PHA-Exch> How political epidemiology research can address why the millennium development goals have not been achieved: developing a research agenda

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crosposted from: EQUIDAD at listserv.paho.org


 *How political epidemiology research can address why
the millennium development goals have not been achieved: developing a
research agenda*



D Gil-González 1,2, M T Ruiz-Cantero 1,2,3, C Álvarez-Dardet 1,2,3

1 Preventive Medicine and Public Health Area, University of Alicante,
Alicante, Spain

2 Observatory of Public Policies and Health, University of Alicante,
Alicante, Spain

3 CIBERESP, University of Alicante, Alicante, Spain

*Journal of Epidemiology and Community Health** 2009 *- *April 2009
(Volume 63, Number 4)*



Abstract: http://jech.bmj.com/cgi/content/full/63/4/278



“…..The Millennium Development Goals (MDG) progress targets have not been
met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth
review in order to discover the reasons behind this lack of progress in
achieving the MDG. From a political epidemiology perspective, the intention
here is to identify the political elements affecting the social factors
impeding MDG fulfilment and, at the same time, to suggest future public
policies and appropriate proposals that are both more coherent and supported
by broader, empirical knowledge of the relevant issues.



The  8 Millennium Development Goals (MDG) and 18 Millennium Targets (MT),
with their respective technical indicators for measuring progress, aim to
influence the international political agenda in order to achieve minimum
levels of well-being and health worldwide by the year 2015.1 Those MDG
dealing directly with reducing infant mortality, improving nutrition and
maternal health and the fight against infectious diseases are influenced by
all the other goals, such as the eradication of poverty, universal access to
education, gender equality, environmental sustainability and global
partnership for development.



In spite of initial political support and the fact that this is an agreement
aimed at achieving minimum standards, halfway through the proposed
timescale, the expected progress has not been achieved.2 3 Given this
context, the construction of a Political Epidemiology Research Agenda4 could
contribute towards a more objective approach to the situation, identifying
those factors that are hindering MDG achievement while at the same time
providing future policies and proposals with greater coherence and supported
by a broader, empirical knowledge base.


Epidemiology has contributed to research on MDG through a description of
health problems, and has also identified and analysed some of their causes
and other barriers hindering MT achievement.5 It has also revealed
methodological problems involved in measuring MDG progress, and in the
evaluation of interventions carried out to this end.6 Concerned as it is
with the study of all factors above populations (epi–demos–logos),
epidemiology not only deals with individuals; social epidemiology, for
example, also highlights social factors affecting health, such as poverty.7
Therefore, it is hoped that research results will raise awareness among
decision-makers and their constituencies as regards the need to take social
issues into account. From a political epidemiology perspective, the
intention is to go even further, and to identify the political elements
affecting the social factors that are impeding MDG fulfilment. This can be
achieved simply by applying epidemiological methodology to the study of the
effect that decisions (or lack of decisions) made by the institutions
representing political power have on a population’s health.8 9



Public policies, and their relation to health, are still not part of
mainstream epidemiology, which continues to consider health as apolitical,
and applies a definition of health that is centred on the individual illness
rather than on society health problems.10 As a result, health policies are
equated to healthcare services policies, and inequalities in health
distribution are considered to be the result of individual problems (chosen
lifestyle) or of how healthcare is implemented. This perspective has the
effect of directing political attention towards the most manageable
variable, the healthcare services. However, health inequalities have a
political basis.10 Information on health inequality is not sufficient in
order to decide what is inevitable and what is unjust, and such a decision
does not depend solely on logic and empirical research, but also on an
assessment of politics and ideology….”

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