While indicators of global health and development have improved since 2000, inequality remains a major barrier to achieving the United Nations' Sustainable Development Goals, a report from the Bill & Melinda Gates Foundation finds.
Now in its third year, Goalkeepers Report 2019 (HTML or PDF, 62 pages) highlights the vast inequalities that remain between rich and poor countries, districts within countries, and men and women, as well as the urgent need for investments in primary health care, digital inclusion, and climate adaptation to address inequality. According to the report, while child mortality rates fell and average years of schooling increased in nearly every country between 2000 and 2017, geographic disparities, both within and between countries, and gender disparities persist, with nearly two-thirds of children in low- and low-middle-income countries living in areas that, at the current rate of progress, won't reach the SDG target for child mortality by 2030.
In sub-Saharan Africa, for example, girls receive two fewer years of schooling than boys, on average, and even when they are well educated are less likely to join the formal workforce. Although Botswana and Ghana both average about eight years of schooling for girls, Botswana's female labor participation rate is three times that of Ghana's, thanks to more progressive gender-inclusive laws and policies.
To address these inequalities, Bill and Melinda Gates have called for a new approach to development that targets the poorest populations in the countries and districts that are being left behind. Using examples from Ethiopia, Kenya, Rwanda, and India, the report argues that low- and middle-income countries — which currently spend only 36 percent of their health budgets, on average, on primary care — need to invest more in health systems that prioritize primary care and benefits the poorest; that digital inclusion and governance policies are needed to ensure the quality and reach of government and financial services for the least-empowered citizens; and that more support is needed to help the poorest farmers adapt to climate change, which disproportionately affects them.
"As we write, billions of people are projected to miss the targets that we all agreed represent a decent life," the Gateses write in the report, which is being released in advance of the UN General Assembly meeting later this month. "We believe that seeing where the world is succeeding will inspire leaders to do more, and seeing where the world is falling short will focus their attention."