Tag Archives: sustainable development goals

Measuring Success: Your Guide to the New Global NTD Indicator

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Community Drug distributor Raymond Kenneh with Nana Jusu.

Community Drug distributor Raymond Kenneh measures Nana Jusu with a dosing stick.

The Headline: The Inter-agency and Expert Group on the Sustainable Development Goals (IAEG-SDGs) has approved the inclusion of an indicator for neglected tropical diseases (NTDs).

What are the Sustainable Development Goals?

The Sustainable Development Goals (SDGs) are a set of 17 global targets that will define and guide the international community’s efforts to end extreme poverty, fight inequality and injustice, and create a healthier environment by 2030. They are essentially the world’s to-do list, and they were adopted by the United Nations (UN) General Assembly in September.

A bit of history: The SDGs replace the eight Millennium Development Goals (MDGs), which were established in 2000 and expire this year. The MDGs accelerated progress in many of their target areas, unifying the global community behind common goals.

What’s all this about an indicator?

In addition to “targets” that establish broad objectives, the SDGs include indicators to measure success on the targets. The indicators serve as a rallying point for the global community. With so many issues competing for resources, measurable, attainable goals are critical to command attention.

For this very reason, the NTD community has been pushing for an indicator to measure global NTD progress. More than 1.4 billion people around the world are infected with at least one NTD, but because of their low mortality rate, these diseases don’t get much attention on the global stage. However, treating NTDs is necessary to ensure that efforts to improve nutrition, education, health and economic productivity are successful. Controlling and eliminating NTDs is critical to ending extreme poverty.

The indicator, “number of people requiring interventions against NTDs,” at a meeting of the IAEG-SDG in October.

How did this happen?

NTD advocates have been pushing for an indicator for months. NTDs were little more than a footnote in the MDGs, so the NTD community has been working hard to secure some much-deserved attention in the SDGs.

The Global Network worked closely with the NTD community to advocate for this indicator, through correspondence with IAEG-SDGs members, an oral statement urging the inclusion of an indicator during a high-level meeting at the UN’s Economic and Social Council, and a community letter to all IAEG-SDGs members. END7, the Global Network’s advocacy campaign, also led three advocacy petitions urging the UN to prioritize NTDs in the SDGs.

So, we’re all good now, right?

Not quite. Once the IAEG-SDGs finishes its work, it will submit its proposed recommendations for the indicator and monitoring framework to the UN Statistical Commission. More unified advocacy from the NTD community will be needed to ensure that the final document is adopted in March 2016 without change.

A Moral Imperative: END7 Student Simran Dhunna Urges World Leaders to Prioritize NTDs

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END7 has just announced the members of the 2015-2016 Student Advisory Board. Congratulations to all of our new and returning board members, and our sincere thanks to everyone who applied! The Student Advisory Board will mentor other student leaders and advise END7 on student engagement for the entire school year. By contributing their time and expertise to the activities of the Board, representatives play a major role in charting the course of the END7 campaign.

As world leaders prepare to finalize the Sustainable Development Goals (SDGs) this September — and their indicators in March — we asked students to tell us how they would make a case to world leaders to include a goal to control and eliminate neglected tropical diseases. Read END7 Student Advisory Board representative Simran Dhunna’s response below.

Simran Dhunna E7

After the Ebola outbreak in West Africa, the world suddenly became acutely aware of the gaps that exist in global health governance and health systems. The World Health Organization demonstrated that there are deep-rooted structural limitations in its own system of finance and accountability. Furthermore, the infectious disease events of this year, including but not limited to Ebola, have shown the debilitating effects of neglect on populations without access to healthcare. For example, we’ve stood by as civil unrest has continued to exacerbate the spread of NTDs, such as the outbreak of Dengue in Yemen. Within and beyond the 17 diseases that the WHO designates as “Neglected Tropical Diseases,” lies an unfortunate truth: communities and the endemic diseases they suffer from are neglected because they are trapped in a cycle of poverty. Thus, the case I would make to world leaders rests on this principle: neglected diseases do not function in a vacuum. Rather than being an isolated public health issue, NTDs are multifaceted, in that they interact with virtually every aspect of society.

The SDGs, naturally, include an emphasis on poverty and climate change. NTDs encompass both of these topics. Firstly, it has been well established through clinical and academic literature that neglected communities remain generally at the lowest tiers of socioeconomic status. In essence, diseases such as sleeping sickness or lymphatic filariasis disproportionately affect the poor much more than every other socioeconomic class. This is not a coincidence. Individuals who suffer from NTDs have nearly every facet of their lives affected, such that they cannot pursue their most basic goals and aspirations, like an education or sustainable employment. To the world leaders, I would say that NTDs are so interwoven with issues of poverty, that to not include diseases of poverty in our global agenda would be a disservice to the SDG that aims to eliminate poverty. In other words, our strengthened efforts to eliminate NTDs could result in more children going to school, getting a job and having prosperous lives. Removing this massive health burden can be the key to lifting millions of individuals, and neglected communities, out of poverty.

One of the other SDGs concerns itself with climate change. The unique characteristic about neglected tropical diseases is that they profoundly interact with the environment. Many of the NTDs are zoonotic or parasitic/helminthic diseases. Thus, there is an inevitable cause-and-effect relationship between a community’s environment and its state of health. Just as several global health professionals use a ‘One Health’ perspective, it’s essential to recognize the unique animal-human interface that is so inherent in NTDs. Changing climates mean that the ecology and evolution of vectors and other pathogenic organisms is also constantly fluctuating. The migration patterns of mosquitos, for example, could be spreading an outbreak to other areas not equipped to deal with it. We already see the rapid development of certain diseases like MDR-TB, in which organisms are spreading resistance genes at a faster rate due to environmental factors. Moreover, weaknesses in environmental systems, such as sanitation and sewage, lend themselves to further public health concerns. Hence, NTDs are not isolated to one community and one clinical issue – they are affected by the agricultural practices of a given region and the environmental policies that govern whether individuals have access to clean water. The ecology and environment of humans, which is undeniably affected by climate change, is a fundamental contributing aspect of NTDs. Including climate change in the SDGs necessitates that NTDs also be addressed, because one is a central causal factor of the other.

Finally, to the world leaders I say this: having broad goals is admirable, but having achievable goals is necessary. Campaigns like END7 demonstrate the austerity in addressing NTDs: medications that eliminate certain neglected diseases exist. There are simply no systems in place for neglected communities to access them. I would implore the world leaders to consider the feasibility of adding NTDs to the Sustainable Development Goals, because eliminating NTDs can be done through appropriate dissemination and implementation of treatment programs, such as deworming initiatives.

The elimination of NTDs is very much a reality in the future. The problem lies in the lack of existing frameworks to address them: there is limited global commitment to eliminating NTDs, and a lack of incentive to invest R&D into them. What I see is a gap in commitment to a worthwhile cause, one that demands as much attention as any other global health or development issue. Dedicating a Sustainable Development Goal to ending neglected tropical diseases is not only an achievable target – it is a moral imperative for world leaders to act upon.

END7 Student Advisory Board representative Simran Dhunna is a junior studying microbiology and global health at the University of Toronto.

Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015.

What Gets Measured Gets Counted

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A man is disfigured and shunned by his community. A child is too tired and sick to go to school. A woman is blinded by an infection. These are just some of the effects of neglected tropical diseases (NTDs). There are 1.4 billion of these stories — one for each person whose life is impacted by an NTD.

We can’t tell every one of these stories, so we rely on numbers. 1.4 billion people. More than half a billion children. These numbers are our rallying cry. Statistics tell us where we are improving and where we are failing, and provide a sense of scale for problems too big to comprehend.

Fifteen years ago, the United Nations (UN) established the Millennium Development Goals (MDGs), eight international development goals that brought together the global health and development community to tackle some of mankind’s greatest challenges. The eight narrow targets “helped channel everyone’s energies — and money,” according to NPR’s Nurith Aizenman. Unfortunately, that meant issues without clear targets were left behind. NTDs were listed in the MDGs as “other diseases,” and had no specific indicator. As a result, these diseases, true to their name, have remained neglected.

When the MDGs expire at the end of 2015, they will make way for the Sustainable Development Goals (SDGs), a new set of targets that present a second chance to ensure NTDs receive the attention they deserve. Back in 2000, the process of developing the MDGs was “brilliantly simple,” Mark Malloch-Brown, a member of the original UN team that developed the MDGs, told NPR. But things are very different this time around. With the MDGs far surpassing initial expectations, all eyes are on the SDGs, and the process is far from simple.

Following years of politicking and debate, the UN Summit is expected to adopt the finalized SDGs in September, and the UN Statistical Commission plans to set official indicators in March 2016. At last count, the proposal contained 17 goals and 169 proposed targets. Though critics say the proposal’s broad scope will dilute its effectiveness, these myriad goals will level the playing field, elevating important issues that were ignored by the MDGs.

NTDs are included in Goal 3 of the proposed SDGs, which reads, “by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.” This explicit mention of NTDs is already an improvement over the MDGs, but what does it mean to “end the epidemic”? A clear indicator will be key to rallying support for NTD elimination.

But an initial draft of indicators presented during the March meeting of the UN Statistical Commission failed to include indicators for NTDs. As we have learned from the MDGs, “what gets measured gets counted,” said Global Network Managing Director Dr. Neeraj Mistry in remarks at the UN Economic and Social Council’s High-Level Political Forum earlier this month.

To effectively control and eliminate NTDs will require a coordinated global effort, and finding the right set of indicators will be extremely important. The NTD community strongly recommends:

90 percent reduction in the number of people requiring interventions against NTDs by 2030

Treating NTDs is extremely cost-effective and contributes greatly to the success of broader development goals. With medications already available, NTD elimination is not only possible, it’s within our grasp. And with a clear indicator, we can meet this target within the next 15 years.

Update: You can join the effort by asking your country’s representative to the UN to support and promote the inclusion of a global NTD indicator in the SDGs.

Photo: Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015.

“Worm Index” Reveals Association Between NTDs and Human Development

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A new “worm index” developed by Sabin President Dr. Peter Hotez and Baylor College of Medicine’s Dr. Jennifer Herricks reveals a strong association between neglected tropical diseases (NTDs) and human development.

The index was based on the disease burden of major worm (or helminth) infections: intestinal helminths, lymphatic filariasis and schistosomiasis, which can lead to diarrhea, anemia, disability, disfigurement and even death. Increasing evidence over the last decade links the most common NTDs to significant adverse impacts on both human and economic development.

Hotez and Herricks created the worm index (see map below) using World Health Organization (WHO) data on disease burden for these worm infections in the world’s 25 most populous countries. Countries’ worm indices range from 0-1, with higher indices indicating a higher disease burden.

Heat map for worm index of the 25 most populous countries:
Worm Index Map

Hotez and Herricks then compared their worm index to the United Nations Development Programme (UNDP) human development index (HDI), which measures a country’s achievement in education, standard of living and years of life lived in good health.

This side-by-side comparison uncovered a strong negative correlation (see graph below).

Comparison of HDI to worm index in the 25 most populous countries:
worm_graph

It is tempting to conclude from these results that worm infections hold back human development, but it could just as easily be that situations of poverty (poor healthcare infrastructure and lack of access to clean water and sanitation, for example) result in worm infections. “It is possible or even likely that the causes and effects flow in both directions,” the researchers state.

That said, evidence illustrating this relationship abounds. Hotez and Herricks cite studies from Kenya showing that deworming led to improvements in school attendance and participation, and the effects of deworming could still be seen into adulthood—adults who received deworming treatments as children were more productive, both in hours worked and wages earned. Higher wages and more schooling are critical tools for achieving the Sustainable Development Goals (SDGs).

“Given the strong associations between helminthic and other NTDs and mental, physical, and economic human development, vulnerable and excluded populations, and HDI, in the coming months and years it may become essential to give due consideration to eliminating helminth infections as a means to achieve SDGs. Of course, poverty, “Water, Sanitation and Hygiene” (WASH), and nutrition play an important role in health outcomes. As we look to reduce poverty and increase WASH and nutrition, we must also focus on chronic diseases such as helminth infections that reinforce the cycle of poverty and malnutrition. Therefore, we suggest that the NTDs need to be an important consideration in any discussion about the SDGs, and helminth control and elimination as proposed by the 2012 London Declaration for NTDs must be embraced by the SDGs and the sustainable development community.”

No matter which came first—poverty or worms—the fact is that these infections impact millions of people every day, disabling communities’ workforces and further limiting economic growth where it’s needed most.