6.2 Other challenges to achieving the MDGs for public health

Despite the undoubted progress of recent decades, the prospects for meeting the MDG targets in relation to infectious disease and public health are constrained by many factors in addition to poverty. They include:

• the biological adaptability of many of the most important pathogens infecting humans, which enables the rapid evolution of resistance to chemical controls
• the lack of finance in heavily indebted countries for installing sanitation and piped water, or providing vaccination programmes, soap, mosquito nets and other preventive strategies
• the shortage of essential skills, scientific and technological knowledge, trained personnel and equipment
• difficult circumstances of geology and climate and the risks posed by major natural disasters – drought, flooding, earthquakes, etc.
• the level of illiteracy and gender inequality in a population, which can limit the effectiveness of health education initiatives
• the extent to which political will, social stability and community action can be harnessed for the public good; individuals and communities may be highly resistant to behavioural change; cultural practices and attitudes may oppose interventions such as vaccination.