On June 23, 2018, twelve boys and their soccer coach became trapped miles inside a flooded cave in Thailand. The team spent more than a week in complete darkness deep inside the cave, with no food and a dwindling supply of oxygen, before a team of search and rescue divers located them on July 2. But the danger was not over. The boys were weak, and there was an imminent risk of new storms inundating the cave and making a rescue impossible. Over the next week, highly skilled Thai emergency personnel worked with experts from other countries to rig a system for extracting the team. Countless people around the world anxiously monitored news reports about the rescue operation and celebrated when the final team member was carried to safety on July 10.
The human interest news stories that capture our attention are usually ones featuring individuals overcoming perilous situations. We can all relate to the terror of being trapped in a dark cave. That emotional connection made it easy for reporters to convince us that there was an urgent need for the boys to be extracted. It is much harder for us as humans to be captivated by news reports about populations. One celebrity dying of a drug overdose can be a lead news item for days. Tens of thousands of other Americans dying from opioids last year does not grab attention in the same way, even though this alarming public health crisis is a priority for the U.S. public health system. We celebrate saving 13 young people from drowning in Thailand. We don’t think about that in the context of the 300,000 people worldwide who will die of drowning this year.
The most riveting news items also tend to focus on immediate crises rather than long-term ones. We have short attention spans. The boys in Thailand were rescued a few days after they were found. If they had remained in the cave for months, waiting until the rainy season was over so they could walk out of the cave, we would have lost interest in the story. We saw that happen during the Ebola outbreak in West Africa a few years ago. Media attention dwindled after a few weeks even though the outbreak raged on for more than a year. Stories about famines, refugee crises, and other humanitarian catastrophes that evolve in slow motion don’t make the headlines.
In sum, there are two big challenges for communicating about public health achievements. One is that public health focuses on large groups of people rather than individuals. The other is that most public health interventions are designed to have an impact over many years rather than just days or weeks. Public health successes are measured over 5- and 10-year spans, or longer, and we often do not expect to see major year-to-year gains.
Introducing the SDGs
When we look at countries around the world (large populations) over the past 20 or 25 years (a long period of time), we can see that the world has made incredible gains in public health. Between the years 2000 and 2015, the percentage of babies who die before their fifth birthdays decreased by 44%. Millions of schoolchildren and teenagers are alive and thriving today because they did not die of pneumonia, diarrheal diseases, or other common infections when they were infants or young children. During those same 15 years, the percentage of people suffering from hunger dropped by half. The maternal mortality ratio decreased by 37% as fewer women died from pregnancy-related conditions. The number of new cases of HIV infection each year decreased by 46%. The number of cases of malaria per year shrank by 41%.
The Millennium Development Goals (MDGs) were one of the driving forces behind these global public health successes. The MDGs were a series of global goals implemented by the United Nations, member countries, and hundreds of partner organizations between the years 2000 and 2015. During the MDG era, the world made remarkable progress toward ending poverty. The MDGs also encouraged massive investments in public health interventions in lower-income countries.
The successors to the MDGs are the Sustainable Development Goals (SDGs), which will be in force through 2030. The SDGs are a broader set of goals than the MDGs. They aim to promote prosperity, advance public health, protect the environment, and foster peace in every country worldwide, not just the world’s lowest-income countries.
The SDGs include bold targets for global health: Ending preventable deaths of newborns and young children. Ending the epidemics of HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases. Significantly reducing the risk of dying before age 70 from cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Strengthening prevention and treatment of alcohol and drug abuse. Halving the number of people who die in road traffic accidents. Ensuring that everyone has affordable access to essential medicines and vaccines. Making sure that every country is prepared to respond to public health emergencies like Ebola outbreaks.
All of the SDGs are interrelated. Progress on the health goal will contribute to the achievement of goals related to economic growth, education, gender equality, water and sanitation, affordable and clean energy, decent work, infrastructure development, urban development, and environmental health. At the same time, progress on all of those other goals will contribute to the advancement of the targets related to SDG 3, which aims to “ensure healthy lives and promote well-being for all at all ages.”
The 2018 annual update on progress toward achieving the SDGs was just released. Significant progress is already being made for some of the SDG targets. We are on track to see remarkable improvements across many domains of human flourishing over the coming decade. The metrics being tracked by every country in the world as part of the SDG process will give us massive amounts of evidence about public health achievements, and those successes will be ones that should be communicated and celebrated.
Teaching the SDGs
The SDGs can be a valuable part of the teaching toolkit for educators who teach courses in global health, public health, and many other subject areas. The interdependence of the SDGs makes them a great framework for exploring the social determinants of health and the environmental determinants of health. (See, for example, chapters 3 and 4 in the new 3rd edition of Introduction to Global Health.) The SDGs can also be used as a foundation for understanding global health priorities and discussing ethical issues in global health. For professors teaching general education courses in the health sciences, the SDGs can be used to show how public health relates to their each student’s intended professional pathway. Students pursuing majors in economics, biology, education, sociology, environmental science, business, engineering, criminal justice, political science, and many others, including nutrition and the health sciences, will be able to identify SDG targets that directly relate to their course of study. They can then examine how those targets relate to the health targets. The SDGs also demonstrate the value of multidisciplinary collaboration and integrative scholarship.
To overcome the “one is more powerful than many” communication challenge, ask your students to look through key SDG indicators and imagine what it is like to live in a place where the SDGs targets have not been met. How would their daily lives be different if they did not have running water and electricity in their homes? How would their daily lives today be different if they had attended school for only a few years when they were children? What would it be like to plan for the future if they lived in a place where pregnant women have a high risk of dying in childbirth? How would their quality of life today be different if they had never had access to a physician, surgeon, or dentist? Would they even be alive today if they hadn’t had access to health services in the past? Translating goals for long-term progress in populations into immediate burdens on individuals will help your students understand the value of the SDGs and global public health more completely than merely focusing on the statistics.
To overcome the “fast is more powerful than slow” communication challenge, ask your students to create infographics that illustrate improvements in public health metrics during the MDG and SDG eras. Ask your students to work in groups to create an SDG profile for one low- or middle-income country. Students can gather relevant metrics from United Nations reports (such as the World Health Organization’s annual World Health Statistics report, the economic and other indicators available from the World Bank, the Human Development Report series from UNDP, and UNICEF’s annual State of the World’s Children report). For most of the SDG targets, indicators are available from 1990 or 2000 through the present, which allows changes over time to be displayed. Students can then use an office software program or one of the free online infographics generators to create a data visualization that uses bar graphs, pie charts, line graphs, and other displays of numbers to illustrate the progress their country is making toward achieving its SDG targets. This exercise will help your students build research and communication skills. The ability to create infographics and other visualizations for disseminating information on social media is a very marketable skill for students pursuing employment in a variety of fields.
Dr. Jacobsen is a professor of epidemiology and global health at George Mason University in Fairfax, Virginia.
She has written more than 150 peer-reviewed articles and is the author of Introduction to Global Health, Third Edition and Introduction to Health Research Methods, Second Edition.