Addressing Global Mental Health: The Role of Sustainable Development Goals
On September 25, the United Nations voted unanimously to enact the Sustainable Development Goals (SDGs). “Transforming our world: the 2030 Agenda for Sustainable Development” officially comes into effect on 1 January 2016, essentially replacing the Millennium Development Goals that expire later this year. These new SDGs provide countries with a comprehensive development framework that incorporates both older development goals, such as the eradication of poverty and the reduction of inequality, as well as new goals, such as the reversal of environmental degradation. In the coming months and years, governments will discuss how to interpret the provisions and create effective progress indicators specific to their regions. This article considers the role of mental health and well-being within the SDGs, and looks at the necessary considerations that should be taken to develop appropriate indicators for mental health.
The third Sustainable Development Goal (SDG 3) focuses on “[ensuring] healthy lives and [promoting] well-being for all at all ages.” Within the goal itself are thirteen key targets that create a diverse and interdisciplinary approach to addressing health issues. Some of these targets tackle maternal and child health by aiming to reduce the number of preventable deaths for newborns and children under five. Others focus on minimizing the prevalence of road traffic injuries, which requires the consideration of both infrastructure and emergency response procedures.
One important target is SDG 3.4, which aims to “reduce by one third premature mortality from non-communicable diseases [NCDs] through prevention and treatment and [to] promote mental health and well-being [by 2030].” The worldwide acknowledgment of mental health as a pressing issue is something the WHO has been pushing for since the initial formulation of the MDGs. Their 2010 report, “Mental Health and Development: Targeting people with mental health conditions as a vulnerable group,” exemplifies the high degree of importance that WHO places on mental health. The WHO’s concern with mental health issues is founded, in part, on their recognition that individuals suffering from mental health issues are often subject to great injustice. Stigma and discrimination, physical and sexual victimization, and barriers in attaining education and employment are all important mental health issues. Given these factors, individuals suffering from mental health issues often experience significant challenges that need to be addressed through the sustainable development of health care systems and community-level service programs.
Other health actors, including physicians, researchers, and health organizations, have also supported the inclusion of mental health as part of the SDGs. These actors often draw upon their experiences working with this population to further strengthen the urgency of including mental health support in the development agenda.
Given the widespread recognition of the importance of this issue, it is surprising that mental health is presented as an after-thought, of sorts, in a discussion about NCDs. NCDs include a wide variety of health risk factors that contribute to premature mortality. In fact, over half of the deaths from NCDs in the global north are caused by pulmonary heart disease, cancer, respiratory diseases, and diabetes. In principle, it is possible to reduce premature mortality from NCDs through “prevention and treatment” alone without meaningfully promoting “mental health and well-being.” This leaves open certain policy questions, such as why mental health was included in this particular target, and whether mental health was given a significant enough role within the SDGs.
Despite the limited inclusion of mental health issues within the SDGs, this issue is of importance to the WHO and other stakeholders who are considering different mental health indicators. An important consideration for policymakers when creating these indicators is to look at international working papers that discuss and assess pre-existing indicators. One of the most prominent attempts comes from the WHO’s “2013 – 2020 Mental Action Plan,” which outlines broad objectives and indicators to address this issue. These include strengthening global governance for mental health by ensuring that eighty percent of countries have developed their mental health policies to reflect international human rights instruments and providing responsive mental health and social care services for communities by increasing coverage by twenty percent. The suggestions are broad and are meant to capture global goals for mental health. As such, countries are able to apply these goals to their country’s particular health needs.
In addition to examining international working papers, another issue to consider when implementing indicators is the aggregation of data. That is, when a country reports its health outcomes, the data often looks at the country as a whole without examining the health outcomes of particular communities. In this way, aggregate data can unintentionally mask significant health inequalities between populations. A population as a whole might see great improvements in mental health coverage, but vulnerable communities within the population might still face significant barriers to these services. A number of different global health and international development researchers have suggested the inclusion of required reporting methods that include health outcomes of vulnerable populations. Having indicators that consider particular populations better ensures accurate measurements of improvement for all groups.
There is little controversy within the international community when it comes to the inclusion of issues of mental health into the SDGs. However, given the ambiguity of SDG 3.4 and the difficulty of generating accurate indicators for mental health, creating effective objectives for domestic policy specific to mental health is difficult. Time will tell if mental health will be meaningfully addressed, or if it is simply a well-meaning, though ineffective, addition to the SDGs.