The Millennium Development Goals

Abstract

W A /ith this issue, EPIDEMIOLOGY joins with more than 230 journals throughout the world in the Council of Science Editors' Global Theme Issue on Poverty and Human Development.' The purpose of this initiative is raise awareness, stimulate interest, and stimulate research into and human development.' For us as epidemiologists, this theme translates to a focus on and health. The Millennium Development Goals (MDGs)2 include a litany of high-priority health concerns (Table). Although these Goals cry out for the attention of epidemiologists, they are seldom mentioned in epidemiology circles. The Millennium Declaration and the MDGs were adopted by the member states of the United Nations in 2000; we are now midway between their adoption and the target date of 2015. Results are mixed, but UN officials are confident that the Goals are achievable-if adequate resources are forthcom 2 ing. Although these necessary resources are primarily financial, they also include a knowledge base to guide the effective deployment of interventions. What are the underlying causes of these health and development concerns? What interventions are most successful? How can indicators of success best be measured? These questions are the domain of epidemiologists. The 8 MDGs and selected indicators are presented in the Table. Progress has been made in eradicating extreme and hunger (Goal 1), but this progress has not been uniform. Rates continue to be high in both sub-Saharan Africa and Southern Asia (primarily the Indian subcontinent). Jeffrey Sachs3 argues that the poorest countries are trapped below the first rung of the development ladder, unable to gain a foothold. African countries in particular are stuck in this poverty trap. Where is being reduced, income inequality is stark and rising. The poorest 20% of the population in developing countries was responsible for only 5% of national consumption in 1990, and this figure declined to 4% in 2004; the lowest share is for Latin America and the Caribbean, at 3%.4 Rates of primary education (Goal 2) and of disparity between girls' and boys' enrollment rate (Goal 3) are improving-again, with dramatic differences among regions. An intervention that illustrates the interrelated nature of the Millennium Goals is providing meals for schoolchildren, which could simultaneously improve their health, their ability to focus on their schoolwork, and their attendance at school.3 Goal 4 calls for a reduction in child mortality. Deaths to children under the age of 5 years (per 1000 live births) have decreased in developing regions from 106 in 1990 to 87 in 2004. Still, these numbers are in sharp contrast to the current rate of 7 per 1000 in developed regions.4 Similarly, the infant mortality rate has declined from 72 to 59 (per 1000 live births) in developing countries, whereas the rate in the developed world is 6. Rates are highest in sub-Saharan Africa. The biggest reductions in child mortality have occurred for children who live in urban areas, whose mothers have some education, and whose families are in the upper income levels.2 There are also unexpected variations among countries; for example, Cuba has a lower infant mortality rate than the United