Written by Michael Hammer of Keele University and Susannah H. Mayhew of the London School of Hygiene and Tropical Medicine.

Health is a one of the most pivotal global public goods, central to the well-being of every individual and the communities people live in. In the absence of health, people and societies face inordinate challenges to realise sustainable achievements against any of the 17 Sustainable Development Goals.

We first started to develop the concept for the Elgar Companion to Health and the Sustainable Development Goals in 2021. At that time the world was six years into the SDG framework and six years into the Paris Accords on climate change. Changes in the political direction of key countries in this period had already made these global unified commitments to address major inequalities in the world and combat global warming much more uncertain than what 2015 had promised. The global Covid 19 pandemic had tested national and global health and economic systems in unprecedented ways. But there was hope that global sustainable development aims could be maintained and continue to provide a guide for shared action.

The intention of our book then was to highlight the tension between the promise of the SDG framework of a better world that the global community was jointly aspiring to, and the realities of an uncertain world. These realities included political fragmentation, growing inequality and disenfranchisement and rapid deterioration of environmental and other livelihoods support for the poorest and most marginalised in the world. These collectively undermine sustainable pathways to development.

Beyond this tension we set out, together with the many authors we brought together from the Global South and North from academia and practice, to offer avenues and models for change and improvement from local level to global approaches. Prof. Seye Abimbola, in his foreword to the book, highlights how important it is when seeking a wider systemic perspective not to jump to judgements which may be misguided because of a lack of understanding of the local context and complexities of a challenge.

Today, some years on from our first concepts for the book which balanced challenge and hope, we live in a world of many intersecting crises that in their magnitude were hard to imagine just a few years – even months – back. Many of these crises are fuelled by narrow self-interest, a zero-sum attitude to the distribution of wealth, and the indiscriminate use of armed violence. Russia’s invasion of Ukraine triggered global energy and food crises. The conflict in the Middle East has brought destruction to the lives of tens of thousands and challenges hitherto known alliances. The wrecking ball tactics of the new US administration jolt European countries out of long-standing assumptions about their security, and cut out millions of people from the supply of life-saving drugs, health services, monitoring of diseases, and many other kinds of vital support. Locally some violent political groups such as the M23 in Eastern DRC and their backers are emboldened. Beyond the immediate killings the levels of sexual violence in this conflict and the complete breakdown of health systems conjure up the worst memories of the wars in the same region in the early 2000s where many thousands died in consequence of the destruction of any kind of infrastructure and health care, and as they continue to do today in Gaza, Sudan and Myanmar.

So, is the promise of global Sustainable Development dead? Is what is left to academics and practitioners in the field of health and other key public goods nothing but a body-count in a world which appears to have lost its moral lode-star of a shared future?

We refuse to believe so.

The Elgar Companion to Health and the Sustainable Development Goals shows across its 21 chapters that another world remains possible.

Some of our chapters, such as on the evolution of health systems, Ethiopia being a case in point, show that an ongoing commitment to community health, across changes in governments of different political colours, can lead to a steady path of strengthening health systems. Case studies like those on the integration of sustainable livelihoods, environmental conservation, and service improvement in the field of sexual and reproductive health and rights in Madagascar and Uganda demonstrate that with a holistic perspective communities can be enabled to develop resilient approaches that address their particular needs.

Across all contributions four main cross-cutting strands emerge as relevant for health and the SDGs: first, participation and inclusion of marginalised voices is key to overcoming power differentials and inequalities. Second, local capacity for adaptation and crisis response needs to be much more valued by global actors when designing programmes to meet the needs of people and communities holistically. Third, realising gender sensitive policies and practices across a range of health topics is key to building resilience and ensure effective crisis response. And fourth, the world needs joined-up, robust and accountable, impact (rather than process) driven public governance (whether at local, national or intergovernmental level) for the delivery and protection of access to public goods, including health through areas as different as access to food and the prescription of drugs.

The Elgar Companion to Health and the Sustainable Development Goals is a critical contribution to the Sustainable Development debate at a time when the frameworks to achieve progress are under pressure in ways rarely seen before. It gives a realistic perspective of the challenges involved in realising access to health for people, and especially people in disadvantaged settings in a volatile world full of conflict and uncertainty. Yet the insights shared by the contributors offer hope that beyond the turmoil a better world, inspired by the ambition of the Sustainable Development Goals, remains possible. Our authors demonstrate that a determined focus on community resilience and capacity, as well as a cogent analysis of where systemic change is needed, remain central assets in the search for improving access to health in this world.

The Elgar Companion to Health and the Sustainable Development Goals

Edited by Susannah H. Mayhew, Department of Global Health and Development, London School of Hygiene & Tropical Medicine and Michael Hammer, School of Social, Political and Global Studies, Keele University, UK

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