Jeffrey D. Sachs is Professor and Director of the Center for Sustainable Development at Columbia University. He is also the Director of UN Sustainable Development Solutions Network and Commissioner of the UN Broadband Commission for Development. He has been advisor to three United Nations Secretary-Generals. He has received many awards including India’s most prestigious award ‘Padma Bhushan’. He has authored numerous bestseller books. Sachs was twice named as Time Magazine’s 100 most influential world leaders and was ranked by The Economist among the top three most influential living economists. Nimisha Singh Verma interviews him on his viewpoint on Sustainable Development Goals and Indian healthcare roadmap to achieve its goal.

Q. Being the architect of Sustainable Development Goals, are you happy with its implementation and impact it has created globally?

I am very pleased and excited by the global acceptance of the SDGs across governments, businesses, and civil society. Yet, actual implementation lags far behind our aspirations and needs. In other words, the big challenge is aligning our plans and actions with the goals. For this we need planning, partnerships, and financial resources in budgets and business investments.

Q. As the world’s most renowned economist, what do you think should be India’s road map to achieve Sustainable Development Goals?

India should pursue the SDGs through six main transformations. First, quality education for all, based on expanded budgets for education at the Union and State levels. Second, quality healthcare for all, similarly based on expanded healthcare budgets at the Union and State levels. Third, decarbonisation of energy, by eliminating the use of coal, oil, and natural gas, and shifting to solar, wind, hydro, and geothermal energy. This will not only contribute to ending global warming but will also clean the air and save millions of lives. Fourth, sustainable land use by restoring degraded lands, protecting endangered species, and ending deforestation. Fifth, investing in sustainable cities, through all-electric vehicles, green spaces, walking areas, and affordable housing. Sixth, being the world leader in using Information and Communications Technologies (the digital revolution) for sustainable development.

Q. Countries have adopted various healthcare financing models as per their needs like Beveridge, Bismarck, and National Health Insurance Model, but every system has its limitations. Do you have any recommendations or hybrid model which India should adopt to serve its healthcare needs for varied segments of its population?

The best healthcare financing is a single-payer approach by government (shared between the Union and State levels). The US model of private health insurance is unjust, costly, and unfair, based on a powerful private – sector lobby that makes exorbitant profits at the expense of society, especially at the expense of the poor. India continues to under-invest in healthcare. It should be spending at least 4 percent of GDP on publicly financed healthcare, with the share rising gradually overtime.Until recently, India has been spending little more than 1 percent of GDP, a shockingly small amount, and perhaps the lowest public-sector outlay on health of any major country. Of course, good health comes not just through a high-quality and equitable health system, but also through healthy life practices. India should avoid the American fast-food industry and the accompanying obesity syndrome, the heavy addiction to cigarettes, and the massive air and water pollution that claim so many lives. Quality education for all, and gender equality will also strengthen health outcomes.

Q. You have vast knowledge of Indian healthcare system, having been associated with various initiatives like National Rural Health Mission. How do you think the Bottom of Pyramid can be served in its healthcare needs?

The surprising point about India is how the government chronically under-invests in healthcare. In this case, India is following the US model, of relying on privately provided healthcare. But that only works for the upper class, not the poor.

Q. How should Indian healthcare policies be structured to integrate the technological innovation to achieve its healthcare goals?

Digital technologies enable low-cost, high-quality, and innovative delivery of healthcare. Smartphones can play a vital role: to connect households with health providers, for remote sensing of patient data, for guiding community health workers (such as ASHAs), for telemedicine and distance diagnostics, for collecting and reporting data, etc. More generally, we are in an era of rapid technological breakthroughs in diagnostics, big data collection and processing, remote monitoring, new medicines, genomics, social medicine (including community-based mental health services), and environmental determinants of health. India should turn to its key institutions such as the Public Health Foundation of India to help set roadmaps for universal health coverage based on innovative technologies. And as with the US National Institutes of Health and the UK’s Wellcome Trust, India should explore an innovation ecosystem built on public financing, private foundations, and private-sector financing for cutting-edge R&D. A single-payer system should reimburse private providers at fixed public rates to give them the incentives to reduce costs and raise the quality through innovations. In other words, a single-payer system can still induce innovation by private providers, but within the context of universal coverage and without the excessive lobbying power of private health providers. European models will be helpful here.

Q. How globalization can help developing countries in improving healthcare? Is it a win-win situation for both developing and developed countries?

SDG 3 sets a shared global set of health objectives – “healthy lives for all at all ages”. In other words, the SDGs can build a shared global perspective and strategy. Of course, the gains are win-win. If all countries coordinate on decarbonizing the energy system, all will gain in improved health (fewer extreme heatwaves and climate-related disasters, reduced air pollution). If they cooperate on improved delivery of primary healthcare, there will be fewer uncontrolled epidemics of emerging diseases. If they cooperate on regulations on antibiotic use, there will be much less onset of antibiotic resistance. If all countries cooperate on sustainable farm practices, there will be healthier diets and less irresponsible use of antibiotics for farm animals. In other words, there are huge gains to global cooperation. Moreover, the poor countries depend on financial support from the rich countries like – to finance the control of epidemic diseases, the shift to clean energy, and the implementation of universal health coverage. Crucial institutions like the Global Fund to Fight AIDS, TB, and Malaria, need much more global financing. The world’s billionaires should be doing much more than most of them are doing now to put their vast wealth at the service of humanity. No country should say, “America first,” or “India first,” or “China first.” All countries should say “The World First,” and we will all come out ahead.

Women’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latest Global Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia.

It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland. Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%).

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Overweight and obesity are increasing in almost every country and are a real concern for many low and middle income countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity.

Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in 2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa.

The world now faces a serious nutrition- related challenge, whether stemming from under nutrition or obesity, states Global Nutrition Report 2017.

The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.

“We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

• At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike
• At least 10 million children in Africa are now classified as overweight
• One-third of North American men (33%) and women (34%) are obese
• 155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth
• 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends:
1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity,
2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and
3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.”

Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030.

EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important – it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.”

The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets. “Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.” Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level.

Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent.

The report found there is a critical need for better data on nutrition – many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit).

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