Introduction
Health's pivotal role in today's economy is often underestimated. While the common man often blames macroeconomic or financial indicators like inflation, interest rates, and GDP as key factors for a nation's economic prosperity, they often overlook crucial micro-level indicators such as "health" that can truly dictate a country's journey to economic growth. Health can be viewed as a capital asset, wherein ongoing inputs and purposeful behaviours serve as investments, yielding incremental enhancements in this health stock. If current decisions influence these increments, today's health stock will be a function of all present and previous prices, incomes, health behaviours, and initial health endowments (Smith, 1999). In the early 2000s, preceding the Sustainable Development Goals (SDGs), the Millennium Development Goals (MDGs) were introduced. Their primary focus was addressing extreme poverty and other crucial health and development objectives, primarily targeting impoverished developing economies (United Nations, 2017). The SDGs aim to impact every level and sector of society, promoting fairness, inclusion, and universality. Within this framework, SDG-3 focuses on enhancing health outcomes by reducing mortality, eradicating epidemics, preventing diseases, and implementing universal health coverage (UHC) to ensure accessible, affordable, quality, and equitable healthcare (Cerf, 2019). UHC, as defined by WHO in 2010, aims to provide people with necessary health services of sufficient quality for effectiveness without exposing them to financial hardship. South Africa is undergoing health system reform for UHC by establishing a national health insurance (NHI) program (Fusheini & Eyles., 2016). The NHI aims to pool funds for quality, affordable health services accessible to all, regardless of socioeconomic status. This article provides a concise overview of health-specific SDGs, explores associations in the health-development nexus, and elucidates how achieving the United Nations' health goals may contribute to the fulfilment of other SDGs.
Overview Of Sustainable Health Goals
The monitoring framework for SDG 3 – "Ensure healthy lives and promote well-being for everyone at all ages" – consists of 13 objectives and 26 indicators. It addresses maternity and newborn/child health, as well as communicable and non-communicable illnesses, drug addiction, accidents, reproductive health, and environmental health threats (Nunes et al., 2016). Investing in health systems is essential to overcome setbacks and address long-standing healthcare shortcomings, with a strong focus on achieving universal health coverage (UHC) to bind these goals together and enhance resilience against future health threats.
1. Health-Development Nexus
Health can be potentially seen as a cause and consequence of development. An individual's health determines their future economic status, impacting a country's overall productivity and growth. The economic resources an individual possesses at each stage of their life cycle influence their health outcomes (Smith, 1999). Analysing this micro-level phenomenon is crucial to grasp its macro-level implications. Understanding how health goals, seen through health and economic development perspectives, support attaining other development goals is fundamental. Poor health may restrict a family's capacity to earn income or accumulate assets by limiting work or raising medical expenses (Smith, 2019). Can being ill be costly?
Health could be considered as a stock that yields an output of "time being healthy", affecting an individual's current income. The loss in output because of ill-health affects their consumption and saving pattern. These losses are high costs which cannot be sustained, especially in poor households. In the long run, there may be variances depending on whether total productivity loss is calculated as the number of days missed from work due to illness or the years of productive life lost due to early death (McIntyre et al., 2006). However, this relationship between health and development can be viewed as bi-directional; e.g., income may impact health through enhanced nutrition, sanitation, and schooling and incentivise future family planning. A different perspective on health and development considers health to be beneficial both intrinsically & instrumentally. This perspective views health as a "constituent component of development," eliminating the need to defend its value regarding its indirect contribution to the rise of GDP or personal income. (Ruger, 2003). Thus, the causality that runs from health to development and development to health is evident, which helps us understand how health can facilitate development through productivity and growth, making the achievement of the health-specific SDGs essential by 2030.
2. Interaction Between Sustainable Development Goals
Examining the impact of health on development indicators offers a foundation for understanding how health governs the development process. Health should be prioritised in the formulation of comprehensive policies. For example, The Health in All Policies (HiAP) approach involves systematically considering health implications, seeking synergies, and avoiding adverse health effects to enhance population health and equity (Mauti et al., 2022). Now, we observe the interplay between SDG-3 and its neighbouring SDGs.
2.1 No Poverty (SDG–1)
Evidence suggests a positive correlation between mortality and poverty (Jahan S., 2008). In households where poverty persists, child mortality rates are high because there are constraints in accessing healthcare and healthy living conditions. High child mortality rates imply an indirect cost to parents in the form of "time lost" (parental care to child time), as they sacrifice productive time. If child mortality persists, the cost of raising the surviving child becomes considerable. Hence, preventing child mortality may reduce poverty within a household.
Similarly, enhancing the health of the impoverished will minimise the "time lost" from ill health, allowing them to accumulate financial resources through sustained employment. Interestingly, the decline in marginal utility of consumption with ill-health may lead to increased savings, benefiting individuals trapped in poverty through reduced consumption. In other words, when faced with health challenges, individuals may find less satisfaction in spending on sin goods and services (for example- cigarettes, alcohol, unhealthy fast foods). As a result, they may choose to increase savings instead of continuing consumption with diminishing well-being returns. In retrospect, children born into poverty often face challenges in survival, primarily due to health complications or a lack of access to healthcare. So, adequate UHC would lower the incidence and intensity of poverty (Guerra et al., 2024).
2.2 Quality Education (SDG-4)
Good health influences education (SDG-4), with a causal link between health and educational attainment, where poor health results in lower educational achievement (Eide, 2011). Poor health outcomes, driven by factors such as poverty, inadequate housing, parental health issues, and lack of education in households, often result in absenteeism, disrupting an individual's lifelong learning trajectory. Absenteeism manifests in both schools and workplaces. According to Allison et al. (2019), students in poverty are more prone to chronic school absenteeism, and those with lower educational attainment are more likely to be unemployed, work part-time, or earn a lower wage. Therefore, good health leads to better economic prospects and growth (SDG-8) through quality education. Similarly, the reverse holds true, as acquiring quality education results in improved health outcomes and enhanced employability.
2.3 Gender Equality (SDG-5)
In our society, persistent inequalities can be alleviated through equitable healthcare distributions. Improved child health is often supported by enhanced access to healthcare, education, and resources for mothers and children (Komro et al., 2013). Prioritising women and children in initiatives is crucial, considering their pivotal roles in social and biological reproduction and their requirement for access to health services (Helldén et al., 2022). Further, within a poor household, nutritional preference may be given to male members, resulting in their significant intra-house bargaining power, in which women are frequently overlooked. This renders women more vulnerable to ill health and frequently leads to discriminatory practices that hinder them from seeking and accessing care. Moreover, research indicates that when money is in the hands of mothers rather than fathers, there is an increase in expenditures on children, leading to improved child outcomes (Lange and Vollmer, 2017).
2.4 Decent Work and Economic Growth (SDG-8)
There is a substantial link between socioeconomic position and health. They complement each other. Improving healthcare provision across individuals, households, and groups will help towards better health and job-seeking opportunities. The main challenge lies in "accessibility"; where access exists, there is prevention, cure, and a higher probability of participation in the job market. Nonetheless, a constraint emerges, as per McIntyre et al. (2006), when an individual faces an economic barrier to health services, they may neglect a disease or decline treatment when unwell. Both direct and indirect costs can impact an individual's contribution to their country's economy. At a micro-level, economic endowments are necessary to access improved health. To offset these expenses, individuals lacking a stable income resort to borrowing, selling their limited assets, and employing various strategies to manage these costs, potentially leading to the entrapment of medical-related poverty. Therefore, at the macro-level, a healthier workforce can stimulate the economy, boosting the supply side of healthcare provision and promoting increased consumption of health-enhancing goods and services.
Conclusion
Therefore, SDGs being interlinked in nature is advantageous because if we accomplish one objective, it gives us a foundation to build on to achieve another and so forth. Health significantly contributes to sustainable development. The causal link from health to development illustrates how achieving health goals leads to accomplishing developmental objectives. By reducing mortality rates, poverty, and addressing the health of citizens, we can accelerate progress towards other developmental goals. Universal health coverage (UHC) plays a crucial role in achieving development goals by narrowing the care access gap and improving women's decision-making power. Its success reduces significant direct and indirect costs, highlighting its fundamental role. Although, as stated earlier, every objective is a "two-way street", and it is better to start now than later in order to fulfil the promises by 2030.
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