In sub-Saharan Africa in 2005, the mortality rate in children under five averaged 169 deaths per 1,000 live births – 28 times the industrialised country average of six deaths per 1,000. [1] More than 500,000 women die each year in childbirth, most of them in developing countries. [2] Worldwide, 39.5 million adults and children are currently living with HIV/AIDS and almost 4.3 million new infections occurred in 2006. [3]

Back in 2000 at the United Nations Millennium Summit, leaders from 189 countries, including the UK, adopted the UN Millennium Declaration. From this an eight-goal action plan, the 'Millennium Development Goals' (MDGs), was promoted, to meet the needs of the world's poorest by 2015. Summarised in the box, the goals range from providing primary education to environmental sustainability.

Healthy targets?

Supported by both rich and poor nations, the MDGs address key development challenges. However, no clear implementation plan was put in place, and the initiative was poorly resourced. In 2008, we stand just over halfway to the target date of 2015, yet – despite all the good intentions – most governments are not keeping their promises, and the UN itself has admitted 'there is a long way to go to keep our promises to current and future generations'. [4]

Health is at the centre of the MDGs (Goals 4 to 6), and the Summit pledged to:

• Reduce by two-thirds, between 1990 and 2015, the number of children five years old or younger who die from preventable illnesses
• Reduce by three-quarters, between 1990 and 2015, the number of women who die giving birth
• Have halted by 2015 and begun to reverse the spread of HIV/AIDS
• Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Although some progress has been made, there is a long way to go. Unless efforts are increased, particularly in sub-Saharan Africa and Asia, there is little hope of eliminating avoidable child deaths. More children are surviving their first years of life but, if current trends continue, the MDG will not be achieved until 2045 – 30 years too late. [5] Ratios of maternal mortality also seem to have changed little in regions where most deaths occur (sub-Saharan Africa and Southern Asia). Inequality between urban and rural care at the time of delivery still exists within many countries, particularly in sub-Saharan Africa. Several countries report success in reducing HIV infection rates, largely through interventions that promote behaviour change. However, rates of infection overall are still growing, and deaths continue to increase. The epidemic remains centred in sub-Saharan Africa, believed to be home to 64 per cent of HIV-positive people and to 90 per cent of children under the age of one living with the virus. Twelve million children in this region have also been orphaned by the virus. Additionally, new tuberculosis cases are on the rise, at a rate of one per cent per year, with the fastest increases again in sub-Saharan Africa. [6]

Achieving health equity

Health is a universal aspiration and a basic need, yet massive inequities – unjust inequalities – exist worldwide. Those in low-income countries suffer from higher rates of illness, particularly infectious diseases. Scarcity of food, poor sanitation, and lack of medical care all contribute. Traditionally, Western response has been to throw money at these problems to increase local financial resources, but is there more to it than this?

The World Health Organisation (WHO) Commission on Social Determinants of Health helps countries and global health partners address the social factors leading to ill health and inequities. Going beyond the contemporary concentration on the immediate causes of disease, the Commission seeks to focus on 'the causes of the causes', to tackle the social determinants of health, including unemployment, unsafe workplaces, urban slums, globalisation and lack of access to health systems. [7]

Commission chair Professor Sir Michael Marmot argues that 'although the Commission recognises the contribution that economic growth can make to the availability of resources for reducing health inequities, growth per se is not a sufficient prescription for equitable improvements in population health… rather action within and between countries to mitigate and remove structural, destructive inequality is the necessary counterpart to worldwide growth'. [8]

WHO hopes the Commission will launch a global movement that perceives equitable health as a societal good by emphasising 'the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries'. [9]

The outcry against health inequity has been growing around the world for many years, and the 'Make Poverty History' campaign, established in 2005 when the UK hosted the G8 summit, did much to raise public awareness about the financial problems faced by developing countries, such as unjust trade systems and crippling debt burdens. However, halfway to the MDG target date of 2015, further action is needed – and governments must be held to account – if the goals are to be achieved.

'What does the Lord require of you?'

I'd not really thought about all this before moving from clinical medicine into public health, but the more I learn, the more I realise that much of the work I do is profoundly Christian. Proverbs 31:8 could be the mission statement of many global public health initiatives: 'speak up for those who cannot speak for themselves'. Indeed there are over 2,000 biblical references to poverty and injustice, from the Old Testament prophets who spoke out against personal behaviour that exploited the poor, to the parable of the Good Samaritan [10] and numerous examples of Jesus speaking up and acting for the poor.

God clearly has the poor in his heart. He calls us to act with mercy [11] and to love our neighbour, [12] and will call us to account for our action or lack of it. [13] Our social involvement also ultimately bears witness to the transforming grace of Jesus Christ. With him as our example, being involved in social justice encourages us to examine our attitudes not only to the poor, but also to our possessions and economic power. Jesus warns those who store up treasures on earth: 'woe to you who are rich, for you have already received your comfort. Woe to you who are well fed now, for you will go hungry.' [14] We constantly need to be seeking God's guidance about using our material blessings.

Although the MDGs may not be met by 2015, progress has been made, and many Christian agencies have contributed. Those whom God has not called to work overseas should support this vital work financially, but we need more than generous individuals. We need governments to respond with generosity and justice to the needs of the poor, to address more than merely the immediate causes of disease.

The Micah Challenge

Micah Challenge UK is a coalition of Christian organisations and churches, of which CMF is a core member, united to fight global poverty and hold our government to account for its MDG promises. It is part of a global initiative seeking to unite Christians in speaking out against injustices. [15]

The 'challenge' is Micah 6:8. 'And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God.' By highlighting such biblical truths, Micah Challenge seeks to sensitise and engage Christians into greater political and practical involvement in poverty issues. It inspires Christians to pray, take action, speak out, and engage with these issues, in the UK and overseas. Building on the momentum of 'Make Poverty History', the coalition will run 'Micah Challenges' to keep the spotlight on Government about delivering the MDGs by 2015.

Focusing on five key areas – AIDS treatment, water and sanitation, climate chaos, trade justice and primary education – the 'Blow the Whistle' campaign in 2007 examined the 'half-time scores' so that extreme poverty and hunger might really be halved by 2015. In 2008, the 'Take Five' campaign16 focuses on a different MDG each month, providing information, practical ways to take action, specific prayer points, and guidance about lobbying.

Micah Challenge seeks to encourage believers to work together to pursue justice, to call decisionmakers to act on their MDG promises, and to work with others in holding leaders accountable in securing a more just and merciful world. Will you take the Challenge?