We are living in the global age, politically, economically and socially. The call to Think globally and act locally has never been so vital to our survival as a species as it is now.
Between COVID, climate change and the exponential growth of our connected world, it is obvious to me that we must now behave as as global community. One in which we all understand that our personal actions have an impact everywhere.
In 2015 the United Nations established the 2030 Agenda for Sustainable Development which sets out 17 Sustainable Development Goals (SDG) to:
...free the human race from the tyranny of poverty and want, and to heal and secure our planet. To take transformative and urgently needed steps to shift the world onto a sustainable and resilient path with no one left behind.
You could be forgiven for thinking the SDGs apply only to low-and-middle-income countries (LMIC) as we take many of them for granted in Australia and New Zealand. But working closely with the SDGs in communities affected by filariasis and podoconiosis, I realised that I could view all my lymphoedema work and research through a sustainability lens. I have even found surprising insights on the importance of the SDGs in my own personal life and habits too. Read the full list of SDGs here.
The goals describe global targets and indictors which at first glance may not appear to be relevant to our daily lives, but together they provide a framework which can be used to make important decisions that affect our personal choices and enable us to contribute positively to the future of our planet. I want to highlight just a couple of ways that the SDG guide my most important life decisions.
On a very personal level, goals 12 (Responsible Consumption and Production), 13 (Climate Action), 14 and 15 (Life Below Water and Life on Land) guide the way that I eat, the clothes I wear and the way I manage my waste. In particular I have chosen a plant based diet and buy locally produced items whenever possible.
I have written previously on my issues with the ketosis fad among people with lipoedema. Whilst I agree fully that managing diet to reduce inflammation and manage weight is essential for affected persons, I am appalled at the frequent recommendations to do this by eating lots of meat and animal fats.
almost cried when I saw a recent advertisement for a virtual summit which included a presentation titled "A Deeper Dive into Keto with a Carnivore Diet: Highlighting the important benefits of animal-sourced nutrition". What I'd really like to see is a presentation on how to achieve ketosis with a plant based diet. Where is the symposium on achieving ketosis for vegans? For the sake of the planet we all need to eat less meat, not more.
The SDGs have been very important in guiding my research work in LMIC, but reflecting on my clinical years I am glad that I resisted using some of the new single use compression systems. At the time my decision was mostly economic, my clients just couldn't afford them. Now I'm happy that I was able to achieve really good compression outcomes for my clients using reusable materials.
Much more will need to be done to address the disability and stigma associated with lymphoedema to meet Goal 3, Achieving good health and universal health care, and rich countries such as ours could learn a lot from LMIC countries. Under the guidance of the WHO, many filariasis and podoconiosis endemic countries have recognised lymphoedema as a national priority in relevant health policy documents and health sector budget allocation. This has led to prioritisation of limited health resources for lymphoedema services, amidst competing priorities and health system challenges (I'll be elaborating on this at my upcomg Invited Address at the 14th ALA Conference in Hobart).
I'm also concerned about the direction lymphoedema research is taking. We seem to be spending a lot of research dollars on drug and surgical therapies, but lymphoedema innately requires self-management on a daily basis, regardless of whatever level of medical intervention is also available. Where are all the research dollars on self-care? Where are the public sector programs teaching effective self-massage and self-bandaging? It seems to me that LMIC are doing this much better than we are.
While the SDGs are not legally binding, governments are expected to take ownership and establish national frameworks for their achievement. I'd like to think that I have taken personal ownership of the SDGs, and am living my life in a way that supports achieving them on a global scale. I hope that becoming aware of the SDGs will influence some of your daily choices and actions too.
Goal 1) No Poverty and Goal 2) Zero Hunger
Very relevant in LF and podoconiosis endemic countries where secondary infections are a major cause of illness and lost work. But I also suspect that if we accurately counted the cost of cellulitis infections in the presence of lymphoedema in Australia and New Zealand as a cause of lost productivity, we would see chronic oedema as a signicant contributor to poverty and dependence on public resources.
Goal 3) Ensure healthy lives and promote well-being for all at all ages
Target 3.8 - Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and
Indicator 3.8.2 is the proportion of the population with large household expenditures on health as a share of total household expenditure or income.
There have been several studies showing the financial cost of lymphoedema, and this impacts people affected by lymphoedema in every country.
Goal 4) Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, and Goal 5): Achieve gender equality and empower all women and girls
Target 5.4 Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate.
This speaks to the children being kept out of school to look after an ill or disabled adult, but we also see a disproportionate burden for home-based and unpaid care falling to women and girls.
Goal 6) Ensure availability and sustainable management of water and sanitation for all
Target 6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally.
This makes me reflect on the single use lymphedema assessments treatments that contribute to medical waste.
Goal 7) Ensure access to affordable, reliable, sustainable and modern energy for all
For me this guides my views on the use of fossil fuels and I have been a long time public transport user. We need to stop using fossil fuels to make plastic too.
Goal 8) Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all
Are 'sustainable' and 'economic growth' an oxymoron? I think we need an altogether different paradigm to the current 'endless growth' one we are living in.
Goal 9) Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
Goal 10) Reduced Inequality
Goal 11) Sustainable Cities and Communities
Goal 12) Responsible Consumption and Production
Goal 13) Climate Action
Goal 14) Life Below Water
Goal 15) Life on Land
Goal 16) Peace and Justice Strong Institutions
Goal 17) Strengthen the means of implementation and revitalize the global partnership for sustainable development