One of the most transformative and far reaching aspects of the Sustainable Development Goals (SDGs) is the pledge to Leave No One Behind (LNOB). Simply put, this is the idea that the SDGs will not be achieved unless the goals and targets reach those who are most vulnerable and marginalised in society. This is a radical approach on many levels and will challenge even the best of governments, UN agencies, and civil society.
Putting LNOB into practice requires several things from governments, multilateral agencies, NGOs and the private sector: having a clear understanding of what LNOB means; having a clear understanding of who is left behind; mobilising sufficient resources; confronting the roots and causes of marginalisation and vulnerability; and being able to measure its success. Each of these alone is a daunting task; together, the challenge is formidable. Even so, LNOB has been a compelling theme to the SDGs and the strength of the pledge lies in its ability to communicate a powerful message in a simple way – this should not be underestimated.
A considerable amount of work has been done to articulate LNOB and take stock of what is necessary to achieve it. The UK Government was at the forefront of championing LNOB and presented a pledge to the UN when the SDGs were agreed that provided an initial roadmap. ODI has done several pieces of work to both assess the challenge ahead and governments’ preparedness. And the UK network of international development NGOs, Bond, outlined both the principles it felt should underpin the delivery of LNOB and carried out an initial stock-take of some efforts to achieve it.
So, what does this mean for older people?
First, older people as a group have long been marginalised and left on the sidelines of international policy making. The SDGs’ predecessor, the Millennium Development Goals (MDGs), did not mention older people even once. One could argue that this aspect of LNOB has already been achieved by the fact that the SDGs include explicit and implicit references to older people. Older people are mentioned in targets on tackling hunger and making cities more inclusive. Goal 3 on health is clearly framed to include older people by using the phrase ‘at all ages’. A target on inequality refers specifically to empowering and promoting “the social, economic and political inclusion of all, irrespective of age”. And older people are implicitly included through references “to all” and the need for disaggregating data by age throughout the SDGs.
Just below the surface, however, a different picture emerges. Within the framing of how the SDGs get measured, older people continue to be excluded. Even in goals that should obviously include older people, such as health and life-long learning, we don’t see older people mentioned in the indicators. The adage ‘what gets measured gets done’ has particular resonance, and little is being asked of governments within the SDG indicators to demonstrate what they are doing for their older populations.
Nowhere is this more true than with commitments to tackling non-communicable diseases (NCDs). There is a positive story to tell about the inclusion of NCDs in the SDGs. It demonstrates a growing awareness that they are the most significant health crisis facing all countries globally. This is hugely important for improving health in later life as the greatest burden of NCDs occurs amongst older people, who typically live with multiple chronic conditions. There is considerable criticism, however, on the way that action on NCDs gets measured. The main focus of reducing premature mortality between the ages of 30-70 can distort how governments tackle NCDs: capping measurement at 70 and the emphasis on ‘premature’ sends an implicit message to governments that the health of older populations is less important; and the focus on mortality obscures the fact that health systems have to help people manage multiple morbidities, even when death rates are reduced.
Even if commitments to helping older people were more explicit in the SDGs, understanding who the most vulnerable and marginalised older people are requires good data. The SDGs helpfully ask for data to be disaggregated by age across a number of goals and targets, but the current state of internationally comparable data on older people is very poor. Data gathering tools and analysis often stop at the age of 49, or unhelpfully use categories of 60+. In this context, it will be impossible to assess whether efforts to achieve LNOB for older people have been successful, or indeed whether older people had been identified as being vulnerable in a particular context in the first place.
A welcome development for addressing this shortcoming has been the creation of the Titchfield City Group on Ageing. This informal working group of the UN Statistical Commission has been set up on the initiative of the UK Government to look at ways of improving the collection and analysis of data on older people in a way which can be used to inform policy and the measurement of the SDGs, and hopefully government action more widely.
There are so many ways in which the LNOB commitment relates to older people, whether we look at poverty and income; the vulnerability of older people in emergencies; increasing health challenges and frailty in later life due to NCDs, including dementia; or the persistent undercurrent of ageism which continuously undermines and devalues older people so that they are not considered capable or active participants in society.
Fundamentally, if carried through fully, LNOB means recognising the diversity of experience of older people in their various contexts. In which case, we are no longer talking about ‘older people’ as a single group, but instead trying to understand and respond to the specific circumstances that an older person may have according to their gender, their economic situation, their social standing, whether they have any form of disability or impairment, as well as helping them to achieve their aspirations. This is a bold project, and unlikely to be achieved. But it is something that is worth trying for.
About the Author
Ken Bluestone leads Age International’s policy and Influencing work in the UK and internationally on issues affecting older people in low and middle-income countries.
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Comments Welcome: We welcome your comments on this or any of the Institute's blog posts. Please feel free to email comments to be posted on your behalf to administrator@ageing.ox.ac.uk or use the Disqus facility linked below.
