How political epidemiology research can address why the millennium development goals have not been achieved: developing a research agenda
Author(s)/Editor(s): Gil-González D, Ruiz-Cantero M T, Álvarez-Dardet C
Publisher/Organizer: Journal of Epidemiology and Community Health
Publication date: April 2009 Volume 63, Number 4
"The Millennium Development Goals (MDG) progress targets have not been met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth review in order to discover the reasons behind this lack of progress in achieving the MDG. From a political epidemiology perspective, the intention here is to identify the political elements affecting the social factors impeding MDG fulfilment and, at the same time, to suggest future public policies and appropriate proposals that are both more coherent and supported by broader, empirical knowledge of the relevant issues.
The 8 Millennium Development Goals (MDG) and 18 Millennium Targets (MT), with their respective technical indicators for measuring progress, aim to influence the international political agenda in order to achieve minimum levels of well-being and health worldwide by the year 2015.1 Those MDG dealing directly with reducing infant mortality, improving nutrition and maternal health and the fight against infectious diseases are influenced by all the other goals, such as the eradication of poverty, universal access to education, gender equality, environmental sustainability and global partnership for development.
In spite of initial political support and the fact that this is an agreement aimed at achieving minimum standards, halfway through the proposed timescale, the expected progress has not been achieved.2 3 Given this context, the construction of a Political Epidemiology Research Agenda4 could contribute towards a more objective approach to the situation, identifying those factors that are hindering MDG achievement while at the same time providing future policies and proposals with greater coherence and supported by a broader, empirical knowledge base.
Epidemiology has contributed to research on MDG through a description of health problems, and has also identified and analysed some of their causes and other barriers hindering MT achievement.5 It has also revealed methodological problems involved in measuring MDG progress, and in the evaluation of interventions carried out to this end.6 Concerned as it is with the study of all factors above populations (epi–demos–logos), epidemiology not only deals with individuals; social epidemiology, for example, also highlights social factors affecting health, such as poverty.7 Therefore, it is hoped that research results will raise awareness among decision-makers and their constituencies as regards the need to take social issues into account. From a political epidemiology perspective, the intention is to go even further, and to identify the political elements affecting the social factors that are impeding MDG fulfilment. This can be achieved simply by applying epidemiological methodology to the study of the effect that decisions (or lack of decisions) made by the institutions representing political power have on a population’s health.8 9
Public policies, and their relation to health, are still not part of mainstream epidemiology, which continues to consider health as apolitical, and applies a definition of health that is centred on the individual illness rather than on society health problems.10 As a result, health policies are equated to healthcare services policies, and inequalities in health distribution are considered to be the result of individual problems (chosen lifestyle) or of how healthcare is implemented. This perspective has the effect of directing political attention towards the most manageable variable, the healthcare services. However, health inequalities have a political basis.10 Information on health inequality is not sufficient in order to decide what is inevitable and what is unjust, and such a decision does not depend solely on logic and empirical research, but also on an assessment of politics and ideology.”