Transitioning to Good Health and Well-Being

The Agenda 2030, signed by the Heads of State and Government in 2015, set out 17 Sustainable Development Goals (SDGs) and, for each of them, a number of targets to be reached within the next 15 years, with a total of 169 targets. SDG 3, “ensuring a healthy life and promoting well-being for all at all ages”, provides, among others, Goal 3.8 “achieving universal health coverage, including protection of financial risks, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all“. Agenda 2030, unlike the global agenda for the previous fifteen years, which focused on the so-called Millennium Development Goals (MDGs), mainly concerning the poorest countries, involves and commits all governments to the adoption of “indivisible” and universal goals that will help to end poverty by 2030 “once and for all”, and also brings the issue of development back to a global dimension. The new agenda is not without contradictions. Among other things, it proposes, among its economic objectives, “sustainable, inclusive and sustained growth”, an oxymoron that was pointed out at the beginning of the 1970s, when the Club of Rome showed the “limits of growth” in a finite ecosystem. Thus, the challenge of sustainability is global and involves all national health systems. Using Universal Health Coverage, SDG 3’s target, which seems to attract most of the attention, as the main focus, the paper argues that SDG 3’s feasibility and sustainability is highly dependent on transnational determinants which, if left unregulated by appropriate global governance processes, may jeopardize its attainment. Global determinants (international macroeconomic policies, migration, climate change, market forces, technological innovation, etc.) affecting health system functions (stewardship, resources generation, financing and the provision of services) are identified, and their impact analyzed. The analysis provides suggestions for the identification of an urgent paradigmatic shift to ensure the effective sustainability of SDG 3 in general, and of universal health coverage (UHC) in particular.

The world is facing unprecedented public health challenges, including changes, due to climate change, that will affect every continent, and limitations on global food and water supplies together with an increasing epidemic of non-communicable disease. The United Nations Sustainable Development Goal 3, “good health and well-being”, includes targets for child mortality, maternal mortality and reducing chronic disease. Breastfeeding is one of the most cost-effective public health interventions available for countries at all levels of development. In the first year of life, appropriate infant nutrition (exclusive breastfeeding to around six months) reduces infant mortality and hospital admissions in infancy by 50% or more. Breastfeeding followed by the introduction of appropriate complementary foods at around six months establishes a healthy microbiome, has a long-term association with reduced rates of childhood illnesses, hospitalizations, obesity and later chronic disease, while improving cognitive development. It is consistent with the historical cultural practices of all societies. While the development of infant formula has been of benefit to some infants, its inappropriate promotion has resulted in a decline of breastfeeding in recent decades, and, as a result, recent health gains in many countries have not been as great as they could have been. Formula use increases health care costs through increased illnesses and hospital admissions. The specific target for non-communicable disease in SDG 3 is to reduce premature mortality from chronic disease by one third by 2030. The Global Burden of Disease project has confirmed that the majority of risk for these targets can be attributed to nutrition related targets, and it is estimated that annually 15 million people between the ages of 30 and 69 years die from a non-communicable disease (NCD), the majority from cardiovascular causes. Healthy life course nutrition, beginning in the first 1000 days of life, is a major public health priority in answering this challenge. Breastfeeding, exclusively for about six months, and appropriate complementary feeding, establishes a healthy developmental trajectory. Children are the population segment most susceptible to the effects of climate change, bearing an estimated 80% of the increased burden of disease associated with climate change. The health benefits of breastfeeding will provide some protection against the health effects of climate change, including projected increases in some infectious diseases. Increased breastfeeding will avoid the high environmental costs associated with the production of infant formula, including the use of large quantities of potable water and energy. In contrast, breastfeeding, as well as being the best infant feeding intervention, has a very low environmental impact. An important part of the sustainable development agenda should be to promote breastfeeding and its benefits and to reverse the inappropriate promotion of infant formula.

Premature death and disability rates from non-communicable diseases (NCDs) have been rapidly increasing with potentially enormous implications on global economy. Three major risks factors for NCDs are tobacco use, harmful alcohol consumption, and poor diet. National governments can create incentives for behavioral changes in the consumption of these products through fiscal policies, such as price increase through taxation. A substantial body of empirical evidence suggests that a significant increase in prices of tobacco and alcohol products through higher taxes can discourage consumption and reduce their negative impact on the individual’s health and the economy. Emerging increasing evidence on the impact of consumption of sugar-sweetened beverages (SSBs) suggests the same. Consumption of tobacco, alcohol and SSBs can undermine development and attempts at meeting the Sustainable Development Goals (SDGs), including health and well-being, hunger and poverty alleviation, quality education, economic growth, and reduced inequality. The empirical evidence shows a strong causal effect of consumption of tobacco, alcohol, and SSBs on NCDs. The attributable estimated economic costs can be very high, and significantly higher than the tax collection on consumption of these goods. Moreover, consumption of tobacco, alcohol, and SSBs can crowd-out spending on food and nutrition and increase hunger. In addition, the attributed NCDs can lead to lost productivity and earnings, as well as high out-of-pocket medical expenses for their treatment, putting an individual and their families into a vicious circle of poverty. At the same time, children may be forced to drop out of school to take care of ill family members or to work to make up for lost earnings, denying them educational opportunities and having an intergenerational impact on their and their country’s economic development and growth. This paper reviews the empirical evidence on the impact of consumption of tobacco, alcohol, and SSBs on SDGs to make a strong case to support a significant tax and price increase to help achieving a country’s development goals.

Today, the crisis of the agrifood sector across several geographical European regions, including our own, combined with social, economic and health inequalities at regional, national and community levels, is characterized by extremely critical aspects, mainly residing in the limited innovation potential of companies and small/medium enterprises (SMEs), the lack of integration with public–private research institutions, the insufficient systematization and organization of the existing resources in an extended territorial networking. This results in increasing difficulties of SMEs to exist in both domestic and foreign markets with characteristics of quality and competitiveness. On the other hand, several epidemiological studies clearly indicate that Western countries, including Italy, are witnessing a dramatic phenomenon consisting of an increasingly large prevalence of chronic noncommunicable diseases (NCDs), including cardio-, cerebrovascular and respiratory diseases, diabetes, obesity and cancer, whose causes are primarily related to (removable) lifestyle risk factors, notably diet. Based on this two-sided consideration, promoting both the sustainable consumption and production of traditional food products in regional, domestic and international markets—through a series of activities aimed at increasing their health and/or nutraceutical potential, to clinically validate their effects on both health and chronic disease(s), and to enable the rapid technological transfer and development of either processes or products—would represent a systemic strategy of high impact in the short, medium and long term for important expected outcomes from an economic, technological and healthcare standpoint. Lessons learned from the Dieta Mediterranea e Salute (DiMeSa) study and its recent advancement, the PASSI project, with both published and unpublished results, are presented and discussed here.

Global health is an area for research and practice that places a priority in improving health and achieving health equity for all people worldwide. Therefore, it corresponds with the aims of the Sustainable Development Goals (SDGs) for providing universal health coverage and leaving no one behind (SDG 3). Public health is understood as global health on a regional or local level. Whereas “old” public health focused mainly on the prevention of infectious diseases and the healthcare for specific subgroups at risk, “new” public health takes a holistic and interdisciplinary perspective on aspects related to health and well-being. Inter alia, public health genuinely deals with the reduction of health inequalities and risk factors—not only by prevention on a behavioural level, but also on a structural level, such as environment and society. Thus, we understand health as part of each of the 17 SDGs. In a world characterised by globalisation as well as epidemiologic and demographic transitions, the impact and sustainability of global health action needs to be taken into account to improve the world population’s well-being. Therefore, this contribution highlights present and future challenges for global health. Furthermore, it provides overarching suggestions and policy advices for improvements to strengthen a global response on today’s challenges and to gain the targets set within the SDGs, by pointing out that almost all of the 17 SDGs are relevant for health-related issues.

The healthcare system’s efficiency and effectiveness depend on policies and procedures, such as the rapid and goal-directed exchange of health-related information between its different actors. In recent years, more national healthcare systems approached sustainable health benefits for their populations by digitalization. Despite numerous advantages such as the improved availability of medical services, their improved quality and cost-effectiveness, new vulnerabilities threatened the trust in the healthcare system. Healthcare institutions are a primary target for cyber attacks and have the stigma of being a particularly easy prey for malicious actors, due to the relatively low levels of problem awareness and preparedness. We argue that cyber threats pose a new challenge to reach sustainable health goals and have to be considered an imminent part of all healthcare development strategies. Cyber threats in the healthcare sector can have detrimental acute effects in times of national crisis, hybrid warfare, or international conflicts above or below the threshold of war. In peacetime and in western democracies, however, breaches of data that were processed by private or public bodies undermine the public trust in these institutions. Public awareness and scepticism therefore influence policies around the digitalization of healthcare, and this consequently affects the development of institutions at the frontline of healthcare and achievement of sustainable development goals. The chapter further discusses the relationship of working towards sustainable health goals, public trust and data security with the example of the Estonian e-health system, where leading principles such as cyber security, transparency, and patient’s data autonomy are prioritized.

Background: Sustainable work ability is a multifaceted concept that involves the matching of the needs and abilities of the individual with the quality of work. Good work ability during a work career is one of the potential indicators of sustainable work ability and employment, as it requires a good balance between individual resources and work demands. We aimed to study the developmental pathways of work ability during midlife until retirement and its impact on functional health in terms of mobility limitations in old age using longitudinal data on employees in a large amount of blue- and white-collar occupations. Furthermore, we studied the difference in survival among people in different trajectory groups. Methods: Questionnaire data on work ability, working conditions, lifestyle, and physical functioning of middle-aged municipal employees (n = 2918) were linked with registers on retirement and all-cause mortality. Perceived work ability was measured as the current work ability compared with the lifetime best in a score of 0 to 10. The trajectory of work ability was analyzed by using growth mixture modeling in 16 years of follow-up data. Mobility limitations as an outcome was defined using nine items related to physical mobility tasks. Trajectory membership of work ability was used as a predictor of mobility limitation after 12 years using generalized linear models. Cumulative hazard curves for mortality by trajectory group were calculated. Results: Three distinct trajectories of work ability emerged. The majority of the participants (65%) had good work ability, which is here defined as sustainable work ability, 25% having L-shaped decreasing work ability and 10% having U-shaped decreasing work ability. Demographics, lifestyle factors, morbidity, and physical workload-adjusted models shows that L-shaped (Incidence rate ratio (IRR) 1.24, 95% confidence interval (CI) 1.18–1.30) and U-shaped (IRR 1.37, 95% CI 1.28–1.47) work ability trajectory membership was strongly associated with a higher risk of mobility limitations in the next 12 years of follow-up. The cumulative hazard for all-cause mortality was highest among those in the U-shaped decreasing work ability trajectory group. Conclusions: Those with a sustainable work ability during midlife showed a lower risk of mobility limitations and better survival compared to those with decreasing work ability. These findings highlight the importance of sustainable work ability throughout the working career as well as the need for early identification of workers with diminishing work ability and need for workplace interventions to help to promote an extended working career as well as a healthy old age.