Advancing sustainable development through public health professionals

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In 2015, one hundred and ninety-three countries of the United Nations General Assembly adopted the ‘2030 Agenda for Sustainable Development’. Sustainable Development Goals (SDGs) have thus become global development framework for the future. This agenda also highlights changing global priorities and provides opportunities for reforms at the country level to address key development challenges, which may hinder progress towards achieving SDGs.

One of the key prerequisites for achieving sustainable development is good health and the 2030 agenda reflects the complexity and interconnectedness of the two. Success in achieving SDGs, especially SDG2- zero hunger; SDG3-good health and well being; SDG6-clean water and sanitation; SDG10- reducing inequalities; and SDG13-climate action are particularly possible through public health action and interventions at the community and the country level. For example, climate change is causing serious damage to crop production, their nutrient values and food systems. These changes exacerbate population vulnerabilities and may lead to nutrient deficiencies at the population level. Public health nutrition programmes would be required to address the public health challenges emerging out of climate change. Hence, one of the most promising ways to ensure success in achieving SDG goals, especially in the developing countries, is to invest resources in strengthening public health systems. It is pertinent to highlight that Universal Health Coverage (UHC) will be integral to achieving good health and wellbeing; ending poverty and reducing inequalities.

Some of the major challenges that developing countries face today, and will continue to face in the future pertain to inadequacy of societal-level preparedness for extreme weather events, infectious disease outbreaks and pandemics, food and health security, inequity in distribution of resources and others. For instance, impoverishment of households because of healthcare expenditures, lack of financial risk protection and concentration of wealth and inequity at the societal level are leading to loss of trust in public policies and public systems. In this context, availability and understanding of reliable data on all SDGs is critical to monitor progress and take corrective actions. In addition, there is an urgent need to set up trans-disciplinary institutional network and mechanism for monitoring progress on SDGs.

Public health professionals can play a key role in design, implementation and evaluation of policies and programmes directed towards achieving SGDGs. Furthermore, the public health professionals like physicians, epidemiologists, public health nurses, economists, sociologists, nutritionists, biostatisticians, health managers, environmental health experts, bioethicists, veterinarians and others not only form the backbone of the public health architecture, but also bring together a diverse set of expertise required to undertake the above-mentioned roles. Since, public health by design is an inter-disciplinary field of action to promote health, prevent diseases, provide treatment and rehabilitation, and prolong life, it provides a fundamental platform for potential synergies across all development sectors.

NITI Aayog, which is an apex agency of the Government of India for monitoring progress on the SDG goals, released its ‘Baseline Report of the Sustainable Development Goals (SDG) India Index’ in December 2018. It comprehensively documented the progress made by India’s states and union territories towards implementing the 2030 SDG targets. One of the key message that emerges from the report suggests that states need to do more not only in terms of governance, but also in terms of investments to achieve desired progress on the SDG indicators. Furthermore, evidence suggests that low density of public health professional at the population level results in poor health outcomes and indicators, which also explains state-level disparities.

To address one of the concerns of the NITI Aayog, the state governments should set up cross-disciplinary advisory councils for each SDG goal and engage public health professionals directly or through their professional associations. These public health professionals are already working in the public health system, healthcare sector, UN agencies, medical colleges, nursing colleges, public health schools, and in the NGOs. For example, two of the largest public health professional bodies in India are Indian Public Health Association and Indian Association of Preventive and Social Medicine. Together, these associations have a membership of more than 10,000 public health professionals, and can be engaged at the state and district level for monitoring and evaluation of public programmes, policy advocacy and advice to the local leadership. The members of these professional associations have requisite skills and competencies in cross-cutting areas of research and practice, monitoring and evaluation, technology assessment, public policy analysis, entrepreneurship, conflict management and leadership, to name a few.

Since a large proportion of public health professionals work in the private sector and with non-governmental agencies in health and development sector, national and state governments can leverage network of these professional public health associations to engage purposefully with private sector in delivering social and public policy goals to achieve SDGs. Going forward, these professional associations can also leverage their diversity to engage with various government institutions and departments working in health and other social sectors to bring social science research, health system research and operational research evidence to the knowledge of programme managers and policymakers to inform public policy and programme designs and make a meaningful impact at the population level.

Leveraging strengths of these professional public health associations could be transformative in health, social and development sectors as their professionals are embedded in both public and private sector and work closely with communities across rural and urban areas. Their cross- disciplinary skills and team-based approach are the ingredients to solve public health and social problems at the village, district and state level, given the socio-economic diversity and implementation challenges of public policies and programmes.