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Sdg 3 Ensure Healthy Lives and Promote Well 81 SDG 3 ENSURE HEALTHY LIVES AND PROMOTE WELL- BEING FOR ALL AT GOOD HEALTH AND WELL-BEING GOOD HEALTH ALL AGES GOAL #3 Philippa Howden-Chapman José Siri Elinor Chisholm Ralph Chapman Christopher N.H. Doll Anthony Capon GOOD HEALTH AND WELL-BEING GOOD HEALTH GOAL #3 82 GOOD HEALTH AND WELL-BEING GOOD HEALTH GOAL #3 83 84 INTRODUCTION sdg 3 seeks to ensure health and well- (sdg 11). Health and well-being are also being for all, at every stage of life. In critically dependent on a safe and enabling its 1948 constitution, the World Health environment, supported by mitigation Organization defined health as “a state of of climate change (sdg 13) and sustainable complete physical, mental, and social well- protection and use of the oceans (sdg 14) being and not merely the absence of disease and land (sdg 15) (Waage et al., 2015). or infirmity” and this is the definition The broad interdependence between envi- adopted here. sdg 3 is underpinned by nine ronmental and human health is recognised targets that broadly fall into separate, but in systems thinking and the new focus overlapping groups: reducing morbidity on planetary health (Whitmee et al., 2015; and mortality for vulnerable groups Gatzweiler et al., 2017). (mothers, newborns, the elderly and The text that follows provides an children), reducing communicable and overview of interactions at the goal level non-communicable diseases, reducing risk between sdg 3 – the ‘entry level goal’ factors (tobacco, substance abuse, road for this assessment – and the other 16 SDGs. traffic injuries and hazardous chemicals Taking into account all the underlying and pollution), providing universal targets of this entry goal, a set of key health coverage, and strengthening the interactions is identified between the sdg 3 health sector. While sdg 3 targets do not targets and those of other sdgs, principally specifically address the social determi- interactions within the range of the nants of health and well-being (csdh, highest magnitude or strongest impacts 2008; Solar and Irwin, 2010; Berkman et based on available scientific literature al., 2014), the importance of social factors, and expert knowledge. The typology and such as working conditions, income, seven-point scale for characterising the education, and housing, is recognised range of positive and negative interactions within other sdgs. Waage and colleagues described in the opening chapter to this noted that achieving health and well- report is used to assess the selected target- being for all relies not only on meeting the level interactions and the context in which sdg 3 targets, but also on ending poverty they typically occur. Illustrative examples (sdg 1), providing access to education (sdg 4), from different world regions show how achieving gender equity (sdg 5), reducing these linkages manifest in practice. Policy inequality between and within countries options are identified for how to max- (sdg 10), and promoting peace (sdg 16). imise positive interactions and minimise Health and well-being also relies on negative interactions between now and adequate services and resources, including 2030, and beyond. The chapter concludes infrastructure (sdg 9), food security and with a list of key knowledge gaps related agricultural production (sdg 2), decent to the interactions studied. work (sdg 8), sustainable consumption (sdg 12), provision of water and sanitation (sdg 6), access to energy (sdg 7), and resilient and inclusive cities that provide universal access to housing and transport 85 KEY INTERACTIONS AT GOAL LEVEL 3 + 1 3 + 2 Poverty reduction leads to improved health Health and nutrition are inextricably and well-being, while good health is a linked. The relationship between food strong enabling factor for effective poverty consumption and health is highly reduction. In fact, a healthy population context-dependent. Under-nutrition is is a prerequisite for development, consti- generally associated with poverty, whereas tuting an engine for economic growth. overconsumption can accompany either Conversely, it is very difficult to ensure poverty or wealth and may be associated health without addressing poverty. At with poor nutritional intake. The rela- low income levels, rising incomes lead to tionship between food and nutrition is health gains as basic needs are fulfilled bidirectional: in some cases, ill health (such as nutrition, health care, health can diminish the ability of households or awareness, and shelter). Increased income individuals to farm and produce food, or is likely to enable positive interaction to work and acquire food. Fundamentally, effects, yet beyond a certain threshold, meeting caloric and micro/macro nutri- further increases may not lead to further ent needs is a primary requirement positive health effects. Similarly, poverty for health. Interruptions in food intake reduction will have a greater effect and quality, whether short- or long- on health in the presence of diseases asso- term, can have lasting impacts on mental ciated with poverty, including aids, and physical development, impacts tuberculosis and malaria, as well as ne- that begin during pre-natal growth and glected tropical diseases, diarrheal and continue through childhood. Good respiratory diseases, and the consequences health also depends on consumption of of malnutrition. Where poverty reduction sufficient micronutrients over the life is most needed, governance structures course. Reducing hunger will result in are often ineffective, and great health immediate improvements in health, challenges usually exist. Reducing poverty and carries long-term implications for will generally result in immediate and physical, psychological and neurological long-term improvements in health. This development. Increasing agricultural relationship is highly bidirectional – production may improve food security and ill health can constitute an inescapable reduce hunger; however, it also impacts poverty trap, where governmental on the environment, with potential impli- redistribution is absent. Before conven- cations for infectious disease transmission, tional poverty reduction policies can and can negatively affect health through be effective, the poorest of the poor often contamination of local environments with need special assistance to enable them arsenic, cadmium and other pesticide to engage effectively with poverty reduction residues. Technological elements of food measures. Good governance, plus invest- and agricultural systems, including ment in health, skills, infrastructure and genetically modified organisms (gmos), education, is crucial to reducing poverty. monocultural crop production, food processing, forest clearing, and irrigation, have the potential to increase production, 86 but also to harm the environment and 3 + 5 adversely affect future food security. Improving gender equality generally en- There is much uncertainty about how to ables the achievement of better health. manage zoonotic diseases related to Women’s health issues are in some agricultural production. Food security will contexts under-prioritised and under- also be increasingly affected by climate- funded, and promoting gender equality induced extreme weather events, as well as in these cases and lead to easy health geopolitical and economic considerations. gains. Moreover, mothers make most health decisions for their children, so their 3 + 4 empowerment leads to improved child Access to high-quality education is asso- health outcomes. Increasing participation GOOD HEALTH AND WELL-BEING GOOD HEALTH ciated with better health, at both of women in the paid work force can individual and community levels. Maternal lead to overall economic gains and hence and paternal education can each influ- improved health. Health gains may be GOAL #3 ence the health status of children – immediate (when they directly improve indeed, the favourable impact of maternal resources or access for women) or long- education is well known in developing term (mediated through childcare). countries and has also been demonstrated The strength of the enabling interaction in the developed world. Informal edu- among these goals will be greatest where cation and other sources of information women face the greatest inequalities. can also play a strong role in good or In general, gender equality has a greater ill health: for example, misinformation effect on health than health on gender can lead to poor health decisions in equality, although improved health both developing- and developed-world of women or children can offer women contexts (as in the case of anti-vaccine more time and resources to participate in sentiment). Education can affect health decision-making and economic activities. immediately through changed behaviour or the adoption of new technologies. It 3 + 6 can also affect long-term health through In all contexts, improving water quality increased income, opportunity, self- and access leads to improved health reliance and empowerment. Health bene- – without clean water and adequate fits from education are not limited to sanitation it is difficult to achieve health early schooling – lifelong learning offers gains. The latter are immediate in terms important opportunities in contexts of of decreased water-borne infections rapid change. While these relationships (e.g. acute diarrheal infections, viral are universal, greater gains are possible hepatitis) and improved nutrition; in developing-world contexts. New improving water quality and sanitation technologies (such as health promotion also leads
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