The millennium development goals and the inverse care law: no progress where it is most needed?

In 2000, global leaders from 192 countries pledged to achieve eight millennium development goals, or MDGs (www.un.org/millenniumgoals). These goals include targets to be achieved in the period from 1990 to 2015, four of which relate directly to health. The first goal—eradicate poverty and hunger—has as one of its key targets the reduction by half of the proportion of children with low weight-for-age. The fourth MDG is to reduce the mortality of children under 5 years by two-thirds, and the fifth to reduce maternal mortality by three-quarters. Finally, the sixth MDG is to “combat HIV/AIDS, malaria and other diseases”. The other four MDGs are also relevant, as they address broader determinants of health, including universal education, gender equality, environmental sustainability and the need for global partnerships.

I will deal specifically with MDGs 4 and 5, the reduction in the mortality rate of children under 5 and maternal mortality. It is estimated that there are half a million maternal deaths and almost 10 million deaths of children under 5 every year.1 In the closing paper of the Lancet’s Child Survival Series published in 2003, we called for a mechanism to monitor progress in child survival and to hold countries and international partners accountable. …