1.1) shows the three dimensions of sustainability: the biosphere, society and the economy, as being embedded within each other. The environmental aspects in the model are the basic elements, where SDGs 6, 13, 14 and 15 represent access to clean water and sanitation, life below water, life on land and climate action. When considering social issues, SDGs 1, 2, 3, 4 and 5 represent health aspects: no poverty, no hunger, education, healthy bodies and gender equality. These are grouped together with SDGs 7, 11 and 16 which represent access to clean energy, good housing and strong institutions. The remaining SDGs 8, 9, 10 and 12 are defined as important for the economy (decent work, innovation and infrastructure, equity, responsible consumption and production). Number 17, partnership, is at the top, with its focus on collaboration for a sustainable future.

Fig. 1.1

The 17 SDGs presented as the wedding cake model. (Credit: Azote for Stockholm Resilience Centre. Stockholm University CC BY-ND 3.0)

The economic layer sits within the societal layer, which ultimately sits inside the Earth’s biosphere. This imparts the irrefutable fact that all activities must be considered within the Earth’s system. Interactions between man-made systems – the economic and social layer – and nature are most often represented by flows of materials and resources extracted from nature and emissions, discharges and waste emitted back into natural environmental systems. The impact on nature can be either local, e.g. toxic leakages from landfill, regional, e.g. acidification of earth areas, or global, e.g. emissions of greenhouse gasses (GHGs).

3 Impact Assessment Methods

It is important during the transition to sustainable development to establish priorities between different measures to be taken. It is therefore vital to understand impacts on the environment and society, and furthermore, on human health and well-being. There are several methods that can be used to assess such impacts, and in turn, to ascertain which are the most significant. One of the models used on a larger systemic perspective is the DPSIR assessment model. The DPSIR abbreviation is explained in the following text:

D :

Driving forces (population, transport, energy use, industry types, industry structure, land use, landfills, sewage systems)

P :

Pressures (use of resources, emissions, waste generation and noise, radiation, hazards)

S :

State (current state of the quality of air, water and soil quality, ecosystems, biodiversity, vegetation, water organisms, human health)

I :

Impacts (eutrophication, global warming, acidification, poor health conditions in a society)

R :

Responses (prioritising, setting targets, policies, regulations)

Figure 1.2 presents an illustration of how the DPSIR framework can be used. Here it is used for a study on drivers that put pressure on biodiversity with an impact on ecosystem services and the resulting consequences for human well-being. The responses here are new policies and regulations to avoid impacts on ecosystem services and human well-being.

Fig. 1.2

Example of DPSIR with reference to the impact on ecosystem services and human well-being. (Modified from Santos-Martín et al. 2013. Reprinted from Fet, Business Transitions: A Path to Sustainability, Springer 2023)

There are also various methods which can be used to assess impacts, for example, risk assessments, based on an evaluation of potential accidents and/or emergency situations, or health assessments based upon an evaluation of any changes to health conditions.

In order to evaluate how ecosystem services are affected, a technical process is often used to analyse and assess material flows between nature and man-made systems. The first step is to analyse the material flows in a process, which might be described by the extraction of natural resources or emissions of pollutants to air, soil or water. Generally, further steps involve classification, characterisation and valuation. Classification briefly describes any potential impacts the flows may cause, for example, on global warming, or terrestrial acidification; see left side of Fig. 1.3. The next step, characterization, is a quantitative step in which the relative contributions of the flows are considered for each of the actual impact categories. There are two mainstream ways to derive characterisation factors, i.e. at midpoint level and at end point level. Whether one decides to consider midpoint or end point consequences is a matter of choice. Emissions of SO₂ or NO_x might be the cause of acid rain which causes terrestrial acidification. This might in turn lead to loss of biodiversity (in this case, in the form of damage to ecosystems). Acidification is defined as a midpoint result, while damage to ecosystem and loss of biodiversity are end point results. The relative importance of different impacts is weighted against each other when the valuation is carried out. Results obtained from the valuation are usually used to prioritise actions, for example, actions by management in an organisation, or recommendations for new regulations.

Fig. 1.3

Overview of the impact categories that are covered in the ReCiPe 2016 method and their relation to the areas of protection. The dotted line means there is no constant mid-to-endpoint factor for fossil resources (RIVM 2016) https://doi.org/10.1007/s11367-016-1246-y

Evaluation in the impact assessment was originally developed for environmental aspects, however, a similar model can be used for the evaluation of midpoint and endpoint categories in regard to the impact on human health. This is illustrated by Fig. 1.3 (RIVM 2016).

4 Drilling Down into Sustainable Development Goal 3: Good Health and Well-Being

The purpose of SDG 3 is to “Ensure healthy lives and promote well-being for all at all ages”. It consists of 13 targets (see Table 1.1). Targets named 3a-3d are of an overall character. Target 3.9 will be used to illustrate the impact assessment methods presented above. The purpose of this example is to show that this target is affected by pollution and air quality, and quantitative information connected with measures to reduce pollution, should be used to evaluate the achievement of target 3.9. SDG 3 is used as an example here; however, health is also influenced by the other SDGs, and targets directly linked to health for other SDGs can be found in the UN Sustainable Development Goals Report 2023: Special Edition.

Table 1.1 List of targets (https://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3) under Goal for SDG 3: Ensure healthy lives and promote well-being for all at all ages

Target 3.9 focuses on the reduction on deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. As illustrated in Fig. 1.2, the reduction of ecosystem services can impact human health and well-being. People can also, for example, be exposed to chemicals. This can happen in a working environment where the workforce is exposed to chemicals and other pollutants like noise, dust and vibration. It can also happen later during use of a product in the indoor environment in the home. There is generally no product labelling system that informs the public about exposure from, for example, furniture, clothing or children’s toys.

The research project Data Assisted Tools for Sustainable Product Information (DATSUPI) performed by researchers at NTNU in 2005–2009 (Fet and Skjellum 2009) developed a model for how to include data from emissions from materials used during the production of furniture (workplace emissions) and during the use of furniture (indoor emissions). As part of this project, a test program was performed to identify emissions from different materials in furniture. Sixteen tests were performed in a closed test chamber by the accredited laboratory Eurofins in Denmark in 2006–2007, and no people were exposed to chemical or other potential negative health impacts as part of these tests. The results were integrated into a database and used for the purpose of developing health impact categories to be used in the products’ label information (Jørgensen 2009, 2013; Fet et al. 2009).

4.1 Measuring Damage to Health

There are different models for estimating the potential damage to human health caused by pollution in the air. Harm can be measured in a variety of different ways, depending on the factors involved. Factors can range from variables like types of pollution, types of protection in work environments, status of human health, and which body area is exposed. In a case study on furniture, health-related aspects which were considered the most significant were identified. After this, a set of indicators was suggested and organised systematically. Health effects were measured in relation to the risk posed by exposure to chemicals in the working environment (Skaar and Jørgensen 2013).

Table 1.2 demonstrates the use of indoor environment indices for potential health impacts after using certain products. In the case of furniture, the substances used in their production can impact air quality. Air quality is affected by both volatile and semi-volatile organic compounds, resulting in respiratory health conditions. In conjunction with other chemicals, these impact health and can be a factor in cancer, nephrotoxicity and allergies. The probability of toxicological complications also increases.

Table 1.2 Indoor Environment Indices in DATSUPI (Jørgensen 2013)

The DATSUPI project identified and then classified substances (see Table 1.2). Some materials release unpleasant odours, triggering headaches and general discomfort (Jørgensen 2013).

This section has presented an example of how quantitative information can be gathered from testing, which can also be used to evaluate the achievement of SDG 3, Target 3.9.

4.2 Sustainable Development Goal Interactions

The report A Guide to SDG Interactions: From Science to Implementation (ICSU 2017) explores interlinkages between the SDGs. It is based on the premise that a science-informed analysis of interactions across SDG domains is essential in supporting more effective decision-making and will thus better facilitate the follow-up and monitoring of progress.

An example of interlinkages between SDGs is shown in a diagram entitled “Interlinkages between Sustainable Development Goals” (ICSU 2017), available at DOI: 10.24948/2017.01. This diagram draws up lines between SDGs 3, 7, 8, 11, 13 and 2. SDG 3 (good health and well-being), target 3.9 (improving health outcomes by improving air quality) is interlinked with SDG 7, since clean energy represents sources with less emissions of pollutants into the air. SDG 2 (zero hunger), target 2.3 (access to sufficient and quality nutrition) is important for good health, and the interaction with SDG 8 (decent work and economic growth) is important for work productivity and health. SDG 11 (sustainable cities and communities) especially targets 11.1 and 11.2 on sustainable urban planning and decent and affordable housing support mental health. SDG 13 (climate action), target 13.2 focuses on the importance between climate change and national policies, strategies and planning, where health concerns are at the centre of decisions made.

In the analyses for the integration of these 5 SDGs, there were 86 target-level interactions, 81 of which were positive and 5 were negative. The analysis concluded that implementing the health dimensions of the SDGs will require the strengthening of national health systems and dedicated laws and regulations to protect people and the natural environment from harmful substances. It will necessitate not only an increased investment in health but also in the infrastructure that supports health and well-being (i.e. sustainable urban design and planning), digital infrastructures, as well as policies that mainstream health concerns from a local (city planning, health and safety in workplaces) to a global scale (preventing and preparing for large epidemics, engaging in multi-stakeholder alliances to tackle antimicrobial resistance, preparing for health impacts as a result of climate change).

The International Science Council³ which consolidates expertise and advice on matters of global concern to science and society provides a global voice for science. The understanding of possible trade-offs as well as synergistic relations between the different SDGs is crucial for achieving long-lasting sustainable development outcomes. A key objective of the scoring approach described here is to stimulate more science-policy dialogue on the importance of interactions, to provide a starting point for policymakers and other stakeholders to set their priorities and implementation strategies, and to engage the policy community in further knowledge developments in this field (ICSU 2017).

5 Transition Instruments

Among other frameworks that support the SDGs is the European Green Deal (EC 2019) with four main goals:

• 1. EU to become climate neutral by 2050.

• 2. Protect humans, animals, and plants by cutting pollution.

• 3. Help companies become world leaders in clean products and technologies.

• 4. Ensure a just and inclusive transition.

The Green Deal Road Map (EC 2019) made clean energy and zero pollution two of its priorities. Air pollution is the number one environmental health problem in the EU. It causes serious illnesses such as asthma, cardiovascular problems and lung cancer, and vulnerable groups are affected the most. Air pollution also damages the environment and ecosystems through excess nitrogen pollution and acid rain. It is also costly for our economy, as it leads to lost working days and high healthcare costs. To tackle air pollution and achieve the EU’s vision of zero pollution for 2050, it has a comprehensive clean air policy based on three pillars: ambient air quality standards, reducing air pollution emissions, and emission standards for key sources of pollution (EC 2019). Therefore, a strategy for the sustainable use of chemicals is part of the European Green Deal plan “A zero pollution Europe”.

Similarly, clean, safe and affordable water is essential for peoples’ health, and the EU’s commitments to the Water Action Plan show its determination to take action for clean water and sanitation for all by 2030. This is also part of the goal of protection of humans, animals and plants by cutting pollution, as is outlined in Goal 2 of that document.

The EU Taxonomy, under the Taxonomy and Transparency Act, emerged from the EU Green Deal initiative as a standardised and comprehensive classification system for sustainable economic activities responsible for up to 80% of EU greenhouse gas emissions (Fet and Sparrevik 2023). These kinds of instruments, which are informative, can raise awareness about the benefits of sustainability through educational programmes. Instruments which are more economic in nature target motivating changes through tax incentives, loan programmes and funding for research programmes or imposing taxes on fossil fuel products or other harmful and hazardous chemicals. The hope is that this will result in not only a cleaner environment, more affordable energy, smarter transport, and new jobs but also an overall better quality of life (Fet and Keitsch 2023).

6 Reflections

6.1 From Stockholm 1972-Stockholm+50

This chapter started with a review of the background for the SDGs. The UN conference in Stockholm in 1972 was organised as an answer to emerging needs regarding the global state of the environment, as reported from the Stockholm+50 Conference that took place in 2022 (UN 2022). The 1972 conference succeeded in bringing the topic of the environment to the global stage.

The Stockholm Declaration (UNEP 1972) proclaimed:

The protection and improvement of the human environment is a major issue which affects the well-being of peoples and economic development throughout the world; it is the urgent desire of the peoples of the whole world and the duty of all Governments.

Since 1972 numerous protocols, conventions and multilateral environmental agreements have been developed. The Rio Declaration, which was a direct outgrowth of the Stockholm Declaration, was adopted in Rio 1992, and Agenda 21 updated the Stockholm Action Plan to address sustainable development issues in the twenty-first century.

The Stockholm+50 conference gave five requirements (UN 2022) for accelerating actions for a Healthy Planet and Prosperity for All. These recommendations are summarised below:

• 1. Co-working between countries and other stakeholders to address the triple planetary crisis of climate change, biodiversity loss and pollution.

• 2. Better collaboration and cooperation across environmental efforts within the UN, the private sector and other stakeholders. There is strength in coming together and calling for change.

• 3. Reinventing an economy for the twenty-first century, e.g. by green or a circular economy; meaning decouple economic development from its destructive footprint.

• 4. Science, technology and data need to be both accessible and used effectively in addition to strengthening the role of science across the board of enterprises.

• 5. Raising public awareness about the global nature of environmental problems.

Based on the complexity of these recommendations, it is difficult to design a single straightforward roadmap to deliver the SDGs related to sustainable good health and well-being. However, Stockholm+50 acknowledged the role of the health stakeholder community as more important than ever. They need to be increasingly involved in environmental agendas. Human health and planetary health are seen as synonymous. This interdisciplinary approach was built on the 2015 SDGs which raised environmental issues as part of global economic and health perspectives.

6.2 Transition Options to Protect Against Unsustainable Development

The overall vision of the SDGs has been to protect against unsustainable development. Results so far, just over halfway through the 2023 Agenda, demonstrate that protection against degradation of the environment on its own is not enough. Regenerative solutions are required: we must give something better back to nature. Five transition options to facilitate this requirement are suggested by Fet and Keitsch (2023).

The first is system change. Society can be viewed as a system with interacting subsystems (e.g. represented by education, health care, industry and government) operating in an environment of common goods where the role of each system element will have an impact on the other. A dynamic understanding of the interaction of systems is based on the insight that much more than incremental changes are needed to depart from the status quo.

The second is transdisciplinarity. There is a need for new knowledge where different scientific insights that contribute to both societal and human well-being and scientific progress are integrated. It is important to combine knowledge about nature and the understanding of, for example, air or drinking water quality and its health impact. This chapter presents an example of an impact assessment model as shown in Fig. 1.3. Understanding the mix of consequences on different systems (nature, people, climate, economy, etc.) requires a holistic understanding. Understanding the impact on nature requires competence in the field of natural science, the use of new technologies requires engineering knowledge, the impact on the economy requires social economists, and – last but not least – the impact on human health requires a broad understanding of health issues. The latter involves not only understanding of the effect of different chemicals or other matters on the different parts of the body, but also an understanding the actual long-term impact on human health. This illustrates the vital need for a transdisciplinary approach in dealing with understanding the complexity between SDGs and their actual impact on health because of changes in the environment as seen in Fig. 1.3.

The third option is net positive leadership: a way to reinvent the economy for the twenty-first century, for example, by decoupling economic development from its destructive footprint. Target 3.9 under SDG 3 points at the need for action to improve air and water quality for better health conditions, not only reducing the pollution that leads to degradation of air and water quality. Polman and Winston signify sustainability-focused companies as “Net Positive” as it:

improves well-being for everyone and at all scales – every product, every operation, every region and country, and for every stakeholder, including employees, suppliers, communities, customers, and even future generations and the planet itself. (Polman and Winston 2021).

The fourth recommendation, digitalization for sustainability, addresses the need within the UN as well as the private and public sectors for improved collaboration and cooperation on environmental efforts. Digital solutions are seen as a means for getting actions implemented across country borders, e.g. through programmes led by international organisations, but also through artificial intelligence (AI) and data gathering by machine learning and the use of algorithms. Fifty years ago, 113 governments acknowledged the bidirectional relationship between humans and their environment in the Stockholm Declaration. However, in 2022, the global community was perhaps better equipped to practically address this nexus.

The last, fair and inclusive transitions, recommends that public awareness should be raised on the global nature of environmental problems. One of the transition instruments in the Green Deal Road Map (EC 2019) is about leaving no one behind. Transition management is seen as essential for directing transformations that support governments in accelerating change towards sustainability and inclusiveness: methodologies for integrating health impacts and well-being with environmental aspects have gained increasing attention. Two global forums with the power of full UN member state participation consider health environment issues on their agendas: the United Nations Environment Assembly (UNEA) and the World Health Assembly (WHA). This bridge is critical, particularly for party-led processes in the UN system. Governments at large are interested in this health environment nexus.

The way you manage nature is of course different than that required to manage human health. The core issue is about understanding the intersectionality and managing that (Willetts 2022).

Communities are increasingly encouraging social innovation in order to manage resources for the public good as fairness and inclusiveness are at the very heart of the SDGs.

7 Concluding Comments

This chapter has contributed background information to the SDGs and with some reflections around a way to analyse and systematise impacts in general as midpoint and endpoint effects. Damage to human health can be through different damage pathways as illustrated by Fig. 1.3. We cannot ignore the impact of environmental health in our quest to improve human health as described in the goal for 2030: to substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.

Through transdisciplinary understanding and new technologies such as AI, we are seeing, and will continue to see, new solutions arising. Interactions between for example SDG 3 and SDG 13 represent opportunities for transdisciplinarity and systems thinking to be used to mitigate climate change and impact on health of future populations. As cross-sectoral and institutional collaboration will become increasingly important if change is to be effective. The following chapters will further illuminate the role of SDGs and their contribution to sustainable good health and well-being.

Appendix

1.1 Sustainable Development Goal 3 Targets to Ensure Healthy Lives and Promote Well-Being for All at All Ages

• 3.1. Maternal mortality

  • By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

• 3.2. Neonatal and child mortality

  • By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.

• 3.3. Infectious diseases

  • By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, waterborne diseases and other communicable diseases.

• 3.4. Noncommunicable diseases

  • By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being.

• 3.5. Substance abuse

  • Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

• 3.6. Road traffic

  • By 2020, halve the number of global deaths and injuries from road traffic accidents.

• 3.7. Sexual and reproductive health

  • By 2030, ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes.

• 3.8. Universal health coverage

  • Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.

• 3.9. Environmental health

  • By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.

  Goal 3: Means of implementation for the targets.

• 3.a. Tobacco control

  • Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate.

• 3.b. Medicines and vaccines

  • Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries. Provide access to affordable essential medicines and vaccines in accordance with the Doha Declaration on Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Public Health, which affirms the right of developing countries to the fullest use of the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) regarding flexibilities to protect public health and, in particular, provide access to medicines for all.

• 3.c. Health financing and workforce

  • Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.

• 3.d. Emergency preparedness

  • Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

  Target 3.8. Universal health coverage

  • This target can be seen as an overarching one that supports the achievement of the other targets. It is derived from the Millennium Development Goals, the new targets and the means of implementation.