Editor's Letter

Abstract

We begin the year 2015 with a warning to our readers regarding the need to examine carefully the policies currently in play in global health. This year is crucial for criticism, renovation or alteration of the "Millennium development goals" (MDG) adopted by the United Nations in 2000. At the time, it was thought that 2015 would be the deadline to meet eight goals (three of which were directly related to health: reducing child mortality, significantly improving maternal health and radically combatting HIV/AIDS, malaria and other diseases). The Declaration was translated into a roadmap setting out time-bound and measurable goals to be reached by 2015. Undoubtedly, progress has been made in reducing child and maternal mortality, increasing the treatment of people affected by TB and HIV/AIDS and protecting people living in malaria-infested areas. However, as is abundantly clear to the majority of specialists, the fulfillment of the goals of the MDG has been uneven and generally speaking most countries will not meet them.Although it is unclear how the process of renewal of the MDG will be negotiated, or what the new priorities might be, it would seem that protecting the environment, defending human rights and combatting what are considered "non-priority" diseases (such as cancers caused by tobacco consumption) will feature in any future reformulation. However, there is a danger of reverting to a recurrent pattern in the history of international public health, namely changing the goal when difficulties are encountered. An example of this pattern was the goal of "Health for all by the year 2000," which was proposed at the Primary Health Care Conference of 1978. Another example was the "3 X 5" initiative, with the goal of treating 3 million people infected with HIV/AIDS with antiretroviral drugs by 2005, launched a few years ago by the World Health Organization (WHO). As the year 2000 drew near in the first case, and 2005 in the second, many international health managers evaded discussing the problems that might explain why the proposed objectives were not being attained on schedule. Indeed, the topic was then changed. For example, proponents of primary care said that what was really important was "Health for all" and in the case of the "3 X 5" initiative, the advance in free access to antiretrovirals was highlighted. It is true that in both cases the idea of universal health care for individuals made some headway. However, it is also true that opportunities to analyze the pending obstacles carefully were missed. In the case of the MDG, we can end the year celebrating the achievements reached in reducing poverty and improving the health of the population to a certain extent.For this reason, it is necessary to consider some lessons from the experience of the MDG. For example, the MDG gave excessive emphasis to obtaining good indicators on national EDITOR'S LETTERhttp://dx