Achieving sustainable solidarity development goals

The Lancet
Dec 16, 2017 Volume 390 Number 10113 p2605-2738  e51-e59
http://www.thelancet.com/journals/lancet/issue/current

Achieving sustainable solidarity development goals
The Lancet
The meaning of social security varies nationally. In the USA, it might bring to mind the eponymous agency that administers social insurance providing benefits for retired individuals and those living with disability. In 1934, in the wake of the Great Depression when as many as 25% of Americans were unemployed, President Franklin D Roosevelt announced his plans to create a social security programme for the nation to “encourage a greater security for each individual who composes it”. He proclaimed: “This seeking for a greater measure of welfare and happiness does not indicate a change in values. It is rather a return to values lost in the course of our economic development and expansion…”

Thus, even early in the last century and beyond the European borders where the tradition of social welfare germinated, the role of government was acknowledged amid growing tensions between national economic development and the security of individuals—a discord that persists around the world with great heterogeneity because of the patchwork of policies and programmes in place to maintain standards of social protection.

The International Labour Organization (ILO), the UN agency that oversees labour standards and liaises with workers, unions, and governments, has endeavoured to formalise a framework to monitor the state of social protection systems around the world. In late November, the ILO released its most recent publication—World Social Protection Report 2017–19: Universal social protection to achieve the Sustainable Development Goals. It is a massive undertaking, using a “life-cycle” approach to quantify social protection, from benefits extended to children and families during maternity, unemployment, disability, to the health and the financing of these security schemes.

The work of the ILO is predicated on the foundation that social security is a right and these efforts are developed in accordance with the UN’s Sustainable Development Goals (SDGs). Specifically, the report focuses on SDG 1·3, the implementation of nationally appropriate social protection systems, including floors (or defined essential levels of security), as part of the main goal to end poverty in all its forms everywhere. The 2030 Agenda for Sustainable Development incorporates related social protection goals prioritising gender equality (SDG 5·4), decent work and economic growth (SDG 8·5), and universal health coverage (UHC; SDG 3·8).

But for all the positive movement in aligning national capacities with the SDGs, the report portrays the steep chasm between those who are secure and those who are not. By the most basic standards, only 45% of the world’s population are covered by at least one social benefit, leaving at least 4 billion people outside of the scope of protection, with Africa, Asia, and Arab States the farthest behind. Nearly 1·3 billion of those people are children. Notably, countries spend on average only 1·1% of GDP on social protection benefits for those younger than 14 years. This chronic underinvestment, left uncorrected, perpetuates staggering long-term inequities.

The report identifies UHC as a crucial piece of social protection, as the need for access to health care is independent of employment status and crosses the lifespan. It might be the most transformative of protections, but also the most fraught, from contracting programmes threatening health services in high-income countries to virtually non-existent long-term care access in low-income countries. Over half of the people in rural areas of the world lack any health coverage, compared with 22% of people in urban areas. Compounding rural–urban inequity is the shortage of health workers, estimated at 13·6 million. To improve access and to achieve UHC, an additional 10 million health workers will be needed. In meeting these care service needs, however, there is also great opportunity for job creation, reducing poverty, and improving conditions for health workers.

As countries navigate the challenging path to improving social protection and realising the SDGs, there is reason to return to the values that drive this work. Fittingly, International Human Solidarity Day is Dec 20, an observance that encourages governments to respect their commitments, promote poverty eradication, and celebrate unity in diversity. As there are many meanings for social security, there are many meanings for solidarity. It is not simply reciprocity or fostering prosocial interventions by government. It is cohesion. The sum will be greater than the parts. In creating a better world, sustainable development goals must also be solidarity development goals. Goals that can only be met by revisiting the fundamental values of promoting unity, harmony, and collective security—in solidarity.