While the original ambitious target has not been met, this acceleration in progress since the Millennium Declaration is to be welcomed. In light of discussions to develop policy post-MDG, it is useful to ask the question: why has this improvement occurred? Was it due to the efforts of national governments and aid agencies in increasing public health expenditure, access to safe water, access to basic sanitation and immunisation rates? Or was it just due to general economic growth, which would have occurred anyway, regardless of what organisations like the UN declare or don’t declare?
If national governments and aid agencies responded to the Millennium Declaration in the manner originally envisaged, data from the World Development Indicators Database should indicate significant increases in public health expenditure, access to safe water, access to basic sanitation and immunisation rates post-MDG and these changes should have made a difference to child mortality rates. From the analysis in my paper, it would appear that the Millennium Development Goals did not change trends in child mortality across the total sample of 129 developing countries considered. It is clear that there has been acceleration in the rate of reduction of under-five mortality rates from 2000-2010. But across all countries considered, there is no evidence that rates of growth in private health expenditure accelerated or that trends in access to improved water sources, improved sanitation facilities or measles immunisation rates have improved. Growth rates in public health expenditure and the trend in DPT immunisation rates have been faster post-MDG but these have not caused child death rates to fall.
In contrast, many countries have experienced rapid economic growth during this period. Income per capita is seen to clearly influence the child mortality rate and this relationship is robust when accounting for endogeneity or a variety of model specifications. The pattern of accelerating economic growth and a slowdown towards the end of the decade in developing countries is also clearly reflected in secular trends in under-five mortality. Furthermore, the most significant factor explaining annual decreases in child mortality over the decade was economic growth.
In September 2015, the UN General Assembly agreed on an expanded list of 17 sustainable development goals (SDGs) with 169 proposed targets. Frameworks for the SDGs should really consider first whether the original goals had any effect on outcomes, including those related to health.
Dr Declan French is a Lecturer in Finance at Queens University Management School, Belfast.