The Millennium Development Goals definitely sound good. There are few things as inspiring as a global pledge to halve world poverty or universalize primary education, but unfortunately development progress is not measured by the content of our promises. It is measured by the content of our deliverables and, equally important yet much less discussed, how we deliver them. In both of these areas the MDGs fall short and so, as we approach 2015 and the Jeff Sachs speaking tour begins to hit full speed, it is an ideal time to reflect on the flaws of the MDGs and begin to discuss key target areas for future initiatives.
The irony is that despite being the most concrete set of development goals ever put forward by the international community, many of the MDGs are impossible to measure. Sure, you can measure some of the economic goals fairly straightforwardly – 28% of people worldwide had less than $1 of purchasing power a day in 1990 so naturally halving that would mean there being less than 14% of people in the same situation in 2015 – and that is possible because the UN, World Bank, IMF and major businesses all collect boatloads of reliable data on economic indicators like income and prices. But how do you measure health indicators on a global scale? Virtually no African countries register births and deaths making it nearly impossible to collect reliable data on things like child mortality or malaria deaths. What we are left with are surveys, mountains and mountains of household surveys that are almost never coordinated between agencies and far from being reliable. While it is not worthwhile to go into the crudeness of the metrics and evaluation for each of the health goals, if you are at all interested you should check out this article published in PLOS Medicine a few years back.
Despite a lack of reliable data, Jeff Sachs has had no reservations championing the perceived successes of the MDGs, resulting in a wide range of criticism from academics analyzing the sources of his conclusions. In 2012, when Sachs published a paper in The Lancet with updates on his Millennium Villages Projects, many social scientists came forward admonishing him for skewing the data to serve his interests. One claim was that of the eighteen indicators used to measure success (e.g. food security, primary education survival rate, etc.), only one represented statistically significant improvement. Another, even more troubling comment, stated that while Sachs applauded declining child mortality rates, these rates were actually increasing in his Millennium Villages, despite generally decreasing in the decontrolled villages. Overall, these unsettling conclusions prompted Michael Munger, economics professor at Duke University, to state “I really don’t understand why a well published PhD economist would bend good practice to this extent, no matter how noble his ultimate goals.” So, as the MDGs approach their 2015 deadline, it is important to realize that despite what their biggest proponents are saying, we really do not know whether they have been successful, and simply renewing or expanding them will not correct the limitations that prevent proper monitoring and evaluation from taking place.
Beyond the content of what the MDGs have or have not delivered, there are also gaping questions of how they are delivering change. The one line that always sticks out to me from the MDG document is the one that says, “In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries.” These are the same pharmaceutical companies whose uncompromising refusal to allow generic drugs into the developing world during the heart of the AIDS epidemic resulted tens of millions of deaths, the same big pharma companies who have racked up record profits despite appalling drug costs and human costs both in the US and abroad. They do not cooperate, they dictate, they lobby and they win, just as they are winning now as they seek to finalize the little heard of Trans-Pacific Partnership that will essentially prohibit generic drugs from ever hitting the market when the next killer disease arrives.
The Millennium Development Goals do not build or change systems, something the UN itself recognized in this report (chapter 13). They work within the existing paradigm that allows multinational corporations like the drug companies, or Bretton Woods Institutions like the World Bank and IMF to dictate development policy in a way that leads to profit and good press for the Global North. These goals were not written by Ministers of health or economic development from developing countries. They were drafted by technocrats with little thought for implementation or system change and they keep the locus of power in the hands of institutions with a notorious record of abusing it. So while the goals may be noble in their promises they are innately flawed in their implementation. Achieving greater health, economic and environmental equity should be our biggest international priority, but we are kidding ourselves if we believe the MDGs are the solution.