Health's role in achieving Australia's Sustainable Development Goal commitments

In 2015, along with 192 United Nations member states, Australia adopted the 2030 Agenda for Sustainable Development.1 The 17 Sustainable Development Goals (SDGs) that form the basis of this Agenda are “an urgent call for action by all countries — developed and developing — in a global partnership. They recognize that ending poverty and other deprivations must go handinhand with strategies that improve health and education, reduce inequality, and spur economic growth — all while tackling climate change and working to preserve our oceans and forests”.2

I n 2015, along with 192 United Nations member states, Australia adopted the 2030 Agenda for Sustainable Development. 1 The 17 Sustainable Development Goals (SDGs) that form the basis of this Agenda are "an urgent call for action by all countries -developed and developing -in a global partnership. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth -all while tackling climate change and working to preserve our oceans and forests". 2 This statement makes it clear: the 17 SDGs are an urgent call to action aimed at all countries, including high income nations such as Australia, to advance planetary health for intergenerational equity and wellbeing (Box 1). 3,4 The 17 SDGs and 169 associated targets are ambitious and demonstrate the need by governments to continue the work commenced during the Millennium Development Goal (MDG) era. The SDG health goal (ie, SDG 3, ensure healthy lives and promote wellbeing for all at all ages) certainly continues the "unfinished business" of the MDG health agenda (ie, MDG 4, reduce child mortality; MDG 5, improve maternal mortality; and MDG 6, combat human immunodeficiency virus infection and acquired immunodeficiency syndrome, malaria and other diseases). It also tasks countries with addressing their non-communicable disease and injury burdens, including promoting mental health and strengthening the prevention and treatment of substance misuse, alongside improving access to medicines and to sexual and reproductive health and quality health care services (Box 2). 1 While there is one SDG explicitly dedicated to health, achieving the remaining SDGs for health is equally crucial (Supporting Information , figure 1). 5 Indeed, the Australian Department of Health acknowledges that good health is both a precondition and an outcome of the 2030 Agenda. 6 The SDGs promote social determinants of health such as nutrition (SDG 2), education (SDG 4), gender (SDG 5), water and sanitation (SDG 6), employment (SDG 8), reducing inequalities (SDG 10), housing (SDG 11) and healthy environments (SDGs 13-15). SDGs 16 and 17 further support good governance and multistakeholder partnerships for health, strong data and information systems, and equitable access to quality health care services and associated entitlements. The importance of SDGs 16 and 17 cannot be understated: robust health systems that can generate reliable vital statistics data are key for strengthening the evidence base for SDG policy and planning, critical for improving the health and wellbeing of all Australians. 7

Australia's voluntary national review on the Sustainable Development Goals and health
In July 2018, Australia was one of 47 nations to present its voluntary national review (VNR) on achieving the SDGs at the High-Level Political Forum on Sustainable Development in New York. 8 Australia's VNR included a four-page narrative on SDG 3 that provided Australia's medical and public health community with its first real insight into the federal government's position around national SDG priorities. This was a significant step as it has been almost 3 years since Australia agreed to integrate the SDGs into development planning nationally and as part of its Overseas Development Aid strategy. 9 The Australian Government progress has been marginal; until the recent release of Australia's VNR, the nongovernment and corporate sectors had been the main  Information ,  table 2). The VNR goes on to note that "innovation and technology may assist" in achieving SDG 3, especially in terms of addressing the health needs of people in rural and remote areas by greater integration of digital technology. 8 However, a cogent SDG program for this integration is not presented in the VNR.
The VNR also states that governments in Australia "recognise the importance of healthy ecosystems and socio-economic factors to human health, with an interlinked, holistic approach that focuses on the underlying determinants of health, consistent with linkages between SDG 3 and many of the other SDGs". 8 However, there is no comment as to how other SDGs that include the social determinants of health will be linked and tracked against Australia's SDG 3 priorities. Again, as inequities associated with the social determinants disproportionately affect Australia's Indigenous peoples and other marginalised populations (eg, persons with disabilities, migrants and refugees, single men and women of all ages), a multidimensional and comprehensive approach to SDG 3 measurement and monitoring by the Australian Government will be imperative. 10

Recommendations for the 2030 Agenda health goal implementation in Australia
Australia's first VNR on the 2030 Agenda is not a national report card on SDG implementation. Rather, it is an expression of intent of the federal government's SDG commitment. The Australian Government's ability to substantively report on SDG implementation (including SDG health-related implementation) is hindered by the country lacking a comprehensive SDG action plan. We recommend the SDG targets and indicators for health should be grounded in a roadmap for action and contextualised to the Australian setting. They need to identify and speak to Australia's unique health landscape and cross-cutting inequities, and structural and data challenges. An Australian SDG roadmap for health, located in a broader national SDG implementation plan, will also need input, monitoring and review by a formal national advisory body that represents the breadth of Australia's public health sector, private industry, and civil society and community stakeholders. The Australasian College for Emergency Medicine's integration of community representatives to ensure balanced policy decisions is a potential SDG participatory governance model (https:// acem.org.au).
The Department of Foreign Affairs and Trade and the Department of the Prime Minister and Cabinet are currently leading an interdepartmental senior officials group to progress whole-of-government coordination on how to give effect to the 2030 Agenda in Australia. 15 This initiative means that responsibilities for reporting on the SDGs are divided across government departments, embedding an ad hoc approach to SDG planning and integration, "antithetical to the SDG vision for game-changing and innovative development solutions through country leadership, national policy coherence and participatory governance". 16 We recommend a single point of government responsibility. France and Belgium have sustainable development ministries tasked with steering whole-ofgovernment SDG rollout.
Under Australia's more piecemeal SDG governance arrangement and approach, the Department of Health is tasked with reporting on SDG 3. The Department of Health is also tasked with supporting the Department of Agriculture and Water Resources to implement SDG 2 (zero hunger) (Supporting Information , table  3 15 ). It is not known at present whether the Department of Health interfaces with other federal agencies responsible for the social determinants beyond SDG 2, or with Indigenous Affairs or the Office for Women that both sit within the Department of the Prime Minister and Cabinet. It is also unclear whether the Department of Health is responsible for, or even included in, SDG 3-related regional and global health planning, or whether this alone falls under the SDG remit of the Department of Foreign Affairs and Trade.
The SDG Index and Dashboards, which report on worldwide SDG progress, show SDG 3 to already be an Australian success story. 17 At a population level that may be so, but this defeats the point of SDG adoption and integration by high income nations such as Australia, given that internationally oriented SDG data reporting platforms are not designed to capture hidden subnational complexities and should be treated with caution. Coupled with a weak VNR, such data platforms have the potential to obscure and mask the intersectional disadvantage and complex health disparities in this country. Therefore, we urge the Australian Government to ensure that Australia's next VNR does not inadvertently perpetuate the invisibility of disadvantaged groups in the Australian community who are at the heart of SDG ambition and its catchcry, "leave no one behind". 1 Comprehensive interdepartmental partnership and national policy and planning for SDG coherence, integration, implementation and review, combined with strong centralised governance, social accountability oversight mechanisms and bipartisan political support, will be crucial.