Attaining Sustainable Development Goals
Abstract and Keywords
At its 2015 General Assembly, the United Nations formulated the Sustainable Development Goals (SDGs) to emergize its Member nations and social workers practicing in these countries to engage in environmentally sustainable social and economic development leaving no one behind. At the core of SDGs is the conviction that protecting planet Earth is possible by working collectively and ensuring that all human beings are able to realize their full potentials. The charges include solving a wide range of environmental, economic, and social problems including poverty, hunger, violence, and discrimination by 2030. The SDGs are inclusive of all people; they have galvanized all Member countries and their policy makers and practitioners, including social workers, to strive toward the common goals. Progress has been made from previous initiatives, but there are still challenges ahead. The first five SDGs are particularly relevant to social workers, who have an important role to play in alleviating poverty, promoting health and education, and empowering women and girls.
Introduction to the United Nations and the Sustainable Development Goals
Table 1. Sustainable Development Goals
Goal 1. End poverty in all its forms everywhere
Goal 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture
Goal 3. Ensure healthy lives and promote well-being for all at all ages
Goal 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Goal 5. Achieve gender equality and empower all women and girls
Goal 6. Ensure availability and sustainable management of water and sanitation for all
Goal 7. Ensure access to affordable, reliable, sustainable and modern energy for all
Goal 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all
Goal 9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
Goal 10. Reduce inequality within and among countries
Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable
Goal 12. Ensure sustainable consumption and production patterns
Goal 13. Take urgent action to combat climate change and its impacts
Goal 14. Conserve and sustainably use the oceans, seas and marine resources for sustainable development
Goal 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss
Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
Goal 17. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development
The United Nations (UN) was established in 1945. It was born after World War II. As of 2020 it represents 193 Member countries from around the world. With the Secretary-General as its chief administrative officer, the UN’s regular General Assembly meets every September at its headquarters in New York. Among its many priorities, the UN provides a platform for its member countries to review, prioritize, and pledge to solve global issues of concern. At the 70th anniversary of the UN in 2015, the Heads of State and government representatives from its Member countries met in New York (United Nations, 2015c). They adopted a universal policy agenda to guide inclusive development efforts over the next fifteen years: the 2030 Agenda for Sustainable Development. The Agenda contains 17 Sustainable Development Goals (SDGs) (see Table 1) with 169 targets for Member countries to pursue collectively so as to improve the well-being of all people and the planet (United Nations, 2015b). This article focuses primarily on the first five SDGs that emphasize human development: poverty, health, education, equity, and social inclusion. Goals 1 and 2 aim to eliminate world poverty and hunger respectively. Goal 3 aims to ensure good health (physical and mental) for all. Goal 4 charges the Member countries to provide equitable and quality primary and secondary education for all children. Finally, goal 5 aims for gender equality and empowerment of all women and girls.
These goals are consistent with core social work values and the 12 Grand Challenges for Social Work (GCSW) released by the American Academy of Social Work and Social Welfare. While the focus of the SDGs is global and that of the GCSW is the United States, they converge on issues making it easier for social workers around the world to unite and engage in innovative cross-disciplinary works that benefit poor and marginalized communities. Whether they are practicing in the United States or in other Member countries, social workers often advocate on behalf of the poor, marginalized, and oppressed populations, and challenge all forms of discrimination and social injustice. The GCSW charge social workers in the United States to strive toward a more just society by finding solutions to persistent social problems such as poverty, inequality, violence, and discrimination (Lubben et al., 2018). SDGs charge social workers globally to arrive at the same end. The article begins with the definition of sustainable development, then considers how the SDGs build on previous initiatives, before moving on to highlight the scope of some of the goals, the challenges ahead, and the roles social workers can play in contributing toward sustainable development.
Sustainable Development Defined
In 1987 a United Nations (UN) report entitled Our Common Future (also known as Brundtland Report) defined sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” (World Commission on Environment and Development, 1987, no page). Since then, disciplinary scholars have analyzed and explained the term sustainable development. Some find the term paradoxical; while the word “sustainability” has its origin in ecology and implies careful maintenance of natural resources—renewable and nonrenewable—so that the opportunities for future generations to generate wealth and well-being remain unharmed, “development” implies interventions and economic growth that may cause change in the ecosystem or the environment (Jabareen, 2008). Such a change in the environment may benefit some at the cost of others or future generations. If an act of commercial forest mining causes environmental degradation (landslide or flood), it may adversely affect poor and marginalized populations who lack the means to relocate, often resulting in human adversity. Whereas, evidence from community forest management literature shows that when such resources are managed properly, a balance can be maintained between the harvest (of fodder, fuel) and the natural replenishment (Pandey & Yadama, 1990). The Brundtland Report underscores that the pursuit of social and economic development must be ecologically sustainable (Jabareen, 2008).
Consistent with social work values, at the core of sustainable development lie fairness, equity, and social justice—the idea that one cannot achieve sustainable development while leaving some people behind (United Nations, 2014). For example, gender inequality—women’s lower education and lower pay—is linked to the unsustainable use of natural resources. Poor women will not be able to shift from biomass-based solid fuel to clean energy for cooking. The Sustainable Development Goals (SDGs) reflect the connection between human well-being and sustainable development. A 2014 UN report defines sustainable development as “economic, social and environmental development that ensures human well-being and dignity, ecological integrity, gender equality and social justice, now and in the future” (United Nations, 2014, p. 26). Sustainable development, thus, implies policies, programs, and services that reinforce the sustainable use of natural resources as humankind pursues fair, equitable, and socially just change. The 2030 Agenda offers each country a unique opportunity to partner with various sections of its society—private sectors, researchers, practitioners, and public—to tackle the causes of poverty, inequalities, and discrimination. The overall goal is to leave no one behind and leave a better planet for future generations.
From Millennium Development Goals to Sustainable Development Goals
The road to the Sustainable Development Goals (SDGs) began 15 years prior in September 2000, at the 55th General Assembly meeting of the United Nations (UN). The world leaders resolved to attain eight goals by 2015, which became known as the Millennium Development Goals (MDGs) (United Nations, 2000a). They inspired nations, national and international organizations, private foundations (e.g., Bill and Melinda Gates Foundation), and professionals from different disciplines to jointly pursue the stated goals. Some countries tested new interventions while others scaled evidence-based programs. Nearly all Member countries from the developing world expanded health and education infrastructures, trained workforce (doctors, social workers, teachers), and promoted good health habits through health and social work professionals and mass media. Nepal began its first Bachelor of Arts program in Social Work in 1996. By 2010 over ten different colleges and universities offered social work education including Masters in Social Work (MSW) starting 2005 (Nikku, 2010). These social workers joined various sectors of government and nongovernmental organizations, challenged the status quo, and influenced policies and programs to attain the stated bold milestones. To eliminate social ills (e.g., child marriage), Member countries either passed new legislation or implemented existing legislation more forcefully. In Nepal social workers initiated a project to establish a community radio station network focused on social and economic challenges; this has been influential in reaching geographically remote villages and fighting against social taboos, such as the isolation of women and girls during menstruation (Truell, 2015). Overall, the result of implementing MDGs was remarkable.
While the attempt to meet the MDGs varied by country, on the whole, the world is a better place for weak and vulnerable populations including women and children today than in 1990. MDG 1 aimed to reduce extreme poverty and hunger, measured as those living on less than $1.25 per day, by half between 1990 and 2015. In 2015 the global target was comfortably met; the world population living in extreme poverty dropped from 1.9 billion or 36% in 1990 to 836 million or 14% in 2015 (United Nations, 2015a). At the country level, 71 countries met the target, with an additional 11 countries slightly off the target (United Nations Development Programme [UNDP] & World Bank, 2016). Most of the progress occurred since the ratification of the MDGs in 2000, with many countries in Sub-Saharan Africa and Asia testing bold ideas. The two most populated countries in the world, China and India, contributed most to the decline in extreme poverty. In 2005 India passed the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). This legislation instituted the largest public works program in the world, which guaranteed 100 days of wage employment annually in the form of unskilled manual work to an adult from every rural household. In the year 2009–2010 adults from 54 million households gained employment from the MGNREGA; many of them were women from marginalized communities (Carswell & De Neve, 2014; Ghosh, 2015). Evaluation studies show that the MGNREGA revitalized the rural economy, reduced poverty, positively impacted climate change, and improved the well-being of women, children, and families (Adam, 2015; Chopra, 2014; Das, 2016; Godfrey-Wood & Flower, 2018; Maiorano, 2014; Mukherjee, 2018; Nair et al., 2013; Nair, Ariana, & Webster, 2014; Sinha, Singh, Basu, & Ghosh, 2017). For example, in Dungarpur District, Rajasthan (India), the children in households that participated in MGNREGA had significantly higher birth-weight and lower stunting (Nair et al., 2013).
In the developing regions of the world, the proportion of undernourished population dropped from 23% in 1990–1992 to 13% in 2014–2016 (United Nations, 2015a). Moreover, the number of people in the working middle class, those living on more than $4 a day, almost tripled from 18% in 1991 to 50% in 2015, which is a remarkable achievement (United Nations, 2015a). As poverty is linked to poor health, a decline in poverty and hunger has also improved health outcomes (more on this later).
Building on the previous achievement, SDG 1.1 aims to eliminate extreme poverty “for all people everywhere,” meaning that no one would have to live on less than $1.25 per day. Moreover, SDG 2.1 aims to end hunger and ensure access to safe, nutritious, sufficient food “all year round for all people,” and SDG 2.2 aims to end “all forms of malnutrition, stunting and wasting” in children under 5 years of age, and ensure the nutritional needs of “adolescent girls, pregnant and lactating mothers and older adults” are met.
MDG 2 aimed to “achieve universal primary education for both girls and boys.” In response, member countries incorporated MDGs in their national plans, tested supply and demand-based interventions, and tried to increase the access and enrollment of children in schools, particularly female children. For example, Nepal prepared an Education for All National Plan of Action (EFA-NPA), which ran between 2001 and2015, to increase access to basic education (1st to 8th grade) for all girls and boys by 2015 (Government of Nepal, 2015; Ministry of Education and Sports & UNESCO, 2003). Subsequently, Nepal has been trying to build early childhood education centers in every village, primary schools (grades 1–5) within walking distance from each village, and to hire at least one female teacher in every primary school. To increase demand, Nepal has also been scaling such proven strategies as free pre-primary and primary education for all children, free text books for all children up to 8th grade, midday meals to children in some schools, and scholarships to some girls and students from marginalized communities (Ministry of Education and Sports & UNESCO, 2003; Shiwakoti et al., 2009; United Nations Girls’ Education Initiative [UNGEI], 2012).
Worldwide, the number of children of primary school age who are not attending school has fallen by almost half, from 100 million in 2000 to 57 million in 2015; developing countries contributed most to this progress by increasing their enrollment from 80% in 1990 to 91% in 2015 (United Nations, 2015a, 2015d). Building on the progress, SDG 4 aims to close the gaps in educational attainment for all sections of society. In particular, SDG 4.1 promises to provide all girls and boys—including children from historically mariginalized communities and children with disabilities—free, equitable, and quality primary and secondary education. To get there, SDG 4.2 aims to ensure that all girls and boys have access to quality and early childhood development and pre-primary education.
MDG 3 aimed to “promote gender equality and empower women.” To this end, member countries tried to close gender disparity in education, employment, and political participation. As a result, a higher proportion of girls of primary and secondary school age are in school, more women are holding leadership positions in legislatures and organizations, and more women are engaged in the paid labor force (United Nations, 2000b, 2009, 2015a, 2015d; World Bank, 2012). As of 2015, women made up 41% of the paid labor force compared to 35% in 1990 (United Nations, 2015a). Building on prior success, SDG 5 aims to eliminate unhealthy practices by 2030 including “all forms of discrimination against all women and girls everywhere” (SDG 5.1), “all form of violence against all women and girls” (SDG 5.2), and all such “harmful practices” as child marriage and genital mutilation (SDG 5.3).
MDGs 4 and 5 aimed to reduce “under-five child mortality rate (CMR) by 2/3rds” and “maternal mortality ratio (MMR) by 3/4ths between 1990 and 2015,” respectively. In response, many developing countries have increased the supply of health and education facilities. They have also trained the workforce—doctors, nurses, midwives, primary health care workers, and community health workers. For example, until the 1990s Nepal had one medical school that enrolled about 20 to 30 medical students annually; fast forward to 2010, Nepal enrolled over 1,400 medical students annually in its 14 medical institutions, graduating nearly 1,000 doctors each year (Huntington, Shrestha, Reich, & Hagopian, 2012).
While MDG 4 fell slightly short of meeting its target, the annual under-five CMR dropped by over 50% globally, from 12.7 million in 1990 to 5.9 million in 2015, or from 90 to 43 deaths per 1,000 live births between 1990 and 2015 (United Nations, 2015a). This progress was realized despite the continued global population growth. Increased rate of vaccination of children with the World Health Organization (WHO) recommended vaccines saved many children. For example, measles vaccination of children alone saved nearly 15.6 million lives between 2000 and 2013 (United Nations, 2015a).
The MMR has also dropped globally. The WHO defines maternal death as:
the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management (from direct or indirect obstetric death), but not from accidental or incidental causes (World Health Organization, 2015, p. 35).
In 1990 the global MMR was 380/100,000 live births with maternity complications alone claiming over 536,000 women’s lives annually (United Nations, 2000a, 2000b, 2009). By 2015 the MMR worldwide had dropped by 43% to 216/100,000 live births (World Health Organization, 2017). Similarly, the global lifetime risk of maternal death fell from 1 in 73 in 1990 to 1 in 180 in 2015 (World Health Organization, 2015). Overall, the global data fell short of meeting MDG 5 by 2015, although 15 countries met the goal (UNDP & World Bank, 2016).
Going forward, SDG 3 aims to ensure healthy lives and promote “well-being for all at all ages.” More specifically, SDG 3.1 aims to reduce the global MMR to less than 70//100,000 live births, and SDG 3.2 has challenged Member nations to end all preventable child deaths and to reduce neonatal mortality to 12/1,000 live births in every country (World Health Organization, 2017). Also, for the first time, a global charge has been deployed to prevent, treat, and promote mental health and well-being (SDG 3.4), and to prevent substance abuse and treat people with problems arising from it (SDG 3.5). A global charge has also been deployed to attain universal health coverage to ensure that everyone has access to quality essential health care including the WHO recommended vaccines (SDG 3.8).
Millennium Development Goals’ Limitations and Sustainable Development Goals’ Promises
While there has been an unprecedented level of progress since the launch of Millennium Development Goals (MDGs) in 2000, they fell short on multiple fronts. First, the MDGs were criticized as being top-down, crafted primarily by the representatives from the United States, Japan, and European countries, with very little input from low-income countries, and supported by the major international financial institutions such as the World Bank, International Monetary Fund, and Organization for Economic Co-operation and Development (Bond, 2006; Fehling, Nelson, & Venkatapuram, 2013; Sengupta, 2016). The MDGs focused on the poorest people in low- and middle-income countries, except for MDG 8 which emphasized a global partnership for development. Developed countries did not see the relevance of these goals within their territories. In contrast, the Sustainable Development Goals (SDGs) are inclusive of all Member countries and everyone within a country. They are more ambitious in that they pledge to leave no one behind and aim for a secure future for everyone in developed and developing countries. Throughout the document, one will find the phrases “for all,” “universal,” and “everywhere” (see Table 1). A HuffPost article from 2017 reported that the SDGs “apply to all Americans and the neighborhoods, cities, and states we live in” (Manley, 2017). All Member countries—developing and developed—are expected to integrate the SDGs into their policy priorities and monitor the extent to which they are solving such social and economic problems as poverty, hunger, food insecurity, drug abuse, and mental health problems.
Second, the MDGs relied on country-level aggregate data that did not capture within-country, sub-national-level inequalities (Zamora et al., 2018). If a country met the target, reduced poverty and hunger proportionally, it was considered a success. In contrast, a country-level progress will not be sufficient to meet the SDGs. To assess the progress made by each section of society and to ensure that no one is left behind, Member nations have to collect high quality, reliable data that reflects the intersectionality of problems, “disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts” (United Nations, 2015c, p. 32). Also, the UN recommends that the Member countries should begin monitoring progress by 2020.
Finally, the MDGs were weak in terms of their approach to human rights. For example, MDG 3 aimed to tackle discrimination based on the binary gender role of men and women. The development programs in the past were not sensitive to the needs of sexual minorities—lesbian, gay, bisexual, and transgender (LGBT) populations—who did not conform to binary gender roles and norms (Rashid, Daruwalla, Puri, Hawkes, & Chow, 2012; World Bank, 2015). Some lamented that MDG 3 did not even protect the LGBT women (Mills, 2015). It is well known that the fundamental human rights of sexual minorities, due to their sexual identity, orientation, or practices, are invariably violated; they are persecuted and denied access to health care, education, employment, housing, and other resources (Math & Seshadri, 2013). The SDGs are also not comprehensive enough to protect sexual minorities from discrimination; they fall short of specifying the need to provide equal opportunities for these groups and the need to protect their rights (Sengupta, 2016). In the 17 goals and 169 targets, there is no mention of sexual minority or the rights of LGBT people. That said, the SDGs are clear on erasing within-country inequalities and discrimination and ensuring human rights for everyone. For example, with SDG 5.1, Member countries agreed to “end all forms of discrimination against women and girls everywhere.” Also, use of the phrases “for all,” “of all,” or “everyone” in many goals and targets should be sufficient for motivated Member countries to address the needs of those who were previously discriminated against and face barriers when they seek to access services, including LGBT people or those who do not fit into binary male or female sex categories (Zamora et al., 2018). Moreover, in 2018 the World Health Organization and the UN released a joint statement to end discrimination in health care settings on the basis of “age, sex, race or ethnicity, health status, disability or vulnerability to ill health, sexual orientation or gender identity, nationality, asylum or migration status, or criminal record” (World Health Organization, 2018).
2030 Agenda and the Role of Social Workers
The United Nations (UN) does not have the authority to mandate countries around the world to adopt the Sustainable Development Goal (SDGs). Individuals, groups, nations, and their governments must be convinced and committed to integrating the SDGs in their national agendas so that they can pass relevant legislation, authorize funds, implement relevant policies and programs, monitor progress, and make adjustments as needed. Many countries—developed and developing—have already mainstreamed the SDGs into their national plan. For example, Somalia’s website indicates that it is exploring strategies to engage “the government at all levels to meet the [SDG] goals and support the Somali people.” The German government’s Agenda for Sustainable Development that:
is committed to leaving no one behind. The report states that “we will only achieve a sustainable Germany by ensuring that no one is left behind. …that the job will be finished only when all the goals of the 2030 Agenda have been achieved for all population groups, especially those who are left furthest behind. Equal rights and non-discrimination are fundamental principles here. For Germany, leaving no one behind means, for example, that even those who cannot achieve the minimum sociocultural subsistence level by themselves must be able to share in the wealth generated in society as a whole” (Federal Government, 2018, pp. 15).
India has embraced the SDGs and plans to engage its corporate sector in sustainable development and social responsibility as it builds on its cash transfer policy of rural employment to eliminate hunger and poverty (Research and Information System for Developing Countries, 2016). The Member countries adopting the SDGs must consider the nuances of the problem as they test innovative strategies and scale evidence-based interventions. Social workers everywhere can advocate on behalf of the poor and previously marginalized populations and help Member countries design and execute comprehensive policies. They have the skills to help build inclusive and just societies and can help ensure that no one is left behind. Social work researchers can document interventions that are inclusive as countries move toward 2030. In the following, several SDG targets and the role of social workers in addressing these 21st century challenges are discussed.
Eliminate Poverty and Hunger
With SDGs 1 and 2 (“end poverty in all its forms everywhere” and “end hunger and achieve food security”), all Member nations—developed and developing—are charged to solve poverty and hunger for every section of our society, leaving no one behind. While countries have made progress under the Millennium Development Goals (MDGs), in 2016 about 815 million people, or 14% of the world population, mostly residing in developing countries, were chronically hungry and undernourished (Food and Agriculture Organization, 2017; Schmeer & Piperata, 2017). In the United States, 15.6 million households (or 12.3% of all households), including 31.6% of female-headed households with children, no spouse present, were food insecure at some time during 2016 (Coleman-Jensen, Rabbitt, Christian, & Singh, 2017). The progress attained thus far has energized Member countries to test new ideas or scale evidence-based interventions. They have introduced a wide range of interventions including income generation programs, innovation in agricultural production, and better access to financial institutions. Some countries have expanded their social protection programs, while others have expanded public works programs, and still others have invited private sectors to play a more prominent role in employing low skilled workers. In particular, cash transfer has captured the imagination of many countries around the world. It addresses multiple SDGs: poverty, health, education, and empowerment of women. The conditional cash transfer (CCT) program was introduced in Mexico in 1997. Subsequently, over a dozen of countries in Latin America and the Caribbean have adopted the program, including Argentina, Bolivia, Brazil, Chile, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Panama, Paraguay, and Peru. While the details of each program vary by country, in general cash is regularly transferred (bimonthly, monthly) to poor women who are pregnant or have young or school-aged children, if they meet the program requirements. These often include using preventive health services, attending health education sessions, and ensuring school enrollment of children. Over the years many countries in Africa and Asia have also implemented their own versions of cash incentive programs (Fenn et al., 2017; Kandpal et al., 2016; Lim et al., 2010; Nguyen et al., 2012; Witter, Khadka, Nath, & Tiwari, 2011). In some countries in Africa, experiments are also underway to make unconditional cash transfer (UCT), a transfer free of conditions, and to trust the poor to make the right decisions (Hanlon, Barrientos, & Hulme, 2010; Parijs & Vanderborght, 2017). Evaluation studies show that the CCT or UCT programs in Latin America, Africa, and Asia have significantly reduced poverty and food insecurity and improved children’s nutrition, health, and education (Barber & Gertler, 2009; Fernald, Gertler, & Neufeld, 2008, 2009; Gertler, 2004; Lagarde, Haines, & Palmer, 2007, 2009; Paes-Sousa, Santos, & Miazaki, 2011; Rasella, Aquino, Santos, Paes-Sousa, & Barreto, 2013; Sosa-Rubi, Walker, Servan, & Bautista-Arredondo, 2011). For example, in Bangladesh a pilot voucher program significantly increased the use of antenatal, delivery, and postnatal care with qualified providers (Nguyen et al., 2012). The Philippines’ CCT is associated with a significant reduction in severe stunting in children aged between 6 and 36 months (Kandpal et al., 2016). A similar program has also reduced severe stunting among children in Pakistan (Fenn et al., 2017). A randomized control trial study examining the effect of Kenya’s UCT program—which transferred $20 per month to low-income households with orphans and vulnerable youth—found that youths in households that received cash transfers were 24% less likely to have depressive symptoms (Kilburn, Thirumurthy, Halpern, Pettifor, & Handa, 2016). Other studies from Latin America, Asia, and Africa also show that the CCT has empowered women—improved their financial security, self-esteem, social status, ability to make financial decisions, and access to health care services (Department for International Development, 2011; Lagarde et al., 2009; Natali et al., 2018).
In the United States millions of Americans experience poverty and homelessness annually. Promoting basic income security, providing affordable housing, and “ending homelessness” together make up one of the 12 Grand Challenges for Social Work (GCSW) (Lubben et al., 2018). A study examining the effect of a temporary financial assistance program from Chicago showed that one-time provision of not more than $1,500 per person to those who are at risk of becoming homeless significantly reduces the risk of eviction within a year (Evans, Sullivan, & Wallskog, 2016). Also, support for a guaranteed basic income program to fight poverty, hunger, and homelessness is growing in the United States (Hughes, 2018; Painter, 2016; Parijs & Vanderborght, 2017; Porter, 2016; Sousa-Pinto, 2017). This movement deserves social workers’ unified attention as it has potential to attack a wide range of social ills including poverty, hunger, homelessness, and inequality.
An expansion of the Earned Income Tax Credit (EITC) program is a proven way to fight against poverty in the United States. The EITC is a form of CCT aimed at incentivizing labor force participation among low- and moderate-income families. Evaluation of the federal EITC program in the United States shows that it has reduced poverty among households with children, improved maternal health, and reduced the incidence of low birth weight in infants (Hoynes, Miller, & Simon, 2015). State level EITCs have yielded positive health outcomes; birth weight of infants improved in states with more generous EITCs (Markowitz, Komro, Livingston, Lenhart, & Wagenaar, 2017). Such positive evidence has encouraged many developing and developed countries to test or scale the CCT or UCT programs. As countries test such poverty alleviation policies, social work researchers can help assess the impacts of such policies on poor and marginalized populations.
Promote Well-Being for All
Based on the human rights perspective, promoting good health for all is the purpose of SDG 3. The World Health Organization (WHO) defines health as a:
state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition (World Health Organization, 2014, p. 1).
Consistent with this vision, one of the GCSW’s goals is to “Close the health gap” by focusing on population health and improving access to basic health care (Lubben et al., 2018). This section will briefly review maternal and child health, mental health and substance abuse, and access to affordable health care globally.
Improve Maternal Health
SDG 3.1 has energized Member countries to improve maternal health. Globally, maternal mortality has been declining since the late 20th century. A closer look at the maternal mortality data, however, shows that about 289,000 women die annually within 42 days of pregnancy terminations due to birth-related complications (United Nations, 2015a). These deaths are occurring mostly in developing countries, among rural women. A pregnant woman in Nepal has nearly ten times higher risk of dying due to birth-related complications than her counterpart in the United States as of 2017 (World Health Organization, 2019). To attain the SDGs’ global maternal mortality ratio (MMR) target of less than 70/100,000 live births from the ratio of 211/100,000 live births in 2017, the member nations must work much harder than they have yet, reducing the MMR by almost 8% annually, which would mean tripling the annual rate of reduction achieved between 1990 and 2015 (World Health Organization, 2017; 2019).
Rural, geographically isolated areas often lack functional health care infrastructure and access to trained health care professionals, making it difficult to provide access to equitable, inclusive, and fair health care services (World Health Organization, 2008b). While this is a global problem, it is more pronounced in developing countries. For example, in rural Nepal the physician ratio is 2.4 physicians/100,000 people, which is 100 times lower than the WHO recommended ratio (Huntington et al., 2012). Going forward, Nepal needs to improve its rural health facilities and incentivize health professionals to practice in these facilities.
A related global challenge is that millions of births continue to occur without any assistance from a trained midwife, doctor, or nurse. In 2016 a skilled birth attendant attended only 78% of all births globally (World Health Organization, 2017). Home delivery is perfectly safe when the pregnancy and birth are normal. If women develop complications, however, home delivery quickly turns fatal. A systematic analysis of 23 studies from 115 countries comprising 60,799 maternal deaths between 2003 and 2009 found that hemorrhage was the leading cause of maternal death, resulting in 37% of all deaths in northern Africa, 30% in southern Asia, and 27% worldwide (Say et al., 2014). Safe strategies to transport the mothers who develop complications to functional health facilities are not yet available for many rural women in developing countries.
The decision to deliver at a health care facility involves a complex set of intra-household, community, and structural factors that health professionals alone cannot address. Health professionals may advise pregnant women to seek an institution for delivery; once in labor, these women will need family or community members to transport them to the health institution at that critical time. Hence, social workers could be instrumental in supporting family and community while promoting institutional delivery among pregnant women.
Once women arrive at a health care institution, making sure that all women, including those from marginalized communities, receive proper care is essential. Women’s unequal access to health services based on class, caste, ethnicity, or living arrangement is well documented (Bhanderi & Kannan, 2010; Iyengar, Iyengar, Suhalka, & Agarwal, 2009; Kesterton, Cleland, Sloggett, & Ronsmans, 2010; Nair, Ariana, & Webster, 2012; Sanneving, Trygg, Saxena, Mavalankar, & Thomsen, 2013; Saroha, Altarac, & Sibley, 2008). To ensure that no one is left behind and that all have equal access to care, social workers can advocate on behalf of the patients, challenge discriminatory practices, and ensure that every patient is treated with dignity and respect whatever their social position.
In the developed regions of the world the MMR is already low, but in the United States the ratio is rising. Overall, the MMR during 2013–2014 was 25/100,000 live births; but the ratio was substantially higher (270/100,000 live births) and growing among women aged 40 years or older (MacDorman, Declercq, & Thoma, 2017). As more women are delaying marriage and childbirth in the United States, the MMR will rise if left unchecked. As 2030 approaches, America’s challenge will be to find solutions to reduce the MMR among this age group of women.
Improve Child Health
SDG 3.2 has charged Member countries to improve child health. Over the years, child deaths between ages two and five have declined, but neonatal deaths have remained persistently high. The 5.9 million under-five child deaths that occur annually are concentrated during the earliest days of their lives: 1 million children die on the day of birth, 2 million die within the first week of birth, and 2.7 million die within the first four weeks of birth, or neonatal period (UNICEF, 2016). Three causes—pre-term births, infections, and asphyxia—contribute to over 80% of neonatal mortality (Lawn, Kerber, Enweronu-Laryea, & Cousens, 2010). Some promising evidence-based interventions are available. Southern Asian and Sub-Saharan countries with high rates of neonatal mortality have been testing their community-based neonatal care programs that include a package of proven interventions (e.g., birth preparedness, hand washing, clean delivery practices, essential newborn care, and additional health education) by local community health workers. A systematic meta-analysis of 13 randomized-controlled-trial studies in India evaluating the effects of community-based neonatal care programs found that the neonatal mortality rates dropped significantly from 15 to 36% when such practices were adopted (Gogia et al., 2011). Also, community-based newborn care programs in three districts in Malawi increased the likelihood of institutional delivery as well as women’s knowledge about risky signs for pregnancy, delivery, and postpartum (Callaghan-Koru et al., 2013). The success of these programs in reducing neonatal mortality elsewhere inspired Nepal to implement its Community-Based Newborn Care Package (CBNCP) in 2007 (Poudel, Acharya, Pant, Paudel, & Pradhan, 2012; Pradhan et al., 2011). One study using data from 2011 from Nepal noted that it had seen a reduction in its neonatal mortality in districts with the CBNCP (Pandey, Karki, Murugan, & Mathur, 2017). Nepal has since nationalized the CBNCP program in a bid to erase preventable neonatal mortalities altogether and attain SDG 3 by 2030.
In the United States, the racial gap in the child mortality rate (CMR) is rising. Black infants, after controlling for the social and economic background, are two to three times as likely to die as white infants (Collins, 1992; Schoendorf, Hogue, Kleinman, & Rowley, 1992; Scott-Wright, Wrona, & Flanagan, 1998; Strait, 2006). This gap is linked not only to higher mortality among black infants of normal birth weight but also to their higher rates of pre-term births and low birth weight. As 2030 draws near, the United States needs to identify and scale the interventions that improve women’s access to quality health care during pregnancy and childbirth and after birth.
Evidence is promising. One study showed that certified Doula-assisted, socio-economically disadvantaged mothers were “four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding” (Gruber, Cupito, & Dobson, 2013, pp. 54–55). Mainstreaming the Doula service to all socio-economically disadvantaged pregnant women, including African American mothers, will help reduce the current gap in maternal and infant mortality between African American and white mothers in the United States.
Improve Mental Health, and Prevent and Treat Substance Abuse
To ensure well-being for all, two of the SDG targets encourage all nations to tackle mental health (SDG 3.4) and substance abuse (SDG 3.5) disorders by 2030. Mental disorders such as depression, psychoses (e.g., bipolar disorder and schizophrenia), and substance use (e.g., alcohol and drug abuse) affect about 450 million people worldwide (World Health Organization, 2003a). The proportion of people with mental disorders has been growing globally (Harvey & Gumport, 2015). Mental disorders are among the 20 leading causes of disability worldwide causing functional impairment and distress among those affected, their families, and their social environment (Whiteford et al., 2013; World Health Organization, 2008a). Lost years of healthy life due to these disorders also have economic consequences. A study projected that the cumulative global impact of mental disorders in lost economic output would amount to US$16.3 trillion between 2011 and 2030 (Trautmann, Rehm, & Wittchen, 2016; see also Bloom et al., 2011). Evidence-based interventions are now available to prevent and treat mental health and substance abuse problems (Drake & Latimer, 2012; Hanlon, Wondimagegn, & Alem, 2010; Harvey & Gumport, 2015; Lund et al., 2012; Mehta et al., 2015; Patel et al., 2010; Petersen et al., 2016). For example, in Goa, India, a randomized cluster trial was executed in primary health care facilities with all adults who screened positive for common mental disorders (Patel et al., 2010). A trained lay health counselor from the community offered case management and psychosocial interventions while the primary care physician provided antidepressant drugs under the supervision of a mental health specialist; the results showed a significant improvement in recovery from mental disorders among patients in public primary care facilities (Patel et al., 2010).
Only a small fraction of all suffering from mental or substance abuse disorders worldwide currently receive treatment. Patient use of mental health services within 12 months of diagnosis ranges from 7% in Japan to 15% in Argentina to 41% in the United States (Fikretoglu, Guay, Pedlar, & Brunet, 2008; Naganuma et al., 2006; Stagnaro et al., 2018; Wang et al., 2005). The U.S. President’s Commission noted that “only 10.6% of youth and adults who need treatment for a substance use disorder receive that treatment” (The President’s Commission, 2017, p. 7). Indeed, the United States leads the world in drug overdose-related deaths. Between 1999 and 2014, drug overdose deaths in the United States tripled with drug overdoses accounting for 52,404 deaths in 2015 alone (Rudd, Seth, David, & Scholl, 2016). Globally, over 70% of those needing mental health services lack access to care (Kohn, Saxena, Levav, & Saraceno, 2004). Some of the factors that limit access to treatment include cost, lack of health insurance, lack of transportation to treatment facilities, and lack of treatment facilities in a rural setting. In the developing countries, the barriers to care also include social stigma that deters people from seeking help. For example, in Nepal, one study examined 1,983 adults from Chitwan District and found that only a small fraction of the adults with depressive disorder and alcohol use disorder sought treatment; the majority were deterred due to social stigma and lack of financial means to afford care (Luitel, Jordans, Kohrt, Rathod, & Komproe, 2017). To reduce social stigma, increase access to treatment services and to subsequently close the treatment gap, some have recommended the Member countries to incorporate mental health issues into the formal education system, provide universal access to health care, and integrate mental health diagnosis and treatment practices into the general health care system (Shidhaye, Lund, & Chisholm, 2015; Wainberg et al., 2017). The prevention and treatment of mental health and substance abuse fit within the WHO’s pyramid framework that includes self-care, community care, primary care, and specialist care in institutionalized mental hospitals (World Health Organization, 2003b). Some developing countries have started incorporating mental health and substance abuse treatment in their health care systems. For example, Mozambique has reduced the mental health treatment gap by shifting from traditional, in-patient care with long-term hospitalization to community-based mental health care and public education by increasing the number of mid-level mental health professionals and psychiatric technicians who deliver mental health services in primary care facilities in every district (Dos Santos, Wainberg, Caldas-de-Almeida, Saraceno, & Mari Jde, 2016).
Social workers can play a critical role in providing mental health and substance use services. In developed countries such as the United States, they are available throughout the education and health care system. Clinical social workers are integrated within general and specialized health care facilities, veterans’ hospitals, child protective services, family service setting, substance abuse prevention and treatment programs, and nursing homes and long-term care facilities; they link people with the mental and behavioral health services they need (Council on Social Work Education, 2014). They diagnose mental or behavioral issues (depression, anxiety, family issues) and provide mental health services. They work with people of all ages, families, groups, and communities. They prepare treatment plans and facilitate interventions. In many developing countries, the social work profession was introduced in the 21st century and is growing rapidly. Social workers can help build and strengthen community mental health programs.
Improve Access to Affordable Health Care
SDG 3.8 aims to achieve universal health coverage, including financial risk protection and access to quality health care for all. This charge aligns with the right to health movement. It is inclusive of all and is relevant both in developed and developing nations where the goal is to make sure that all individuals have access to timely and appropriate health care regardless of race, color, caste, gender, or sexual orientation (Zamora et al., 2018). This target is also consistent with American social workers’ support for a universal, single-payer health care system where everyone—regardless of pre-existing conditions, race, gender, or sexual orientation—will have access to quality care (Gorin, 1997; Gorin, 2009; Gorin & Moniz, 2004).
Improve School Enrollment
SDG 4 aims to ensure inclusive, equitable, quality education for all. This section will focus on pre-primary, primary and secondary education because intervention at this stage has a lifelong positive impact. SDG 4.1 emphasizes free, equitable, and quality primary and secondary education for all girls and boys; and SDG 4.2 ensures that all girls and boys have access to quality early childhood development, care, and pre-primary education. While there has been progress, many school-age children are not in school. As of 2016, 61 million children of primary school age worldwide—one in ten of all children in low- and lower-middle-income countries—were not enrolled in school (World Bank, 2018). Additionally, 202 million children of secondary school age were not in school (World Bank, 2018). Nearly one-third of these children came from conflict-affected countries such as Myanmar, Syria, and others (World Bank, 2018) and were on the move, which makes it difficult to reach out through the traditional education system. Others who often skip school enrollment include children from socially marginalized groups in developing countries—the poor, geographically isolated, ethnic minorities, girls, and disabled children (World Bank, 2018). Of those that are enrolled, nearly one in four will drop out before completing their primary education, and most of these children, too, tend to be poor, rural, girls, or disabled. For example, ill and malnourished children, or children from marginalized communities, tend to experience higher challenge in learning and are more likely to drop out. Similarly, female children are more likely to drop out when the cost of education goes up. Despite the MDGs’ success, as of 2010 about 6% of school-age Nepalese children, mostly from marginalized families, were not enrolled in school (UNGEI, 2012). Some of these children, especially female children from a disadvantaged background, are held back for child labor and require more aggressive financial incentives, beyond free education. By sending girls to school, parents from a disadvantaged background must not only forgo the child labor but also cover the indirect cost of uniforms, shoes, book bags, and sometimes admission and examination fees (Bista, 2004). Social workers understand these nuances; they can help build the scholarship amount available for girls from disadvantaged backgrounds, considering such indirect costs.
SDG 5 aims to empower all women and girls. Historically, unequal power between men and women in some key indicators—education, income, employment, property ownership, participation in politics, and ability to make intra-household decisions—has undermined women’s ability to realize their full potential (Kabeer, 1999; Sen, 1999; United Nations Development Programme, 1995). Empowerment is key to a woman’s ability to decide when to get married, have children, and control the number of her pregnancies. As countries engage in the SDGs, social workers have the charge to promote policies and programs that empower women so that they may develop their full potential and that of society. Three SDG targets in this goal are relevant to social workers.
End Discrimination Against Women and Girls
SDG 5.1 targets ending all forms of discrimination against women and girls. Under this target, social workers can help prevent discrimination against all women, including LGBT women. They can work with policymakers to decriminalize homosexuality or non-normative gender identities and expressions and prevent discrimination and violence against them. To monitor the fundamental human rights of sexual minorities, the World Bank has developed a resource guide to work with LGBT women around the world (World Bank, 2015). It outlines examples of progress made in different countries to assert the LGBT community’s rights. In 2008, India’s Tamil Nadu state developed a Transgender Welfare Board (TGWB), whose members are mostly transgender community leaders, to help transgender people better access government social policies and to protect them from discrimination and violence. To assess how well each sub-group is moving toward health equity, the WHO has proposed the “Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind,” an eight-step process that is consistent with the SDGs commitment to reach everyone. This Innov8 approach has been tested in the Americas, eastern Mediterranean, European, and South East Asian regions including Indonesia, Mongolia, Nepal, and Morocco. The tool is updated with every use; hence, some describe it as a living tool (Koller et al., 2018). Social workers can use this tool to empower all women and girls including the LGBT.
End Violence Against Women
With SDG 5.2, Member countries from around the world agreed to “eliminate all forms of violence against all women and girls in public and private spheres, including trafficking and sexual and other types of exploitation” (United Nations, 2015c, p. 22). Violence against women is widely prevalent in developed and developing countries and is a serious public health concern because of its link to a host of adverse maternal and child health consequences including maternal depression, pre-term births, and child mortalities (Ackerson & Subramanian, 2009; Chandra, Satyanarayana, & Carey, 2009; Koenig et al., 2010; Pandey & Lin, 2012; Peedicayil et al., 2004; Sabarwal, McCormick, Silverman, & Subramanian, 2012; Silverman et al., 2011; Varma, Chandra, Thomas, & Carey, 2007). This violence prevents us from meeting many SDG targets. A closer look at the prevalence of just one form of violence against women—intimate partner violence (IPV)—shows the urgent need for action to end this problem. Overall, one in three women worldwide experiences IPV at some point in her life. Studies from multiple sites covering ten countries around the world documented that between 13 and 61% of ever-partnered women had experienced physical violence, and 6 and 59% had experienced sexual violence perpetrated by an intimate partner at some point in their lives (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006). In the United States, approximately one in four women experience physical or sexual violence by male intimate partners across the lifespan (Miller et al., 2010; Miller, 2006). It has also been established that IPV tends to peak during women’s reproductive years and that less than half of these victims ever seek professional help (Hussain & Khan, 2008; United Nations, 2015d).
Until recently, many societies around the world considered IPV against women a private matter, a social taboo to discuss in public (Hien, 2008; Hussain & Khan, 2008; Mitra & Singh, 2007). Over the course of the 21st century, however, IPV has become a topic for social policy action globally, thanks to the MDGs and SDGs. Over 90 low- and middle-income countries around the world have deployed the Demographic and Health Surveys (DHS), collecting reliable, nationally representative data directly from women of reproductive age on their health and well-being. Many DHS also ask about the women’s IPV experience using the Conflict Tactics Scale-2 (CTS-2) originally developed by Straus (Straus, 1979; Straus & Douglas, 2004). The DHS allow social work researchers to monitor and document the prevalence of IPV in countries around the world.
Evidence shows that social workers can improve IPV survivors’ social support, reduce the risk of abuse recurrence, and increase access to community resources through individualized case management (e.g., home visits during pregnancy and birth, counseling, and advocacy services) (Bybee & Sullivan, 2002). Health and social work professionals can jointly protect women who are at risk of experiencing IPV.
End Harmful Practices
SDG 5.3 has charged the Member countries to examine their marriage norms and practices and “end all harmful practices, such as a child, early and forced marriage and female genital mutilation.” While child and forced marriage of girls is more concentrated in developing countries, the developed nations such as the United States are not immune to it. In the United States about one in ten married women surveyed between 2001 and 2002 were married before age 18 (Hamilton, 2012; Le Strat, Dubertret, & Le Foll, 2011). As of 2018, 20 states do not have any minimum statutory age for marriage (Kristof, 2018, June 1). As of May 2020, 48 states allow marriage of minors with parental consent and/or judicial approval except Delaware and New Jersey that banned marriage of children under age 18 without exception in 2018 (Malo, 2018, June 22). Worldwide, about 14 million girls under the age of 18 are married every year (United Nations Population Fund, 2012). In southern Asia, where child marriage is highly concentrated, somewhere between 50 to 70% of girls are married before age 18 (Hampton, 2010; Kopelman, 2016; McFarlane, Nava, Gilroy, & Maddoux, 2016; Nour, 2009; Pandey, 2017; Raj, 2010; Sabbe et al., 2013; Salvi, 2009). One nationally representative study showed that over half of the Nepali women who had given birth in the previous five years were married before age 18 and one-third were married by the time they were 15 years of age (Pandey et al., 2017). Eliminating child marriage is not simple. The practice is connected to poverty, social norms, and expectations. Regardless of why it occurs, the practice of child marriage has adverse consequences on women and girls and slows the SDGs’ progress. These girls are not only at higher risk of IPV, poor mental and physical health outcomes, and poor maternal and child health outcomes, but also miss out on their childhood, education, financial independence, and are denied the right to choose their partners in marriage (Babu & Kar, 2010; Gage, 2013; Hampton, 2010; Koenig, Stephenson, Ahmed, Jejeebhoy, & Campball, 2006; Lloyd & Mensch, 2008; Nour, 2006, 2009; Ouattara, Sen, & Thomson, 1998; Pandey, 2016; Raj, 2010; Raj, McDougal, & Rusch, 2012; Raj et al., 2010; Speizer & Pearson, 2011). Women married as children in Nepal had the highest risk of experiencing both neonatal and under-five child deaths (Pandey et al., 2017). The UN considers marriage before reaching age 18 to be a violation of human rights and children’s rights (United Nations, 1989).
Many developing countries, including Nepal, have laws specifying the legal age of marriage as 18 or 20 years, but the enforcement of these laws and of laws requiring marriages to be registered is weak (Nour, 2006, 2009b). Social workers can advocate collecting vital statistics—to register birth and marriage—which will make it easier to monitor the implementation of child marriage prohibition laws (Pandey, 2017). They can also mobilize children in school, parents, and community members such as the school teachers and priests to delay the marriage of girls until they reach their legal age.
To understand how countries are progressing toward the United Nations’ 2030 Agenda, this article reviewed the key elements of the first five Sustainable Development Goals (SDGs), the progress made from previous initiatives, challenges ahead, examples of promising practices, and the roles social workers can play going forward. Member countries may have solved relatively less complex problems since 2000 under the Millennium Development Goals. Those who could afford it benefitted from the new infrastructures—schools and hospitals. Those lagging behind tend to be poor, disabled, or from marginalized communities. The road ahead will require greater imagination, innovation, cross-disciplinary work, and, with it, a more significant role for social workers. Social work practitioners have the necessary skills to understand the complexity of problems. To help everyone move forward, social workers around the globe can unite under the SDGs and jointly work with individuals, families, groups, and communities.
Social work researchers can begin monitoring the progress in SDG indicators using such individual-level data as the Demographic and Health Surveys that are now available for many low- and middle-income countries. They can document how countries are attacking poverty, food insecurity, intimate partner violence, and maternal and child mortalities. They can also monitor the impact of different interventions and document the best practices.
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