Martin Luther King, Jr. said that, ‘Of all the forms of inequality, injustice in health care is the most shocking and inhuman’. Consider the following – in 2018, the total life expectancy at birth in the Central African Republic was 53 years, whereas in Hong Kong SAR, China – it was 85 years. In a likewise manner, palatial towns guarantee a more healthy and productive life to their citizens as opposed to shanty towns. Pakistan can be categorized as a classic case where wealth buys health.
The insidious cycles of fear, exorbitant medical costs, and a lack of properly trained medical personnel has plagued our health system for decades. It is not an uncommon practice to forestall vaccination cycles, and not take precautionary attempts – measures which can prevent debilitating ailments in the first place. It is an undeniable fact that infections will keep on multiplying, and viruses will keep spreading, so in light of this, we need to ask ourselves whether our current progress is sufficient to achieve the third Sustainable Development Goal: ‘Good Health and Well-being’? This aforementioned question is the most pressing concern in the ‘Decade of Action’ – especially in the midst of a pandemic.
Diseases flourish when there are various other factors in play aside from their modes of transmission, including unhygienic health practices, poor socio-economic situations, and lack of resources for treatment and isolation
Target 3.1 obligates us ‘to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030’. According to the Pakistan Maternal Mortality Survey of 2019, the estimated maternal mortality ratio (MMR) is 189 maternal deaths per 100,000 live births – which is 170 percent below the required target. Moreover, the disparity between the provinces in this regard is quite eye-opening – with the highest ratio being in Balochistan, i.e., 298 deaths per 100,000 live births. This maternal mortality ratio is closely associated with the proportion of births attended by skilled health personnel – which is another indicator (3.1.2) of the same target. According to Pakistan Demographic and Health Survey (2017-18), the skilled assistance during delivery includes the assistance of a doctor, nurse, midwife, lady health visitor, or a community midwife. In the five years before the survey, only 60 percent of the births were assisted by doctors. A dai or traditional birth attendant was involved in 24 percent of the cases, and relatives or other individuals were involved in 5 percent of the births. Marriages at a young age pervade Pakistani culture, and due to a lack of education, many women are unaware of health practices, thus putting their lives in jeopardy. Taking into consideration the already depleted health infrastructure as exposed by Covid-19 – the trajectory to achieve this target will require efforts of monumental dedication.
Target 3.2 commits us to ‘end preventable deaths of newborns, and children under 5 years of age by 2030, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births, and under-5 mortality to at least as low as 25 per 1,000 live births’. The neonatal period refers to the first twenty-eight days of life. In this regard, some estimates developed by the UN Inter-agency Group for Child Mortality show that in the case of Pakistan, there were 67.2 deaths per 1000 live births in 2019. A silver lining existed here as there had been a reduction from 73.8 deaths in 2016. However, many countries have already achieved a lot of progress over the years regarding a reduction in under-5 mortality, including El Salvador – a lower middle income and densely populated country, with 13 deaths per 1000 live births in 2019. Moving on to the neonatal mortality rate, Pakistan had the second-highest rate of deaths at 41 deaths per 1000 live births in 2019. While in El Salvador, this number was 7 deaths per 1000 live births in the same year.
Target 3.3 obligates us to ‘end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, while concomitantly combating hepatitis, water-borne diseases and other communicable diseases by 2030’. UNAIDS estimates show that in 2019, the incidence of HIV was 0.2 per 1000 uninfected population, for ages 15-49 for Pakistan – with the highest numbers being reported in Lesotho. In 2019, numerous HIV cases were reported in Larkana – majority of which were children. A lack of awareness can be the leading cause of such appalling situations. As yet, there is no cure for HIV but medications can be used to manage the condition for life.
Another indicator of this target deals with an ancient affiliation – tuberculosis. In 2018, the tuberculosis incidence was 265 per 100,000 population in Pakistan according to the World Health Organization, Global Tuberculosis Report. This statistic stands at 3 for the United States, and 0 in the case of Barbados – for the same year. The situation is exacerbated by the fact that many cases of this disease have become drug-resistant. Similarly, for the case of incidence of malaria as reported by the Global Health Observatory Data Repository/World Health Statistics, there was an incidence of 3.4 per 1,000 population at risk in the case of Pakistan in 2018. Typically, these diseases flourish when there are various other factors in play aside from their modes of transmission, including unhygienic health practices, poor socio-economic situations, and lack of resources for treatment and isolation. Another ghastly statistic to consider in this regard is that, the World Health Organization announced that in 2019, in the case of Pakistan – an average of 5 and 10 million people are affected by hepatitis B and C respectively. All these aforementioned diseases can be labelled as the ‘silent’ pandemics – wreaking havoc for many. Correspondingly, stigmas related to these issues prevent timely diagnosis and saving of lives.
Dr. Izza Aftab is the chairperson of the Economics Department at Information Technology University, Lahore. She is also the Director of the SDG Tech Lab and the Program Director of Safer Society for Children. She has a PhD in Economics from The New School University (NY, USA) and is a Fulbrighter. She tweets @izzaaftab.
Noor Ul Islam is currently working as a Research Associate at the SDG Tech Lab established in collaboration with Information Technology University, Lahore, UNDP and UNFPA. She is a post-graduate in Economics from Lahore University of Management Sciences. She tweets @Noor_Ul_Islam20.