Asthma and the UN’s Sustainable Development Goals 2030
The United Nations’ (UN) 2030 Agenda for Sustainable Development, aiming to transform our world, has set 17 Sustainable Development Goals (SDGs) and 169 targets. Among the SDGs, Goal 3 “ensure healthy lives and promote well-being for all at all ages” specifically addresses health priorities. Several targets and indicators address many of the issues to reduce the global burden of asthma, but there is an overemphasis on mortality rather than disability.
Building on the Millennium Development Goals that expired in 2015, the SDGs were endorsed by Heads of State and Government, and High Representatives at the UN Headquarters in New York in September 2015. The vision of the SDGs is ambitious: a world free of poverty, hunger and disease; a world where all life can thrive; a world with equitable and universal access to quality education at all levels, healthcare and social protection; and a world that assures physical, mental and social well-being for all. The SDGs, which came into effect on 1 January 2016, will guide global development actions until 2030.
Reduce premature mortality
Goal 3 has 13 Targets, in which Target 3.4 “By 2030, reduce by one third premature mortality from non-communicable diseases (NCDs) through prevention and treatment and promote mental health and well-being” is particularly relevant for asthma. Indicator 3.4.1 assesses the mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease (including asthma and chronic obstructive pulmonary disease). In 2015, deaths due to NCDs were 40 million, 70% of 56 million deaths globally. The major causes of death were cardiovascular disease (17.7 million), cancer (8.8 million), chronic respiratory disease (3.9 million), and diabetes (1.6 million). The risk of dying from one of the four main NCDsbetween 30 and 70 years old decreased from 23% in 2000 to 19% in 2015.
Although Target 3.4 includes chronic respiratory disease (asthma and chronic obstructive pulmonary disease (COPD)), it monitors mortality but not morbidity. Air pollution (Target 3.9) is associated with asthma attacks, but Indicator 3.9.1 “mortality rate attributed to household and ambient air pollution” also monitors only mortality. Focusing on mortality alone is not sufficient to capture the economic and personal burden of asthma. Asthma causes considerable morbidity and frequently affects the quality of life of asthma patients, especially those with poorly controlled asthma. To understand the burden of asthma, we need monitoring of emergency room visits and hospitalisations due to asthma attacks.
Universal health coverage
Target 3.8 states “Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. Indicator 3.8.1 monitors coverage of essential health services (including NCDs), and Indicator 3.8.2 monitors the “proportion of population with large household expenditures on health as a share of total household expenditure or income”. This target will address the financial barriers experienced by asthma patients and their families.
UHC is one of the key drivers of Goal 3, and health workers are the backbone of UHC. Target 3.C “Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries” is highly relevant for asthma. Indicator 3.C.1 monitors health worker density and distribution, but training is also crucial. Health workers require training in the diagnosis and management of asthma, and capacity building of health workers at the first referral level is crucial for decentralisation of asthma care.
Quality-assured asthma medicines
A significant burden for asthma is the lack of availability and affordability of quality-assured asthma medicines. Target 3.C states “Support the research and development of vaccines and medicines for the communicable and NCDs that primarily affect developing countries” and specifically highlighting “provide access to affordable essential medicines and vaccines in accordance with the Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on TRIPS regarding flexibilities to protect public health, and, in particular, provide access to medicines for all”. This clearly acknowledges the fact that some essential medicines may not be affordable in resource-limited settings, in part due to trade-related issues. Studies have reported that inhaled bronchodilators are widely available in developing countries but not inhaled corticosteroids. Although inhaled bronchodilators provide quick symptom relief, they do not effectively address the underlying problem of airway inflammation. Management of asthma requires inhaled corticosteroids (see Chapters 8 and 10). For Indicator 3.C.3 “proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis”, it would be particularly important to ensure essential asthma medicines are available and affordable on a sustainable basis in resource-limited settings.
“No one will be left behind” is the fundamental spirit of the SDGs. Globally, the number of people living with asthma is substantial. Asthma is a major chronic respiratory disease that not only results in death but also causes substantial suffering and reduced productivity; yet, asthma can be managed. The monitoring framework of SDGs in all countries should ensure effective management of asthma using affordable and quality-assured essential asthma medicines.