Introduction and Background

The High-Level Panel of Eminent Persons (HLPEP) notes in its work on developing post-2015 goals that ”… [i]nvesting more in health, especially in health promotion and disease prevention, like vaccinations, is a smart strategy to empower people and build stronger societies and economies” (United Nations, 2014, p. 38). It argues that solutions for child mortality are simple and affordable, and that therefore all preventable deaths should be averted by 2030, with a specific aim ”… for an upper threshold of 20 deaths per 1000 live births in all income quintiles of the population” (United Nations, 2014, p. 38).

While estimating the feasibility of reducing infant deaths overall, we zoom in on neonatal mortality (deaths in the first 28 days of children's life), which accounts for over 40 percent of total under-five mortality today and will become the main area to tackle for most countries if major progress in under-five mortality is to be made over the next 15 years.

Under-five Mortality Today and Global Progress Made over the Period 1990–2013

Major progress has been made in the realm of child mortality over the past 40 years. While close to 18 million children died before reaching their fifth birthday globally in 1970, this had been reduced to less than 7 million in 2013 (UN Inter-agency Group for Child Mortality Estimation [IGME], 2014), at the same time as the number or births has increased.

Table 14.1 shows that there has also been a shift in the distribution of deaths within the first five years: while early neonatal mortality (deaths in the first seven days of children's lives) accounted only for about 22 percent in 1970, it accounts for 32 percent of total mortality today; less than 29 percent of total under-five deaths today occur among children after the first 12 months of their life.

Figure 14.1 shows the current child mortality burden by cause of death, highlighting the relatively large share of current under-five mortality occurring in the neonatal period (first 28 days) and that the most common cause is simple prematurity. This analysis also shows the rather remarkable progress in reducing mortality from infectious diseases.

Summary

This chapter offers some reflections on the components of SDG1, dealing with poverty, noting first its huge scope. Ending poverty can justifiably be seen as an overarching aim of all development efforts, and hence one can hardly object to SDG1 as an aspirational goal for “the future we want.”

The target on eradication of extreme poverty (SDG1.1) is similar to that set by the World Bank. However, the latter calls for reduction to a minimal, low target (3 percent). The conceptual argument has to do with the notion of “frictional” poverty – the idea that at any given point in time, there may always be an irreducible lower bound to poverty given that economic systems are constantly in the process of adjusting to shocks of one kind or another, and even the most comprehensive social protection system is unlikely to guarantee that no one ever falls below the poverty line. This is conceptually sounder, and the post-2015 target should be aligned with this.

However, the 3 percent is a global target, which raises the uncomfortable possibility that it could be reached with many smaller countries still having much higher levels of extreme poverty. This is a very real possibility, given that there are 17 countries with a projected poverty incidence of 30 percent or higher (15 in sub-Saharan Africa) in 2030, by which time the global incidence is projected to have reached 4.8 percent, based on growth data from national accounts.

There is also an issue of Purchasing Power Parities. The $1.25 per day figure is set in terms of 2005 PPPs, but a new set became available in 2011. These are controversial, but there is agreement is that the new PPPs entail a large downward revision relative to the 2005 PPPs if extrapolated to 2011 using relative rates of inflation. This is not a trivial issue, as the use of the new PPPs without a recalibration of the 2005 $1.25 poverty standard could imply a reduction of the incidence of extreme poverty by more than half. There is no agreement on which set of figures should be used, but the debate argues for some flexibility in the post-2015 target. The threshold of extreme poverty should be reviewed with each methodologicallysound revision of purchasing-power parity exchange rates.

Introduction

The last two decades have seen a large body of evidence of substantial health effects for long-term exposure to air pollution – especially fine particulate matter – be it in the form of outdoor ambient air pollution (AAP) or household air pollution (HAP) from the use of solid fuels. There are compelling arguments that air pollution should feature in a new set of post-2015 development goals.

Global Health Effects and Exposure

to Air Pollution

Health Effects

Nearly six million deaths were attributed to AAP and HAP in 2010 according to the Global Burden of Disease (GBD) 2010 Project (Lim et al., 2012). This is more than from alcohol and drugs, about the same as from active and passive tobacco smoking, and four times more than from child and maternal undernutrition. Of 67 risk factors assessed, it is only surpassed by total dietary risk factors and high blood pressure, of which the latter is influenced by air pollution, tobacco smoking, and diet. The most recent estimates attribute 5.5 million (GBD 2013; Forouzanfar et al., 2015) to 6.5 million (WHO, 2016) deaths to air pollution.

The GBD 2010 Project developed an integrated PM2.5 exposure–response (IER) model to estimate these health effects by using relative risk (RR) information from studies of ambient PM2.5 air pollution, secondhand tobacco smoke, household solid fuel use, and active tobacco smoking (Burnett et al., 2014). The exposure–response relationships in the IER model are highly nonlinear withdeclining marginal relative risks of health outcomes at higher PM2.5 exposure levels.

Ambient Air Pollution Exposure

Nearly 90 percent of the world's population lived in areas with ambient outdoor PM2.5 concentrations exceeding WHO's AQG of 10 μg/m3 (annual average) in 2005, and nearly one-third lived in areas with ambient PM2.5 exceeding WHO's Level 1 Interim Target of 35 μg/m3 according to estimates by Brauer et al. (2012).

The highest annual average population weighted PM2.5 concentrations are found in a large belt extending from western sub-Saharan Africa (SSA-W) and the Middle East and North Africa (MNA) through South Asia (SA) to East Asia (EA) and the High Income Asia Pacific (HI AP) countries. Regional average population weighted exposures were below 10 μg/m3 in most of South America, the southern part of Africa, and in Australia and the Pacific Islands (Table 1.1).

Post-2015 Consensus: Food Security and Nutrition Perspective

Summary

By 2050, there will be far more people to feed, increasingly distant from the rural areas where food is produced, and with the vast majority of the increased demand coming from Africa and Asia. In a world where currently up to 900 million people are chronically malnourished, reducing postharvest losses could play a significant role in meeting the coming challenge.

Rosegrant et al. make the most serious attempt to date to come to a reasonably rigorous answer to the question of the role that lower PHL might play. It is particularly useful that they have compared the effectiveness of reducing losses with the impact of increased spending on agricultural R&D. In the end, they project that both infrastructure investment to reduce PHL and agricultural R&D investment would significantly improve food security, especially in South Asia and sub-Saharan Africa, the regions of greatest global concern. Their conclusion is very sensible: PHL reduction can contribute to improvements in food security globally, but it is relatively less important and less cost-effective an approach than alternative policy instruments available to policymakers.

For a variety of reasons, I suspect that the authors’ estimates even err in the direction of exaggerating the role that PHL reduction can play. Their simulations only consider the food security impacts of infrastructure improvements that reduce PHL and ignore the simultaneous impact due to lower prices and uptake of improved production technologies by farmers who have better access to markets. As an aside, one very noteworthy result of the study is that infrastructure investment in Africa gives a much higher return than in Asia or Latin America. The second reason why the attractiveness of PHL reduction may be exaggerated is that there is no comparison with other potentially high-return interventions.

Another issue is that targeting reductions in food waste is difficult because losses appear for different reasons in different parts of the chain. PHL rates are endogenous to food prices and to incomes and in ways that will naturally make PHL increase as food security improves. Lower food prices improve poor people's access to food. But lower food prices also reduce the opportunity cost of food waste; poverty, not PHL, is the principal driver of food insecurity.