The Role of Health Education Specialists in Supporting Global Health and the Millennium Development Goals.

The Millennium Development Goals and Burden of Disease Globally Several documents (UN Universal Declaration of Human Rights, Declaration of Alma Alta, Ottawa Charter for Health Promotion) preceded formulation of the Millennium Development Goals (MDGs) in 2000. In 1978, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) adopted the Primary Health Care Initiative calling for "an acceptable level of health for the people of the world by the year 2000". (1) To attain health for all will require major revisions and changes in health care funding and service delivery in many countries. Among these global changes are universal access to clinical services based on need; necessary community involvement to generate, define, and implement health agendas; as well as access to appropriate technology for health. Unfortunately, basic universal access, "Health for All," was not attained by the aforementioned year 2000 target date. (2) The world did not lose focus on unmet health and education needs. UN Member States endorsed the Millennium Declaration in 2000 with an emphasis upon achieving eight inter-related Millennium Development Goals (MDGs) by 2015. Of particular note to health education specialists are Goals 3, 4, 5, 6, 7 and 8 (3): Goal 1: Eradicate extreme poverty and hunger Goal 2: Achieve universal primary education Goal 3: Promote gender equality and empower women Goal 4: Reduce child mortality Goal 5: Improve maternal health Goal 6: Combat HIV/AIDS, malaria and other diseases Goal 7: Ensure environmental sustainability Goal 8: Develop a global partnership for development According to the UN Secretary-General, "the Millennium Declaration represents the most important collective promise ever made to the world's most vulnerable people. This promise is not based on pity or charity, but on solidarity, justice and the recognition that we are increasingly dependent on one another for our shared prosperity and security". (4) Although progress is evident, much has not been achieved. Ambassador Rick Barton (2010), U.S. Representative on the Economic and Social Council, stated "we need to redouble efforts to build momentum towards some of the goals, such as those related to maternal and child health". (5) While global expected years of life and child mortality rates have improved from 1990 to 2001, but nearly 20% of worldwide deaths (10.5 million) in 2001 were among children younger than five years of age. Close to 4 million of these deaths were to infants before 1 month of age. Nearly all (99%) of child deaths occurred in low- and middle-income countries. Further, 30% of all deaths between the ages of 15-59 years occurred in these same countries, as compared to 15% of deaths in the same age group for high-income countries. One of every three deaths worldwide is due to communicable diseases, nutritional deficiencies, and maternal and perinatal conditions. HIV/AIDS accounted for 14% of deaths due to communicable disease in 2001. (6) WHO supports a Burden of Disease Framework, a schematic illustration of determinants of excess morbidity and mortality. Outcomes include mortality and "nonhealth well-being." Determinants listed in reverse order include functional limitations, impairments, morbidity and injuries, risk factors, socioeconomic and environmental causes. Health analysts and administrators may refer to this framework when allocating finances, conducting research and planning service delivery. (7) A Call to Action to Support Millennium Development Goals Worldwide What are indicators of progress to attain MDGs? How do we measure goal attainment? There is good news; some results are favorable. According to the UN, the number of persons living in extreme poverty (living on less than $1.25 US per day), decreased from 1.8 to 1.4 billion people between 1990-2005. …