Can the world become a place where the planet and all people flourish after the pandemic? – The BMJ

Covid-19 has impeded achievement of the sustainable development goals and a radical rethink of the global economy is required to meet them argue Fran Baum and colleagues

In 2015, the world adopted 17 sustainable development goals (SDGs) with 169 targets to be achieved by 2030. These goals aimed to create a world in which people and the planet flourish. They were more ambitious than the previous millennium development goals and linked human wellbeing with the sustainability of the planet. Achieving these goals would make the world fairer, more sustainable, biodiverse, and healthy as well more participatory, decolonised, and democratic. Yet even before the covid-19 pandemic concerns emerged about whether governments had the will to achieve these aspirational goals. Covid-19 has cast further doubt and seen reversals rather than progress on many of the goals.

We examine the effect of covid-19 on progress across the five inter-related dimensions of the SDGsplanet, people, prosperity, peace, and partnership1and discuss the political, social, and economic transformations required to meet them. Although creating new challenges for the SDGs, covid-19 has shown that governments can change policy rapidly when they want to. Similar rapid changes are now needed to advance progress towards achieving the SDGs, including radical reforms to fiscal and economic systems to reduce inequities and devise policies that confront the interests of elite groups.

Planetary health and tenable human life on earth are at risk. Irreversible climate change will have a huge negative effect on health, particularly for those living in poor and marginalised settings. Unless there are immediate, rapid, and large reductions in greenhouse gas emissions, limiting warming to 1.5C or even 2C will be unachievable.2

Although the pandemic has had some positive effects on the planet (eg, reducing air travel), some countries are reducing their environmental safeguards and seeing natural resources as capital on which to build their post-pandemic economic recovery.3 Countries rapidly adopted new policies to limit the human and economic effect of the covid-19 pandemic, yet no government has similarly acted for the arguably greater existential threat of climate change.4 Nothing short of rapid, transformative change to protect ecosystems and reduce carbon dependence will be enough to safeguard planetary and human health.

Our best guides to this future may be indigenous peoples around the world, many of whose livelihoods remain based on principles of living in harmony with nature and protecting the liveability of the planet. For example, Australian Aboriginal methods of agriculture and land management are now informing current fire reduction strategies across the country.5 Another example is the Latin American concept of buen vivir,6 which emerged from indigenous traditions and embraces the broad notion of wellbeing and cohabitation with others and the environment, stressing ecological balance and cultural sensitivity.6

Young people around the globe are also demanding more political action on climate change. Governments, especially of countries that are major emitters of greenhouse gases, must step up their efforts and place long term health above short term growth and not allow temporary energy crises, including that resulting from Russias February 2022 invasion of Ukraine, to divert them from reducing emissions. Some businesses are also realising that adapting to a post-carbon world through more localised production (eg, reducing energy use) and material throughput (eg, minimising waste) is vital to future profitability.7

The SDGs envisaged a world in which people can flourish, where poverty and hunger are reduced, and extreme poverty is eliminated by 2030. Health and wellbeing, access to quality education, and the reduction of socioeconomic, gender, and other inequalities were also seen as critical for people to fulfil their potential (table 1). Even before covid-19 it was projected that 670 million people would be extremely poor in 2030.20 The World Bank estimated that collapsing supply chains and economic contraction associated with the pandemic pushed around 97 million more into extreme poverty in 2021 raising the estimated total to 732 million people.21

How covid-19 has affected progress towards the 17 sustainable development goals8

Disparities in covid-19 infections and mortality were experienced by minority ethnic groups in various parts of the world, including some South East Asian countries, the US, and UK, and reflect longstanding patterns of racism.2223 The pandemic also contributed to increases in violence against women, girls, and LGBT+ people and higher rates of poverty and food insecurity among women.2425 Women experienced greater income and employment losses than men as well as increased domestic caring demands.25 Globally, the pandemic both revealed and exacerbated the social protection gap between high and low income countries, with health inequities likely to increase.26

In his July 2020 report to the Human Rights Council,27 the special rapporteur on extreme poverty and human rights noted that poverty is a political choice and eliminating it would require transformative policies including tax justice and redistribution, universal social security, and equitable participatory governance. The adoption of participatory governance is essential to hold governments to account and strengthen the political will for such redistributive policies. There is enough wealth in the world for all countries to meet their SDG targets; distribution, not scarcity, is the fundamental and policy amenable problem.23 Social security, public health, and education systems need to be based on the right of all people to have access to them as such systems are essential to redress systemic inequities that marginalise social groups and to ensure that quality healthcare, childcare, and education are accessible to all.

The SDGs are also intended to provide the means by which all people can enjoy a prosperous and fulfilling life. An important pathway to prosperity is ensuring decent work through strengthened labour rights, protection of trade unions, and proper pay and working conditions. Social protection measures that safeguard people against shocks and stresses are also critical to decent work. Yet the pandemic has seen those already in precarious work, such as those in informal or casual work, being more likely to lose their jobs and at increased risk of covid-19.28

Table 1 provides examples of how wealth inequalities have worsened markedly during the pandemic, with 2020 recording the steepest increase in global billionaires share of wealth on record. The 2022 World Inequality Report notes that the poorest half of the global population owns just 2% of total global wealth, while the richest 10% now own 76%.29 In wealthier countries, governments rapidly introduced massive income and business support programmes that saw public debt soar in a way that would have been unthinkable before the pandemic.22 This had a mixed effect: although the support maintained most peoples prepandemic income, it created cheap money for banks and investors in a liberalised and under-regulated financial system. Those owning companies directly benefiting from a pandemic (eg, drugs and online sales) or with the financial means to speculate more broadly (eg, in equity markets, derivatives, real estate) saw their wealth increase substantially.30 At the same time millions of people around the world struggle for the prerequisites for healthy living. A small progressive tax (eg, 2%) on wealth could be used to improve access to health services, quality education, social security, and better work conditions for those with fewer resources.

A fundamental change is needed in the way prosperity is understood and measured. Growth of gross domestic product (GDP) continues to be the conventional metric of economic health and trickle down prosperity for all. However, endless growth and material consumption are incompatible with planetary and human health and are based on a colonial model of wealth through resource extractivism.31 The pandemic destabilised one path: the need for balanced government budgets, at least for high income countries with sovereign currencies. Therefore, achieving the SDGs will require rethinking the idea that an economic system must be based on GDP growth. Instead, alternative measures of prosperity need to be adopted, such as the genuine progress indicator32 or the happy planet index,33 both of which incorporate environmental and social components not measured by GDP.

Disruptive models of degrowth or prosperity without growth are also required to challenge embedded economic path dependencies. Examples of degrowth economic models include steady state economics, which aims for a balance between production and population growth without exceeding boundaries of planetary health,34 and doughnut economics, which defines the environmental and social space in which inclusive and sustainable economic development can happen.35 Glocalisation, which emphasises local production or consumption and producer cooperatives, is another approach to economic degrowth, prioritising environmental awareness and economic equity.

Wars, regional conflicts, terrorism, and attacks on human rights activists pose serious threats to peace. For people living in conflict zones, the covid-19 pandemic reduced already constrained mobility and opportunities to establish a new life elsewhere. In 2021 the UN Refugee Agency36 noted that borders were less likely to be open to refugees and that 168 countries fully or partially closed their borders at the peak of covid-19; around 100 of these countries made no exceptions for people seeking asylum.

The pandemic also provided cover for clawing back civil liberties and democratic systems. For example, concerns were raised about the implications of militarised approaches to public health mandates in many countries.18 The global civic society alliance CIVICUS reported that in 2020, 87% of the worlds population lived in countries rated as having closed, repressed, or obstructed civic spacean increase of over 4% in 2019.18 It also identified restrictive legislation to silence critical voices, censorship and restrictions on access to the internet, and attacks on journalists over pandemic reporting in at least 32 countries.37 In 79 countries, security forces used excessive force during protests related to covid-19, such as against confinement or weak political leadership responses, or to the consequences of the pandemic, including racial injustice, labour rights violations, and gender based violence.

A more peaceful world is requisite to all the other SDGs being met. In turn, if all peoples basic needs were met, rights to democratic expression were respected, inequities were reduced, and we lived within our ecological limits, peace would be more likely. Peaceful relations within and between countries rely on effective, accountable, and inclusive governance systems that can legitimately resolve conflicts between the rights of individuals and those of the community. These systems should facilitate the free flow of information, promote informed decision making and trust in governance institutions during global crises, and provide protected spaces for civil society participation.

SDG 17 considers multistakeholder partnerships and voluntary commitments38 important for achieving the SDGs. Rather than sparking greater multilateral partnerships for health, covid-19 highlighted persisting power imbalances between high income countries and lower income countries. An example of this was the failure of the Covid-19 Technology Access Pool (C-TAP), which was launched in May 2020 by WHO and international partners to facilitate timely, equitable, and affordable access of covid-19 health products by removing monopoly barriers that reduced their supply.39 Similarly, Covax, a global health partnership set up to provide equitable access to covid-19 vaccines, was initially hailed as an exemplar of global solidarity but was almost immediately undermined by bilateral advance market commitments between rich countries and vaccine manufacturers that prevented it from securing sufficient supplies.40 This resulted in rich countries having much higher covid-19 vaccine coverage than low and middle income countries. The EU, Germany, Switzerland, Canada, and the UK have so far failed to support efforts at the World Trade Organization to agree a temporary intellectual property waiver to reduce barriers to covid-19 technologies, including vaccines.41

The growing influence of the financial sector on global health is also a concern. For example, the covid-19 pandemic saw an increase in the trend to use investment bonds (a form of loan to governments or other agencies) to finance healthcare.42 Investors are also encouraged to support SDG aligned businesses through profit-making socially responsible investments.26 These approaches will inevitably increase wealth disparities since only the wealthy have the capital for profitable investment. WHOs ability to provide global leadership for health has also been reduced by a steady erosion of its autonomy and capacity over the past two decades,43 and this will likely worsen as it, alongside other UN agencies, seeks private financing to cover inadequate public funding.

The interdependence of all SDGs means more holistic approaches are required, and these will rest on effective public interest partnerships. First, the power imbalances of multi-stakeholder partnerships must be addressed. Private sector interests should not dominate international, regional, national, or local partnerships to realise the SDGs. For example, multi-stakeholder partnerships enable food corporations to participate in the formulation of nutrition policy despite their conflict of interest.44 There are also concerns about the influence of fossil fuel corporations in climate change negotiations.45 Public interest, civil societys voice, and elected officials should instead be prioritised in policy making so that public good is at the forefront.

In addition, effective intersectoral action such as WHOs health in all policies is needed to break down barriers between different sectors and to encourage a joint focus on shared outcomes. Countries will need to establish mechanisms to build citizen trust and adopt collaborative budget processes such as Brazils participatory budgeting, whereby residents allocate a portion of public funds to local priorities and needs, including health.46If multi-stakeholder partnerships for the public good are to be fully realised, the public sector must also value, reward, and encourage effective public participation and genuine power sharing.46

Transformative political, social, and economic reforms are needed to disrupt the status quo and promote wellbeing for all. These reforms will enable a redistribution of wealth and power through a fairer economic system based on tax justice and prosperity rather than prioritising growth. They will also reduce carbon dependence to halt global warming and protect and restore the earths ecological systems. The SDGs cannot be achieved without the flourishing of effective, accountable, and inclusive systems of justice and processes to reduce violence and resolve conflicts peacefully.

The UN sustainable development goals were intended to create a sustainable planet and a world in which all people could flourish by 2030

The covid-19 pandemic has set back the achievement of the SDGs

It has worsened social determinants of health, increased socioeconomic inequities, and restricted civil society activism

New economic models are needed that enable strong social security, education, and health systems and encourage participatory democracy

Contributors and sources: FB, RL, and LP have expertise in public health, political economy of health, and social and commercial determinants of health; JF in economics, public health, social determinants of health; and CM in public health, sociological analysis of covid-19, and social determinants of health. All authors contributed to the conceptualisation of the article. FB and JF wrote the first draft and all other authors offered critical comments. FB revised the article, and all other authors offered critical comments and approved the article for submission. FB is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: FB is co-chair of the global steering council of the Peoples Health Movement.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of a series (https://www.bmj.com/pmac-2022) supported by the Prince Mahidol Award Conference 2022. Funding for the articles, including open access fees, was provided by the Prince Mahidol Award Conference (PMAC) and The Rockefeller Foundation. The BMJ commissioned, peer reviewed, edited, and made the decision to publish. Viroj Tangcharoensathien and an expert panel that included PMAC co-chairs and members advised on commissioning for the collection. Rachael Hinton and Kamran Abbasi were the lead editors for The BMJ.

IPCC. Climate Change 2021: the Physical Science Basis Working Group I contribution to the sixth assessment report of the Intergovernmental Panel on Climate Change. 2021. https://www.ipcc.ch/report/sixth-assessment-report-working-group-i/

Colback L. The role of business in climate change. Financial Times 2020 Dec 17. https://www.ft.com/content/7ab0bfb0-b37c-463d-b132-0944b6fe8e8b

United Nations. The sustainable development goals report 2021. United Nations, 2021. https://unstats.un.org/sdgs/report/2021/

Puliti R. Energy access takes center stage in fighting covid-19 (coronavirus) and powering recovery in Africa. World Bank blog, 22 Apr 2020. https://www.worldbank.org/en/news/opinion/2020/04/22/energy-access-critical-to-overcoming-covid-19-in-africa

CIVICUS Monitor. Country rating changes 2020. 2020. https://findings2020.monitor.civicus.org/rating-changes.html

International Labour Organization. World social protection report 2020-22. Social protection at the crossroadsin pursuit of a better future. ILO, 2021.

Alston P. The parlous state of poverty eradication: Report of the special rapporteur on extreme poverty and human right. Human Rights Council, 2020.

New Economics Foundation. Happy planet index. 2006. https://neweconomics.org/2006/07/happy-planet-index

CIVICUS Monitor. Civic freedoms and the covid-19 pandemic: a snapshot of restrictions and attacks. 2021. https://monitor.civicus.org/COVID19May2021/

Meuller B, Robbins R. Where a vast global vaccination programme went wrong. New York Times 2021 Oct 8. https://www.nytimes.com/2021/08/02/world/europe/covax-covid-vaccine-problems-africa.html

Peoples Health Movement. Money talks at the World Health Organization. In: Global Health Watch5. 2017. https://phmovement.org/download-full-contents-of-ghw5/

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Can the world become a place where the planet and all people flourish after the pandemic? - The BMJ