IFMSA's Contribution Towards the SDGs by International Federation of Medical Students' Associations

IFMSA's Contribution Towards the SDGs

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IFMSA List of contributors: Klaudia Szymuś Coordinator Christos Pappaioannou Coordinator Eglė Janušonytė Coordinator Rocío González Mohammed SaifAldeen Abdelrahman Yeuk Shun Joshua Tran Sarraa Basim Hrez Maria Inês Francisco Viva Samuel Nathan Kelvin Gutiérrez Herrera Mohammed Mamdouh Eissa Abdallah Tom

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains more than 141 National Member Organizations from more than 130 countries across six continents, representing a network of 1.3 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future. IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

Yousra-Imane Benaskeur Mathew Siu Chun Chow

Publisher IFMSA Nørre Allé 14, 2200 København N., Denmark

Email: gs@ifmsa.org Homepage: www.ifmsa.org

vpprc@ifmsa.org

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Contents

www.ifmsa.org 3 | SDG Report 2021

Introduction

Methodology

Data Analysis

Africa Region

Americas Region

Asia-Pacific Region

EMR Region

Europe Region

COVID-19 Effect

References

Annex 1

INTRODUCTION The Sustainable Development Goals (SDGs) are the United Nations’ agenda that needs to be fulfilled by 2030. Transforming our world: the 2030 Agenda for Sustainable Development was adopted in 2015 by the United Nations General Assembly and obliged the member states to work together in achieving 17 intersecting goals. This developmental framework aims to ensure a sustainable future for all. It gives a specific focus on vulnerable populations as well as emphasizes a collective responsibility of the global community. The International Federation of Medical Students’ Associations gives a platform for over 1.3 million students from 141 National Member Organizations (NMOs) from 131 countries within 5 regions: Africa, Asia-Pacific, Americas, Eastern Mediterranean Region and Europe. All students engaged in IFMSA can build their capacities, exchange ideas, raise awareness, gain their voices and shape the reality on a local, national and international level. Under the theme “Think global, act local” we support our members working in 6 different Standing Committees: on Medical Education, Public Health, Sexual and Reproductive Health and Rights including HIV and AIDS, Peace and Human Rights, Professional Exchange and Research Exchange. Since 2003 we have been an officially registered non-governmental organization in consultative status with the UN Economic and Social Council. We also collaborate with other UN agencies such as the WHO. With such international recognition and commitment to the United Nations’ work, we carry the liability to promote and contribute to SDGs’ fulfilment. As future healthcare providers, we conduct activities that specifically target SDG 3 Good Health and Well-being. However, our efforts tackle all goals not only because we have different areas of work but mainly because health is a versatile aspect that affects the achievement of other goals. With motivation in hands, passionate members on board and gathered experience in the past, we tirelessly act upon 17 SDGs. Moreover, as a youth-led organization, we extensively work on youth inclusion to SDGs’ commitments and continue to bring positive change. We shape future advocates that work on the grassroots, play key roles in decision-making spaces and significantly bring us closer to meeting the 2030 Agenda. We emphasize the importance, power and responsibility of youth for global improvement. This report aims to showcase the efforts of IFMSA and its NMOs on SDGs for the past 2 terms - 2019/20 and 2020/21. We take into account local, national and international implementation of actions, regional and national diversities as well as capacitybuilding projects, advocacy and community-based activities. This report also serves as a form of reflection as we develop recommendations for improvements hoping to create more and more impactful actions.

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METHODOLOGY 1. Data collection Activities conducted by our National Member Organizations can be enrolled all year round under IFMSA Programs: ●● ●● ●● ●● ●● ●● ●● ●● ●● ●● ●● ●● ●●

Communicable Diseases Emergencies, Disaster Risk and Humanitarian Actions Environment and Health Ethics and Human Rights in Health Gender-Based Violence Health Systems Healthy Lifestyles and Noncommunicable Diseases HIV/AIDS and other STIs Maternal Health and Access to Safe Abortion Medical Education Systems Mental Health Realizing Sexual and Reproductive Health and Rights Teaching Medical Skills

Activities are enrolled by Activity Coordinators through an enrollment form and if it meets quality criteria, it becomes internationally recognized. Once in a year activities are reported (their outcomes, outreach, effect of external events such as COVID-19 pandemic). All reported activities that were conducted between the 1st of October 2019 until 1st of February 2021 were included in our data analysis. Data was collected with the help of the Programs Team through the Enrollment and Reporting Databases. For international or regional activities we used the same methodology as for national data - the usage of the enrollment form. Activities included: Campaigns, IFMSA workshops and SRTs, sessions in GAs/RMs, adopted Policy Documents, official publications (manuals, booklets, toolkits etc), signed Memoranda of Understanding and surveys results (only those analysed in reports, abstracts, posters and other publications), which is different from national projects that usually do not include Policy Documents, sessions on National General Assemblies or official publications or Memoranda of Understanding? The timeline of the collection was the same as the national data.

2. Data analysis The data were aligned with SDGs with the help of the Small Working Group for the Alignment of Programs with SDGs, where each activity was assigned one or more SDG and its target that corresponds to the activity according to its description and objectives. Each activity was also assessed how it was impacted by the pandemic. The statuses to choose from were: cancelled/postponed; moved to virtual settings; unaffected; not indicated and other. 5 | SDG Report 2021

After this, we will perform statistical analysis for the number of activities per SDG and its target and SDG worked on the regional levels. We will also analyse the overall effect of COVID-19 as well as in regards to the most impacted regions and SDGs.

3. Conclusions After all data are analyzed, we will phrase conclusions and recommendations to improve SDGs’ fulfilment and regional commitments to it proposed by External Affairs Regional Assistants. We will discuss where we, as IFMSA, are still lacking progress and where we already achieve successes.

DATA ANALYSIS In total analysis, we included 509 national activities and 43 international ones. In the regional distribution of national activities, we used the definition of IFMSA Regions and the number presents as below: Africa: 70 Americas: 65 Asia-Pacific: 113 EMR: 147 Europe: 116 Activities between NMOs from different regions were included as one activity in the total number of activities, but separately in regional distribution.

Figure 1. Regional distribution of included activities. 6 | SDG Report 2021

National activities were distributed over Sustainable Development Goals and the highest number of activities worked under SDG 3 (Good Health and Well-Being), the next ones were SDG 4 (Quality Education) and SDG 5 (Gender Equality). The NMOs did not work under SDG7 (Affordable and Clean Energy), SDG8 (Decent Work and Economic Growth), SDG12 (Responsible Consumption and Production) and SDG15 (Life on Land) at all.

Figure 2. Number of activities per Sustainable Development Goals.

In the chart below, it is visible that Africa is the only region working on SDG1 (No Poverty), Europe on SDG9 (Industry, Innovation and Infrastructure) and Asia-Pacific on SDG14 (Life Below Water).

Figure 3. Regional contributions to Sustainable Development Goals. 7 | SDG Report 2021

International contribution On the international level of IFMSA, there is a range of campaigns and workshops that contribute to the SDGs’ achievement. In the total analysis, 43 international activities were included. Once again, the most worked on SDG was Good Health and Well-Being followed by SDG4 (Quality Education) and SDG5 (Gender Equality). IFMSA on the international level did not tackle SDG2 (Zero Hunger), SDG7 (Affordable and Clean Energy), SDG9 (Industry, Innovation and Infrastructure), SDG12 (Responsible Consumption and Production). Contrary to national activities, IFMSA worked on SDG8 (Decent Work and Economic Growth) and SDG15 (Life on Land).

Figure 4. Number of international activities per Sustainable Development Goals.

Limitations On both levels, one issue is extremely prominent, which is the low number of enrolled activities. Should all NMOs and International Teams report their projects, the number included in the analysis would exceed the current number multiple times. With this picture in mind, we are aware that this report does not reflect all SDGs tackled by local, national and international activities as they lacked international reporting. Another mechanism that impedes the analysis is the timeline. In this report, we included activities that took place between the 1st of October 2020 and the 1st of February 2021. However, the deadline for reporting activities in the term 2020-21 is the 15th of June 2021. Therefore, for this term, we could only include activities that were reported before the 15th of May 2021 which undoubtedly affected the number of analysed activities for this term. The last issue we identified was the lack of alignment of our Programs (and their reporting) with the SDGs’ targets. In the analysis, the Small Working Group examined the reports of activities and assigned them its SDG and target according to what was 8 | SDG Report 2021

written in the form. While some activities are comprehensive and touch upon many SDGs at once, it might be hard to capture it explicitly in the report and as the activities were analysed by people who did not participate in them personally, so it made it harder to reflect the whole scope of work of each activity. Therefore, in the future editions of the SDG report, we recommend including SDGs targets in the reporting form so that Activity Coordinators can mark all relevant targets. Having these issues in mind, further, we conducted a more detailed analysis performed for each SDG, region and the effect of the COVID-19 pandemic.

Discussion In terms of the current scale of work, SDG3 is the highlight of our contribution towards this goal. On all levels of IFMSA’s work, we advocate for health equity, universal health coverage, quality, affordability, accessibility and availability of healthcare services along with the extension of provided services such as: mental health, environmental health and sexual and reproductive health. Our involvement in achieving this goal is undeniable. However, more focus on the national and international level should be given to SDG1 and SDG2 as these goals are at risk of not being fulfilled by 2030, and we share the global responsibility to contribute there too as finances and nutrition are immensely important factors of health attainment. Since IFMSA’s Global Priorities for the term 2020-21 were both - Gender Equity and Health Workforce 2030, there should be more emphasis put on the activities working under SDG5 and SDG8. Only less than 15% of national activities are tackling Gender Equality and just one activity is touching upon Decent Work and Economic Work. This is not reflecting the importance of these matters. Mirroring the one health approach and arising from our belief in its utmost importance in addressing global health issues, which is reflected in our collaborative initiatives with other student and non-student organizations, focusing on veterinary and environmental health, it is crucial that our vision of the one health approach, together with our global priority on Health, Environment and Climate change, gets into more practical applications through the formulation of activities that focus on environmental health and ensuring that other activities focusing on human health, can still tackle the environmental health perspective. Therefore, we recommend putting more emphasis on performing under SDGs: Clean Water and Sanitation, Sustainable Cities and Communities, Climate Action, Life Below Water and Life on Land always from a health perspective. Intersectionality in IFMSA is a starting point for many activities, however, this is hardly noticeable from the number of activities that tackled SDG10. This might be a result of an insufficient description of activity’s methodology outlining this goal in the reporting form (annual reporting of internationally enrolled activities) or simply insufficient action under this SDG. This part of the report remarks that SDGs are interconnected, as working on one SDG directly or indirectly affects other goals. This also leads us to the conclusion that we 9 | SDG Report 2021

should not only focus on SDG3 but collectively work on all SDGs to fully achieve the Agenda 2030 for sustainable development and maintain health-related progress. In this section, we also highlight the role of youth and civil society in the fulfillment of Sustainable Development Goals. Youth-led organizations such as IFMSA are active actors in building strategies, their implementation, conduction and evaluation. Including young people in all stages of development is crucial to ensure diverse, comprehensive and just programs. Collective efforts of various stakeholders, therein youth, calls for inclusive, accountable participation in change towards an equal world.

1. No Poverty Overlapping crises of COVID-19, climate change and armed conflicts make the SDG1 almost impossible to achieve at the current pace of progress 1. Poverty can affect people’s access to healthcare services and this is why by an intersectoral approach we, as medical students, should work in the achievement of this goal to leave no one behind. However, under this SDG we only have one national activity from Africa that focused on target 1.3 (Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable). The effect of the COVID-19 pandemic was not indicated for this activity. On the international level, there was one online campaign conducted on this goal Universal Health Coverage campaign focusing on target 1.3 tackling affordability of health services as a part of social protection.

2. Zero Hunger The world still struggles to ensure food security to all its residents, even before the pandemic. In our NMOs, we only reported 7 activities that worked under the goal of Zero Hunger that aims to reduce the number of people affected by hunger, malnourishment and conditions resulting from them as well as increase the productivity of agriculture 2 . Nutrition is extremely important in the maintenance of health, therefore should be tackled in the activities of medical students. The national activities, however, focused on two targets: 2.1 (By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round) and 2.2 (By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons). The European region was the only region that did not have any activity under this SDG. No international activity was performed under this goal.

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Figure 5. Number of activities on SDG2: Zero Hunger. COVID-19 pandemic had its impact on the outcome of these activities with 2 of them being moved to online settings, 0 cancelled/postponed and 3 unaffected (and 2 did not indicate their status).

3. Good Health and Well-Being As an organization uniting medical students, this goal was of utmost importance for our work. It encompasses many health dimensions such as non-communicable and communicable diseases’ prevention, maternal and newborn health, injuries, substance abuse, mental health, sexual and reproductive health and rights services, universal health coverage and environmental health 3. National Member Organizations organized 310 activities, with 2 activities being organized between two IFMSA regions (therefore, it was included separately in the regional distribution). In the chart below, it was visualised that the highest number of activities on SDG3 was performed by NMOs within EMR and Asia-Pacific. However, if we consider the percentage of all activities under one region, then Africa and AsiaPacific are the two regions with the highest share of activities reported on SDG3 with over 70% of all national activities that partially work on SDG3. However, the remaining 3 regions had a significant difference between these with only over 50% of all national activities performing under SDG3.

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Figure 6. Number of activities on SDG3: Good Health and Well-Being. Since Good Health and Well-Being is the most worked on SDG, a more detailed analysis of our contribution to specific targets was performed. As visualised in the chart below, the most worked on targets are 3.3 (By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases), 3.4 (By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being) and 3.8 (Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all).

Figure 7. Total share on SDG3: Good Health and Well-Being targets. 12 | SDG Report 2021

Each region has its own health challenges and priorities. Therefore, an analysis of SDG3 targets was conducted in the distribution of regions. In the chart below, it becomes clear that for Asia-Pacific prevention of non-communicable diseases (3.4) is the biggest aim for the region which responds to the growing needs of the region on this topic caused by rapidly increasing ageing and lifestyle factors 4. Along with this target, the Asia-Pacific region also puts a lot of efforts into communicable diseases (3.3) and achieving universal health coverage (3.8). In the EMR, more emphasis was put on strengthening capacity for health risks and preparedness for health emergencies (3.d). Similarly to Asia-Pacific, EMR also works prominently on non-communicable diseases (3.4) as well as on universal health coverage (3.8). In Europe, the highest amount of activities was performed targeting communicable diseases (3.3). A lot of attention was given to universal health coverage (3.8) along with sexual and reproductive health and rights (3.7). African region equally worked on communicable (3.3) and non-communicable diseases (3.4), sexual and reproductive health and rights (3.7), universal health coverage (3.8) and health emergencies preparedness (3.d). Meanwhile, Americas focus the most on non-communicable diseases (3.4) and universal health coverage (3.8).

Figure 8. Number of activities on targets of SDG3: Good Health and Well-Being distributed over regions. COVID-19 pandemic left its mark on the effectiveness of the activities’ conduction. The analysis of the effect on activities in regional distribution was performed. In the chart below, we can observe that more than 50% of the activities were unaffected by the pandemic. If we subtract “not indicated” activities, then all regions had 50% or more unaffected activities, with the highest proportion of it in Asia-Pacific. Europe had the highest number of cancelled activities, while EMR - the number of activities moved to online settings. However, analysis was skewed due to 54 activities that did not indicate the effect of the pandemic on their performance. 13 | SDG Report 2021

Figure 9. The effect of COVID-19 pandemic on national activities on SDG3: Good Health and Well-Being. If we look at the specific targets being impacted by the pandemic, then it becomes visible that from targets that had more than one activity touching upon that, the least negatively impacted one is 3.4 (non-communicable diseases and mental health), while 3.d (health emergencies preparedness) had the highest number of activities that were moved online and the highest share of cancelled/postponed activities tackled the targets 3.7 (sexual and reproductive health services) and 3.c (health workforce).

Figure 10. The effect of COVID-19 pandemic on the targets SDG3: Good Health and Well-Being.

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International contribution On the international level, 30 activities were performed under this SDG. The most attention was given to sexual and reproductive health services, followed by communicable diseases and then evenly distributed over non-communicable diseases and mental health, universal health coverage and improvement of the access to healthcare in developing countries. However, there was no action towards targets 3.6 and 3.d. Out of all activities under SDG3, 11 was performed on a regional or interregional level with at least 2 activities performed in each region. The highest number of them was observed in the EMR (6 regional and interregional campaigns).

Figure 11. Total share on SDG3: Good Health and Well-Being targets in international activities. Discussion As it was observed above, there were some health issues that were given insufficient attention. The least activities were performed under target 3.6 (By 2020, halve the number of global deaths and injuries from road traffic accidents). Road safety is usually considered a domain outside the health sector that has health-related results and this rhetoric is very negligent towards the burden that road accidents carry on the health aspect. Road safety remains a public health challenge in all regions and in this chapter we would like to reflect on the necessity of NMOs’ and ITs’ commitments towards the Policy Document on Road Safety and Health adopted in March Meeting 2021 5 6. Another prominent inaction is reflected in the number of activities under 3.5 (Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol) and 3.a (Strengthen the implementation 15 | SDG Report 2021

of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate). Since 2010 annual alcohol consumption was still above 6 litres of pure alcohol per capita and this rarely seems to decrease in the last years 7. The prevalence of smoking has decreased but due to the population growth - the total number of smokers has increased 8. Therefore, they continue to be a public health challenge. Smoking remains the second biggest risk factor of death globally, while alcohol abuse - ninth according to The Institute for Health Metrics and Evaluation 9. Aside from the direct health outcomes, alcohol abuse and smoking might indirectly affect the socioeconomic situation of an individual leading to the deepening of other social determinants of health as well as their families and people in their environment 10 11 . The solemnity of these issues is not reflected in IFMSA’s activities performing under any of these two targets. Worldwide, maternal and under-five mortality has been improving over the last two decades. Betterment was also observed in dimensions such as adolescent pregnancy rate and satisfied needs for family planning. However, experts ring the alarm bell on the effect of the COVID-19 pandemic that halted or reversed progress in these aspects 3 12 . Bearing in mind these disruptions in services, we believe that there should be more actions towards the targets 3.1 (By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births) and 3.2 (By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births), considering that in some regions there were no activities reported on one of these. Hindered situations should come hand in hand with the response of organizations such as IFMSA. Environmental health is a fast-developing and emerging area of health. As the branch is dynamic, we hope for more activities to be performed under the target 3.9 (By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination). Air pollution globally is a 4th risk factor of death 9. Nowadays, 2 billion people globally use contaminated water sources and it is estimated that by 2025, water-stressed areas will be inhabited by 50% of the world’s population 13. Soil pollution threatens the food security of many, influencing nutrition and posing the risk of diet-related conditions 14. It is undeniable that urgent action of health-associated organizations should be taken to tackle approaching crises.

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4. Quality Education The IFMSA continues to build the capacity of its members through a series of workshops, campaigns and other projects. It also advocates for access to education for all social groups. In this chapter we will showcase the IFMSA’s contribution to the SDG 4 (Quality Education) that touches upon the access and quality of pre-primary, primary, secondary, tertiary and vocational education, ensures equal opportunities for women, people with disabilities among others, increase literacy and remove disparities between Global South and North 15. National Member Organizations organized 139 activities within all 5 regions. In the chart below it was visualised that the highest number of activities on SDG4 was performed by NMOs in the EMR and Europe. However, if we consider the percentage of all activities under one region, then 40% of all European activities tackle this SDG and it is followed by the Americas (31%) and the EMR (30%).

Figure 12. Number of activities on SDG4: Quality Education. A more detailed analysis of our contribution to specific targets was also performed for this goal. In the chart below, it becomes prominent that the biggest efforts were put on the target 4.3 (By 2030, ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university), which encompasses many trainings and workshops for our students. What is worth to be noted is that no activity was touching upon the goal 4.c (By 2030, substantially increase the supply of qualified teachers, including through international cooperation for teacher training in developing countries, especially least developed countries and small island developing States). When it comes to regional contributions, all regions prioritised the target 4.3, while on the second place in Europe was 4.7 (By 2030, ensure that all learners acquire the knowledge and skills needed to promote 17 | SDG Report 2021

sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development); in the EMR 4.4 (By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship) and for other regions they roughly equally worked on targets 4.4 and 4.7 and in terms of Americas - 4.2 (By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education).

Figure 13. Number of activities on targets of SDG4: Quality Education distributed over regions. After evaluating the effect of the COVID-19 pandemic on the national activities, it was observed that after removing the “not indicated” effect, more than 50% of the activities were unaffected by the pandemic and this threshold was reached by every region after subtracting the “not indicated” item. However, the highest proportion of it was achieved in the EMR and in the same region, there was the highest number of cancelled/postponed activities. In Europe, there was the biggest share of activities moved to online settings.

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Figure 14. The effect of COVID-19 pandemic on national activities on SDG4: Quality Education.

International contribution On the international level, 14 activities were performed under this SDG. 11 of them focused on the goal 4.7 (By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development), 3 of them worked under 4.3 (By 2030, ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university) and only 1 under 4.5 (By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vulnerable situations). One of the activities under 4.7 was performed on the regional level - in the EMR.

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5. Gender Equality Gender Equity is one of the Global Priorities in the term 2020-21 and was our area of work many years before that. Through various events, we advocated for the elimination of violence and discrimination against women and girls, abandonment of female genital mutilation and forced marriages, the inclusion of women in social, economic and political life and empowerment of women in leadership positions 16. Our NMOs conducted 72 activities in this field with 1 of them being between 2 regions (therefore in regional distribution they are counted separately). In the chart below, we can observe the number of activities conducted in each region under SDG5. However, if we adjust this number to the total number of activities per region, then the lowest percentage is reached in the African region (23%), while the lowest - in the Americas (11%).

Figure 15. Number of activities on SDG5: Gender Equality. While analysing specific targets, it becomes apparent that in all regions apart from the EMR, the biggest efforts were done under the target 5.6 (Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences). In the EMR, the priority was given to target 5.2 (Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation). In none of the regions, targets 5.4, 5.5, 5.a and 5.b were tackled.

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Figure 16. Number of activities on targets of SDG5: Gender Equality distributed over regions. Measuring the effect of the COVID-19 pandemic on the activities conduction, we observed that more than 50% of activities were unaffected by the pandemic. The biggest share of both - unaffected and cancelled/postponed activities was noted in the EMR and activities moved to online settings - in Europe. However, this analysis is skewed due to the number of activities (23%) with “not indicated” status.

Figure 17. The effect of COVID-19 pandemic on national activities on SDG5: Gender Equality. 21 | SDG Report 2021

International contribution On the international level, 11 activities were conducted under this SDG. The highest efforts were registered under target 5.2 (Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation) and 5.6 (Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences). However, the only activity performed under 5.3 (Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation) was conducted on the regional level only - in the EMR. There were no activities under goals 5.4, 5.a and 5.b.

Figure 18. Total share on SDG3: Good Health and Well-Being targets in international activities.

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6. Clean Water and Sanitation Clean drinking water, access to sanitation and hygiene services as well as management of waste are crucial to health. However, these matters still remain a challenge for the global community as there are still billions of people that do not have access to clean water, handwashing facilities or safely managed sanitation and this SDG is projected to not be on track to be fulfilled 17. On the national level, there were only 4 activities performed under this goal: 2 in Asia-Pacific, 1 in Americas and 1 in Africa. Each one of them focused on the target 6.2 (By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations) and 1 activity additionally on 6.b (Support and strengthen the participation of local communities in improving water and sanitation management). Due to the COVID-19 pandemic only 1 activity was moved to online settings, 1 unaffected and 2 did not indicate their effect. On the international level, there was only one campaign - Menstrual Hygiene Day that tackled this SDG and as well target 6.2. 7.

8. Decent Work and Economic Growth Improving working conditions of health and care workers and ensuring sufficient workplaces and their distribution in the health sector will positively affect access to and quality of the services in terms of time, distance and costs. Having this in mind, there should be a bigger focus on the enhancement of the global health workforce situation. Beyond this, safe working conditions, a decent amount of working hours and occupational risk also affect the health of all people and thus, play an important role in long-lasting prevention 18 19. On the national level, there were no activities undertaken on this SDG, while on the international level only two. The International Women’s Day Campaign focused on the target (By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value), while the Global Health Workforce Campaign focused on the target 8.8 (Protect labour rights and promote safe and secure working environments for all workers, including migrant workers, in particular women migrants, and those in precarious employment).

9. Industry, Innovation and Infrastructure Investment in research, a strong network of the medical industry and a focus on innovation can enhance health, increase the quality and range of available services. Investment in digital health tools provides patients more information and allows them to make more informed decisions 20. On the national work, there was only one activity focusing on this goal and its target was 9.5 (Enhance scientific research, upgrade the technological capabilities of industrial sectors in all countries, in particular developing countries, including, by 2030, encouraging innovation and substantially increasing the number of research and development workers per 1 million people and public and private research and development spending). This activity was cancelled/postponed due to the COVID-19 pandemic. 23 | SDG Report 2021

10. Reduced Inequalities More equitable societies tend to enjoy good health and thus, reducing persisting inequalities among social groups is essential to provide adequate and necessary care to all people in need 21. In IFMSA, we address this SDG by working on migrants’ health, eliminating discriminatory policies, empowerment of vulnerable populations and extension of social protection services such as access to healthcare. Our NMOs carried out 36 with the highest number of them in the Americas and Europe and the lowest in Africa. However, if we compare the number of activities under SDG10 to the total number of activities within a region, then the highest percentage was achieved in the Americas (15%) and the lowest in Asia-Pacific (3.5%).

Figure 19. Number of activities on SDG10: Reduced Inequalities. In the chart below we analysed 3 targets that NMOs worked on. The most tackled target was 10.2 (By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status) and secondly, 10.3 (Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard). The same pattern was observed in the Americas and Asia-Pacific. For the European region, 10.3 was given more priority, while the EMR worked equally on both of them and Africa - only on 10.2. In the case of target 10.7 (Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and wellmanaged migration policies) there were only 3 regions working under this: Americas, Africa and the EMR.

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Figure 20. Number of activities on targets of SDG10: Reduced Inequalities distributed over regions. During the COVID-19 pandemic, this SDG was severely impacted with less than 50% of activities being unaffected, even after exclusion of “not indicated” activities. One activity was cancelled in each of three regions: Europe, EMR and Americas. All of the activities in Africa were moved to online settings. The highest percentage of unaffected activities was achieved in the Americas and Asia-Pacific region (50%).

Figure 21. The effect of COVID-19 pandemic on national activities on SDG10: Reduced Inequalities. 25 | SDG Report 2021

International contribution There were 7 activities reported on this SDG by the Team of Officials. 3 activities were carried out under the target 10.2 (By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status) and 10.4 (Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality), while for the target 10.3 (Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard) - 2 activities. However, one activity under 10.4 was an interregional campaign and regarded Asia-Pacific and the EMR.

11. Sustainable Cities and Communities By ensuring housing with basic services, upgrading slums, increasing the safety of cities and roads and planning sustainable urbanization we can improve living conditions and therefore, decrease the impact of some negative social determinants of health 22. Our NMOs conducted 3 activities under this SDG: 2 of them in AsiaPacific and 1 of them in the EMR. All of them worked under the target 11.1 (By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums). One activity was moved to online settings due to the COVID-19 pandemic, another was unaffected and the last one was not indicated. There were no activities under this SDG performed on the international level.

12.

13. Climate Action Effects of climate change impact social determinants of health such as food security, access to clean and drinkable water, clean air and a safe place of living. It will also increase the prevalence of communicable diseases such as malaria and lead to direct health effects such as heat stress or death in a natural disaster. Thus, climate action is important to not deepen the current situation 23. 10 activities were registered in our NMOs with only 3 regions contributing: Americas, Asia-Pacific and Europe All activities were performed under the same target: 13.3 (Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning). No project was cancelled due to the COVID-19 pandemic, 3 of them were moved to online settings, 1 was reported as unaffected, 1 was marked as “other” and 5 had their status not indicated.

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Figure 22. Number of activities on SDG13: Climate Action.

International contribution There were 3 activities conducted on the international level. All of them worked under target 13.3 and one of them additionally under 13.1 (Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries) and 13.2 (Integrate climate change measures into national policies, strategies and planning). This was in fact an interregional workshop between Africa and EMR Public Health Leadership Training & Advocacy to Policy-making on Climate Change.

14. Life Below Water & 15. Life on Land In One Health approach, we recognize the interconnection of animals, plants and humans in achieving optimal health. Therefore, sustaining biodiversity is essential to enjoy good health for all 24. On the national level, there was only 1 activity conducted - in Asia-Pacific. This activity tackled target 14.1 (By 2025, prevent and significantly reduce marine pollution of all kinds, in particular from land-based activities, including marine debris and nutrient pollution). This activity did not specify the effect of the COVID-19 pandemic on its conduction. On the international level, the World Environment Day SCOPH campaign worked under both SDG14 and SDG15. It aimed for the targets 14.1, 14.3 (Minimize and address the impacts of ocean acidification, including through enhanced scientific cooperation at all levels) and 15.9 (By 2020, integrate ecosystem and biodiversity values into national and local planning, development processes, poverty reduction strategies and accounts). 27 | SDG Report 2021

16. Peace, Justice and Strong Institutions Living in the conflict zone or in a refugee camp; being subjected to violence and discrimination might cause many health-related conditions 25. In IFMSA we foster activities that aim to mitigate adverse health outcomes, ensure health equity and promote non-discriminatory policies. Within our NMOs there were 50 activities organized under this SDG with 1 of them being conducted between 2 regions (and counted separately in the regional distribution). The region with the highest number of reported activities was the EMR and with the lowest - Africa and the Americas.

Figure 23. Number of activities on SDG16: Peace, Justice and Strong Institutions. While looking at the more detailed analysis of the targets, we can observe that the most common target was 16.b (Promote and enforce non-discriminatory laws and policies for sustainable development). This was also the priority for Europe, AsiaPacific, Americas and for Africa - equally important with 16.3 (Promote the rule of law at the national and international levels and ensure equal access to justice for all). In the EMR, the most attention was given to the target 16.4 (By 2030, significantly reduce illicit financial and arms flows, strengthen the recovery and return of stolen assets and combat all forms of organized crime). Asia-Pacific and the EMR worked disproportionately more on the target 16.2 (End abuse, exploitation, trafficking and all forms of violence against and torture of children).

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Figure 24. Number of activities on targets of SDG16: Peace, Justice and Strong Institutions distributed over regions. During the COVID-19 pandemic, the majority of activities was unaffected with the highest number of them being reported in Asia-Pacific. The only cancelled/postponed activities occurred in the EMR. Asia-Pacific along with EMR were the only regions that moved at least one activity to online settings. Yet again, the analysis was altered by a significant number of activities that did not indicate the pandemic effect on their performance.

Figure 25. The effect of COVID-19 pandemic on national activities on SDG16: Peace, Justice and Strong Institutions. 29 | SDG Report 2021

International contribution On the international level, there were 6 activities with the biggest focus on the target 16.1 (Significantly reduce all forms of violence and related death rates 7everywhere). One of them was a regional campaign in the EMR (Zero Tolerance Against FGM) and another interregional between Asia-Pacific and EMR (Human Rights for Medical Practitioners). The remaining activities were international.

Figure 26. Total share on SDG16: Peace, Justice and Strong Institutions targets in international activities.

17. Partnerships for the Goals Multilateral action is a key point for achieving the goals and health-related targets are no exception. Our NMOs organized 3 activities under this SDG, one in each of these regions: Africa, the Americas and Europe. They focused on different targets so they worked separately on the target: 17.6 (Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation and enhance knowledge sharing on mutually agreed terms, including through improved coordination among existing mechanisms, in particular at the United Nations level, and through a global technology facilitation mechanism), 17.14 (Enhance policy coherence for sustainable development) and 17.17 (Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships Data, monitoring and accountability). One of the activities was cancelled/postponed, one unaffected and one did not specify the pandemic’s effect. On the international level, there was only one campaign - Innovate4AMR - that supported this SDG. This campaign was also evaluated to work under the target 17.6.

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Africa Introduction and challenges The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by all United Nations Member States in 2015 as a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity by 2030. The 17 SDGs are integrated—that is, they recognize that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability. Several African NMOs are already taking steps to translate the ambitions articulated in the 2030 Agenda into tangible outcomes in their countries; they are beginning to advocate integration of the SDGs into their national visions and plans. The challenge here is the low level of knowledge in some technical topics like climate change and sustainable cities, that leaves NMOs not paying attention to these very important topics. There is also a low rate of reporting of activities after having been enrolled.

Overview After analysing 70 national activities from Africa, the results showed the highest number of activities in the field of SDG 3 (Good Health and Well-Being), followed by SDG 5 (Gender Equality) and SDG 4 (Quality Education). Africa was the only IFMSA region that had an activity on SDG 1 (Zero Hunger), however, from SDGs tackled by IFMSA, the African region did not work on SDGs: 9 (Industry, Innovation and Infrastructure), 11 (Sustainable Cities and Communities), 13 (Climate Action) and 14 (Life Below Water). In terms of Climate Action, this is the only region that did not report this SDG in its national activities. When comparing it to the global scale (Figure 3) African contribution was low for SDG 10 (Reduced Inequalities) and SDG16 (Peace, Justice and Strong Institutions). However, low contribution might be a result of a relatively smaller amount of reported activities that were later on included in the analysis. Africa was the only region that did not report cancelling or postponing activities due to the COVID-19 pandemic.

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Figure 27. Sustainable Development Goals worked on in Africa.

Recommendations General Recommendations Keep track of your country’s progress towards the SDGs. Some tools for further reference: check the Voluntary National Reviews Database. Another very useful website is the WHO data visualizations dashboard - Monitoring Health for the SDGs. Capacity Building Recommendations IFMSA has collected several useful toolkits and manuals that you can use to build your and your members’ capacity. Check them here. Activities that you can develop (including but not limited to): • Policy Documents (check IFMSA Policy Documents database for further reference) • Workshops/Sessions for your NMO members • Capacitate your national/local team on the topic • Showcase how your NMO activities contribute towards achieving the SDGs If you would like help in order to implement the topic within your NMO, reach out to ra.ea.africa@ifmsa.org.

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Specific Recommendations It appears that these are the areas in which the African Region in general is lacking in the following areas: • Industry, Innovation and Infrastructure • Sustainable Cities and Communities • Climate Action • Life Below Water • Reduced Inequalities • Peace, Justice and Strong Institutions It is therefore recommended that the Region tackles the following : • Continue developing activities around SDG 3(Good Health and well-being) • Continue to develop more activities in SDG 5 (Gender Equality) • Continue to develop more activities surrounding SDG 4 (Quality Education) • Develop more activities around SDG 2 (Zero hunger) • Start developing initiatives to tackle SDG 16 (Peace, Justice and Strong Institutions) • Start developing initiatives to tackle SDG 11(Sustainable Cities and Communities) especially clean cities in Africa. • Develop activities that target SDG 13 (Climate Action) • Initiate activities that deal with SDG 10 (reduced inequalities) • Develop activities that target SDG 9 (Industry, Innovation and infrastructure) • Start developing initiatives that tackle SDG 14 (life below water) • Raise awareness and build capacities in the technicalities in the areas that did not have activities reported. • Incorporate the SDGs that are not frequently addressed in the region in the Afro Regional Meeting and the pre-ARM • Work on regional MoUs with organizations working on promoting SDGs

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Americas Introduction and challenges Since the adoption of the Sustainable Goals in 2015, various stakeholders in the Americas have implemented actions to accelerate the achievement of those goals through a regionalized approach. In 2019, ECLAC adopted the Regional Agenda for Inclusive Social Development to help with the implementation of the social dimension of the 2030 Agenda (1). In 2017, the PAHO Member States adopted the Sustainable Health Agenda for the Americas (2), which represents the health sector commitment to the 2030 Agenda and outlines goals that are aligned with it.

Overview After analysing 65 national activities from the Americas, the results showed the highest number of activities in the field of SDG 3 (Good Health and Well-Being), followed by SDG 4 (Quality Education) and 10 (Reduced Inequalities). From SDGs tackled by IFMSA, Americas did not work on SDGs: 1 (No Poverty), 9 (Industry, Innovation and Infrastructure), 11 (Sustainable Cities and Communities) and 14 (Life Below Water). When comparing it to the global scale Americas’ contribution (Figure 3) was low for SDG 5 (Gender Equality) and SDG16 (Peace, Justice and Strong Institutions). However, low contribution might be a result of a relatively smaller amount of reported activities that were later on included in the analysis. The Americas had the highest share of activities that were unaffected due to the COVID-19 pandemic.

Figure 28. Sustainable Development Goals worked on in the Americas.

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Recommendations General recommendations • Increase the knowledge on SDGs and their implementation by getting informed through official reports and evaluations. Creating a stakeholder database with important reports, to be constantly updated. • Maintain relationships with stakeholders that work towards the accomplishments of SDGs. • Guide NMOs who are interested in working on SDGs on how they can be implemented within their national activities. Capacity Building recommendations • Host regional workshops on how to work with SDGs within their NMOs. • Encourage members to construct activities related to the accomplishments of SDGs. • Create a toolkit on how to apply an activity at a local, national and international level related to SDGs. • Promote the use of IFMSA policy documents through training on the specific policy documents and applicability in the region. Specific recommendations • Encourage NMOs to report all their activities. • Increase the number of activities related to both SDGs and Regional Priorities. • Promote regional initiatives to work on SDGs. • Work towards the least implemented SDGs in the region: - SDG 1 No poverty: focusing on target 1.5: Build resilience to environmental, economic, and social disasters. - SDG 6 Clean water and sanitation: focusing on all of its targets. - SDG 9 Industry, Innovation and Infrastructure: focusing on target 9.c: Universal access to information and communications technology. - SDG 11 Sustainable cities and communities: focusing on target 11.6: Reduce the environmental impacts of cities, Target 11.b: Implement policies for inclusion, resource efficiency and disaster risk reduction - SDG 14: Life below water: focusing on Target 14.1: Reduce marine pollution.

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Asia-Pacific Introduction and challenges With the adoption of the Sustainable Development Goals in 2015, stakeholders in the Asia-Pacific region have been working in line with these Global Goals for global progress. Generally, more people in the Asia-Pacific region have been able to live healthier and longer lives. However, the Asia and the Pacific regions are currently not on track to achieve any of the 17 goals, with our region falling short of the 2020 milestones set. At its current pace, Out of the 104 measurable targets, the region is on track to reach only nine by 2030 (1). This progress is being further hampered by our dealings with the global pandemic. There should be an active effort to fast-track Asia-Pacific transformations towards achieving the SDGs. In this context, the IFMSA Asia-Pacific Region and its 20 NMOs have been working within the framework of the Sustainable Development Goals to help accelerate progress within our own communities and networks, with reference to representing the youth voice and that of future healthcare professionals on all levels.

Overview After analysing 113 national activities from Asia-Pacific, the results showed the highest number of activities in the field of SDG 3 (Good Health and Well-Being), followed by SDG 4 (Quality Education) and 16 (Peace, Justice and Strong Institutions). From SDGs tackled by IFMSA, Asia-Pacific did not work on 3 SDGs: 1 (No Poverty), 9 (Industry, Innovation and Infrastructure) and 17 (Partnership for the Goals), which makes it a region with the highest number of diverse SDGs encompassed by national activities. When comparing it to the global scale Asia-Pacific’s contribution (Figure 3) was low for SDG 13 (Climate Action) and high for SDG 2 (Zero Hunger), 6 (Clean Water and Sanitation) and 11 (Sustainable Cities and Communities). Asia-Pacific was the only region that had at least one activity on SDG 14 (Life Below Water). The region had the lowest share of activities that were moved to online settings due to the COVID-19 pandemic.

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Figure 29. Sustainable Development Goals worked on in Asia-Pacific.

Recommendations Prior to the COVID-19 pandemic, the Asia-Pacific Region has been successful in our activities, particularly how we can go from idea to impact on organisational levels. This has been widely recognised within the IFMSA space, such as the Rex Crossley Awards and our Activities Fairs. However, this does not mean that they are perfect - there is always room for improvement and to grow. We recommend the following recommendations: General Recommendations • Keep track of your country’s progress towards the SDGs - this can form as part of your outreach and advocacy with governmental and non-governmental organisations, to hold them accountable for their actions. • WHO data visualizations dashboard - Monitoring Health for the SDGs. • Other national level datasets • Actively integrate the Sustainable Development Goals in part of the planning or evaluation process of activities. Capacity Building Recommendations Over the years, IFMSA has created and collected several useful toolkits and manuals for member and NMO capacitation. Activities that can be developed include, but are not limited to: • Organising Workshops/Sessions for members 37 | SDG Report 2021

• Capacitating your national/local team on the topic • Showcasing and consolidate how your NMO activities contribute towards achieving SDGs • Formulating Policy Documents and Processes (Ref: IFMSA Policy Documents) Feel free to contact ra.ea.asiapacific@ifmsa.org and rdasiapacific@ifmsa.org, as well as the relevant IFMSA Program Coordinator if you would like assistance to implement such topics within your NMO. On a regional level: • Incorporating SDGs in Regional Sessions of General Assemblies, Regional Meetings, pre-Regional Meetings and sub-regional Trainings • Organising a regional campaign in which NMOs can share their experiences in working towards and with different SDGs. • Capacitate NMOs on advocacy related to SDGs • Work on regional MoUs with organizations working on promoting SDGs Specific Recommendations As we find our way out of the pandemic, we must align our responses to accelerate transformations for the SDGs within our jurisdictions, countries and regions. • It is clear that IFMSA and our work as NMOs strongly revolves around SDG 3. As a health-oriented organisation, we must continue these efforts, with particular focus on: • NCD and Mental Health (3.4) • Sexual and Reproductive Health (3.7) • Universal Health Coverage (3.8) • Environmental Pollution (3.9) • Vaccine Coverage (3.b) • Moreover, there should be an increasing focus on vulnerable populations within our own communities and beyond, vis-a-vis strengthening social solidarity and accountability. • As for specific SDGs and topics to tackle, we recommend designing initiatives and orienting organisations towards the following: • Environmental Quality and Climate Action (Goal 13) • Clean Water and Sanitation (Goal 6): Drinking Water (6.1) and Sanitation and Hygiene (6.2); • Sustainability: Sustainable Cities and Communities (Goal 11) • Social Equality: Gender Equality (Goal 5) 38 | SDG Report 2021

• Reforming organisations to be in line with SDG Goal 12 (Responsible Consumption and Production). • Continuation of successful activities on an online platform in a sustainable manner. With the Asia-Pacific region having a sizable portion of the global population, our efforts have the potential to have a transformative impact, particularly within the realm of health, human rights and education.

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EMR Introduction and challenges Since the adoption of the UN SDGs agenda almost 6 years ago, countries in the EMR have been trying to progress towards accomplishing these goals and including them in their policies and activities. Progress has been achieved in some SDGs such as SDG 1 (No Poverty) more than other SDGs such as SDG 4 (Quality Education). This does not apply to those SDGs only, but several other disparities are apparent in regards to the progress made on different SDGs. Several countries in the region have endorsed national strategies to achieve SDGs by 2030. However, challenges still exist, which may make many of these goals impossible to achieve by 2030, for many countries. Challenges include the increase in conflicts in many countries of the region, affecting the stability required to work on the SDGs, in addition to the evident defect in the quality of the governance systems in different sectors in terms of lack of integrated approach and low capacity of human resources. All these challenges need to be addressed in order to ensure more satisfactory progress towards SDGs.

Overview Eastern Mediterranean Region (EMR) had the highest number (148) of submitted national activities. After analysing them, the results showed the highest number of activities in the field of SDG 3 (Good Health and Well-Being), followed by SDG 5 (Gender Equality) and 16 (Peace, Justice and Strong Institutions). From SDGs tackled by IFMSA, EMR did not work on SDGs: 1 (No Poverty), 6 (Clean Water and Sanitation), 9 (Industry, Innovation and Infrastructure), 14 (Life Below Water) and 17 (Partnership for the Goals), which makes it the least diverse region (along with Europe) in terms of SDGs encompassed by national activities. When comparing it to the global scale EMR’s contribution (Figure 3) was low for SDG 4 (Quality Education). EMR had the highest share of activities that were moved to online settings due to the COVID-19 pandemic.

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Figure 30. Sustainable Development Goals worked on in the EMR.

Recommendations General Recommendations • Encourage and guide NMOs to keep track of the national work done towards SDGs • Recommend establishing national relationships with UN agencies and other organizations working on tackling SDGs nationally Capacity Building Recommendations • Encourage NMOs to host national and regional capacity building sessions to promote the SDGs that are not being tackled in the region such as clean water and sanitation • Prepare an international campaign during which NMOs can share their experiences with different SDGs so that they can learn from one another, for example if the NMOs of a region are particularly strong in a specific SDG they can share their experiences with other regions • Create an EMR SDG toolkit that highlights the regional work done towards the SDGs and amplify the work done by the NMOs in the region • Incorporate the SDGs that are not frequently addressed in the region in the EMR Regional Meeting and the pre-RM • Promote the use of IFMSA policy documents through trainings on the specific policy documents and applicability in the region 41 | SDG Report 2021

Specific Recommendations Based on the analyzed data, the EMR region had reported the highest number of submitted national activities; however, SDG 1, 6, 9, 14, and 17 have not been tackled. In order to continue encouraging NMOs to working on SDGs and particularly those that haven’t been addressed in the region: • Host a regional campaign to highlight all the SDGs, the work done in the region, and how to apply it on a national level • Train NMOs on advocacy related to the SDGs not often worked on in the region • Encourage NMOs to host activities that allow combinations of different SDGs for instance tackling the refugee crisis through the lens of SDGs: 1 (No Poverty), 9 (Industry, Innovation and Infrastructure), and 6 (Clean Water and Sanitation) • Promote the regional initiatives related to SDGs • Explore regional MoUs with organizations working on promoting SDGs

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Europe Introduction and challenges Almost 6 years have passed since the 2030 Agenda for Sustainable Development was adopted by the United Nations General Assembly. Additionally, in 2017, all WHO European Region Member States endorsed the Roadmap to implement the 2030 Agenda in 2017. Even though implementation of the 2030 Agenda is advancing in all WHO European Member States, recent projections indicate that no country is fully on track to achieve SDGs and health-related targets. The Agenda and some health targets in SDG 3 will be achieved only if action is accelerated, implementing at a higher pace. According to literature, this includes halving the number of deaths and injuries from road traffic accidents, reducing new HIV infections, scaling up immunization rates, addressing mental health disorders, tackling risk factors such as obesity, alcohol, tobacco use, air pollution as well as reducing interpersonal violence and addressing mental health factors and diseases.

Overview After analysing 116 national activities from Europe, the results showed the highest number of activities in the field of SDG 3 (Good Health and Well-Being), followed by SDG 4 (Quality Education) and SDG 5 (Gender Equality). From SDGs tackled by IFMSA, the European region did not work on SDGs: 1 (No Poverty), 2 (Zero Hunger), 6 (Clean Water and Sanitation), 11 (Sustainable Cities and Communities) and 14 (Life Below Water), which makes it the least diverse region (along with the EMR) in terms of SDGs encompassed by national activities. Also, this is the only region that did not tackle SDG 2 (Zero Hunger). However, Europe was the only region that worked on SDG 9 (Industry, Innovation and Infrastructure). The region had the lowest share of unaffected activities and the highest share of cancelled/postponed activities due to the COVID-19 pandemic. However, this also had the highest percentage of effects marked as “other” which usually were: implementing safety measures or limited outreach of activities.

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Figure 31. Sustainable Development Goals worked on in Europe.

Recommendations General Recommendations Keep track of your country’s progress towards the SDGs. Some tools for further reference: check the Voluntary National Reviews Database. In case your country is part of the European Union, you can also check Eurostat - SDG indicators goal by goal. Another very useful website is the WHO data visualizations dashboard Monitoring Health for the SDGs. Capacity Building Recommendations IFMSA has collected several useful toolkits and manuals that you can use to build your and your members’ capacity. Check them here. Activities that you can develop (including but not limited to): • Policy Documents (check IFMSA Policy Documents database for further reference) • Workshops/Sessions for your NMO members • Capacitate your national/local team on the topic • Showcase how your NMO activities contribute towards achieving the SDGs If you would like help in order to implement the topic within your NMO, reach out to ra.ea.europe@ifmsa.org.

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Specific Recommendations We would recommend for you to 1st check your country’s progress towards the SDGs (Voluntary National Reviews Database can help you) and after develop initiatives/activities that could contribute towards achieving specific goals/ targets. However, and taking into account the general needs of the region as of 2021, these are some areas that the European Region is struggling with putting the needed efforts: • Road traffic crashes and respective injuries/deaths • Sexual and Reproductive Health and Rights • Mental Health Disorders • Interpersonal Violence • Substance Abuse • Nutrition and Physical Activity • Friendly Health Services • Climate Change and Air Pollution • Chemicals and waste • Digital Technologies and Health Taking into account the activities developed by IFMSA European Region as well as the analysis of NMOs’ and international activities, we recommend tackling the following: • Continue developing activities under SDG3, investing more in other topics such as: maternal mortality (3.1); Newborn and Child Mortality (3.2); Noncommunicable diseases and mental health (3.4); substance abuse (3.5); road traffic injuries (3.6); environmental pollution (3.9). Special emphasis should be given to tobacco control (3.a); vaccine coverage (3.b); Health workforce (3.c); • Design initiatives under SDG1 and SDG2, specifically Mobilization of Resources (1.a) and Child malnutrition (2.2); • Design initiatives under SDG6, specifically Drinking Water (6.1) and Sanitation and Hygiene (6.2); • Design initiatives under SDG11, specifically Clean Cities (11.6) • Keep investing in initiatives under the topic Violence (SDG16, target 1) • Build the capacity of your members regarding statistical analysis (SDG17, target 19) If you would like to learn more about specific activities (and even be inspired by some of them to design your own), kindly check the toolkit Youth: The Future is ours! 45 | SDG Report 2021

From Recommendations to action WHO Europe developed a tool called EA4 which provides a value-based and practical framework for public health action to achieve the SDGs.The EA4 approach consists of five building blocks: engage; assess; align; accelerate and account.

Figure 32. The E4A approach to achieve the SDGs (World Health Organization Regional Office for Europe, 2019) 32

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COVID-19 Effect Many of the activities included in the report were conducted after the outbreak of the pandemic. This unforeseen situation affected continuous or long-planned projects to adjust to the existing reality. Some changed their objectives, some moved online, some were cancelled or postponed, some had a negative influence on impact and some were left unaffected. In this chapter, we summarize the effect of the pandemic. However, the analysis of this aspect was impeded by the fact that the reporting time encompassed activities that took place from 1st October 2019, which comprises at least 5 months of the non-pandemic period for the majority of the world. This might explain the high number of “not indicated” activities which contribute to the hindered analysis. In the chart below, it is visualized that the biggest share of activities moved to online was reported in the EMR and activities cancelled/postponed - in Europe. No activity was cancelled/postponed in Africa and the biggest percentage of unaffected activities was observed in the Americas.

Figure 33. The effect of COVID-19 pandemic on national activities. Since the activities tackled unequally the SDGs, the comparison of how the pandemic impacted each goal was difficult. In this case, we analyzed only these SDGs that had at least 10 activities that indicated and specified the COVID-19 pandemic effect on their conduction. Thus, cancelled/postponed and moved to online settings activities were counted as affected. These labelled as “not indicated” and “other” were excluded from this analysis. Later on the numbers were adjusted to the total number of activities under each SDG which allowed us to compare percentages of unaffected and affected activities. As represented in the chart below, the most affected SDG was the SDG10: Reduced Inequalities having the unaffected activities at the lowest number and the affected ones at the highest. The biggest share of unaffected activities was noted under SDG5: Gender Equality and of the smallest share of affected - under SDG16: Peace, Justice and Strong Institutions. 47 | SDG Report 2021

Figure 34. The effect of COVID-19 pandemic on Sustainable Development Goals.

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References 1. Goal 1. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal1. 2. Goal 2. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal2. 3. Goal 3. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal3. 4. Yiengprugsawan, V., Healy, J. & Kendig, H. Health system responses to population ageing and noncommunicable diseases in Asia, Comparative Country Studies. vol. 2 https://apps.who.int/iris/handle/10665/252738 (2016). 5. Technical discussion on Road traffic injuries: a growing public health concern. in EM/RC56/Tech.Disc.1 (2009). 6. Save lives: a road safety technical package. https://www.who.int/publications/i/ item/save-lives-a-road-safety-technical-package (2017). 7. Total alcohol consumption per capita (liters of pure alcohol, projected estimates, 15+ years of age). World Bank Open Data https://data.worldbank.org/indicator/ SH.ALC.PCAP.LI. 8. GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet (2021) doi:10.1016/S0140-6736(21)01169-7. 9. Ritchie, H. & Roser, M. Alcohol Consumption. Our World in Data (2018). 10. Tobacco. World Health Organization https://www.who.int/health-topics/ tobacco. 11. Alcohol. World Health Organization https://www.who.int/news-room/factsheets/detail/alcohol (2018). 12. Maternal mortality. UNICEF https://data.unicef.org/topic/maternal-health/ maternal-mortality/ (2019). 13. Drinking-water. World Health Organization https://www.who.int/news-room/ fact-sheets/detail/drinking-water (2019). 14. Polluting our soils is polluting our future. Food and Agriculture Organization of the United Nations http://www.fao.org/fao-stories/article/en/c/1126974/ (2018). 15. Goal 4. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal4. 16. Goal 5. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal5. 17. Goal 6. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal6. 49 | SDG Report 2021

18. Discussion on SDG 8 – Decent work and economic growth. in Review of SDG implementation and interrelations among goals. 19. Health services sector. International Labour Organization https://www.ilo.org/ global/industries-and-sectors/health-services/lang--en/index.htm. 20. SDG Industry Matrix for Healthcare and Life Sciences. https://assets.kpmg/ content/dam/kpmg/xx/pdf/2017/05/sdg-healthcare-life-science.pdf (2016). 21. SDG 10: Health and reduced inequalities. (2021). 22. Goal 11. United Nations Department of Economic and Social Affairs: Sustainable Development https://sdgs.un.org/goals/goal11. 23. Climate change and health. World Health Organization https://www.who.int/ news-room/fact-sheets/detail/climate-change-and-health (2018). 24. One Health. World Health Organization https://www.who.int/news-room/q-adetail/one-health (2017). 25. Wesley, H., Tittle, V. & Seita, A. No health without peace: why SDG 16 is essential for health. The Lancet 388, 2352–2353 (2016). 26. Economic Commission for Latin America and the Carribean. Regional Agenda for Inclusive Social Development. (United Nations, 2020). 27. Sustainable Health Agenda for the Americas 2018-2030. Pan American Health Organization https://www.paho.org/en/sustainable-health-agendaamericas-2018-2030. 28. Pan American Health Organization. The Sustainable Health Agenda for the Americas 2018-2030: A call to action for health and well-being in the region. https://iris.paho.org/bitstream/handle/10665.2/49170/CSP296-eng. pdf?sequence=1&isAllowed=y (2017). 29. Economic Commission for Latin America and the Caribbean. Second annual report on regional progress and challenges in relation to the 2030 Agenda for Sustainable Development in Latin America and the Caribbean. https://repositorio. cepal.org/bitstream/handle/11362/43439/5/S1800379_en.pdf (2018). 30. United Nations General Assembly. Resolution adopted by the General Assembly on 25 September 2015. https://www.un.org/en/development/desa/population/ migration/generalassembly/docs/globalcompact/A_RES_70_1_E.pdf (2015). 31. WHO Regional Committee for Europe. Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being. https://www.euro.who.int/__data/assets/pdf_ file/0008/345599/67wd09e_SDGroadmap_170638.pdf (2017). 32. Menne, B. et al. Health and well-being for all: an approach to accelerating progress to achieve the Sustainable Development Goals (SDGs) in countries in the WHO European Region. Eur. J. Public Health 30, i3–i9 (2020).

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Annex 1. List of Analyzed Activities

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51 | SDG Report 2021

Afghanistan (AMSA

Dominica)

Kuwait (KuMSA)

Republic of Tatarstan

Afghanistan)

Dominican Republic (ODEM)

Kyrgyz Republic (AMSA-KG)

(TaMSA)

Albania (ACMS Albania)

Ecuador (AEMPPI)

Latvia (LaMSA)

Rwanda (MEDSAR)

Algeria (Le Souk)

Egypt (IFMSA-Egypt)

Lebanon (LeMSIC)

Senegal (FNESS)

Argentina (IFMSA-Argentina)

El Salvador (IFMSA-El

Lithuania (LiMSA)

Serbia (IFMSA-Serbia)

Armenia (AMSP)

Salvador)

Luxembourg (ALEM)

Sierra Leone (SLEMSA)

Aruba (IFMSA-Aruba)

Estonia (EstMSA)

Malawi (MSA)

Singapore (AMSA)

Australia (AMSA)

Ethiopia (EMSA)

Malaysia (SMMAMS)

Slovakia (SloMSA)

Austria (AMSA)

Finland (FiMSIC)

Mali (APS)

Slovenia (SloMSIC)

Azerbaijan (AzerMDS)

France (ANEMF)

Malta (MMSA)

South Africa (IFMSA-SA)

Bangladesh (BMSS)

Gabon (AEMG)

Mauritania (AFMM)

Spain (IFMSA-Spain)

Barbados (IFMSA-Barbados)

Gambia (GaMSA)

Mexico (AMMEF-Mexico)

Sudan (MedSIN)

Belgium (BeMSA)

Georgia (GMSA)

Montenegro (MoMSIC)

Sweden (IFMSA-Sweden)

Bolivia (IFMSA-Bolivia)

Germany (bvmd)

Morocco (IFMSA-Morocco)

Switzerland (swimsa)

Bosnia & Herzegovina

Ghana (FGMSA)

Namibia (AMSNA)

Syrian Arab Republic (SMSA)

(BoHeMSA)

Greece (HelMSIC)

Nepal (NMSS)

Taiwan - China (FMS)

Bosnia & Herzegovina –

Grenada (IFMSA-Grenada)

The Netherlands

Tajikistan (TJMSA)

Republic of Srpska (SaMSIC)

Guatemala (IFMSA-

(IFMSA NL)

Thailand (IFMSA-Thailand)

Brazil (DENEM)

Guatemala)

Niger (AESS)

Tanzania (TaMSA)

Brazil (IFMSA-Brazil)

Guinea (AEM)

Nigeria (NiMSA)

Togo (AEMP)

Bulgaria (AMSB)

Haiti (AHEM)

Northern Cyprus, Cyprus

Trinidad and Tobago

Burkina Faso (AEM)

Honduras (IFMSA-Honduras)

(MSANC)

(TTMSA)

Burundi (ABEM)

Hungary (HuMSIRC)

Norway (NMSA)

Tunisia (Associa-Med)

Cameroon (CAMSA)

Iceland (IMSA)

Oman (MedSCo)

Turkey (TurkMSIC)

Canada (CFMS)

India (MSAI)

Palestine (PMSA)

Turkey – Northern Cyprus

Canada – Québec

Indonesia

Pakistan (IFMSA-Pakistan)

(MSANC)

(IFMSA-Québec)

(CIMSA Indonesia)

Panama (IFMSA-Panama)

Uganda (FUMSA)

Catalonia - Spain (AECS)

Iran (IMSA)

Paraguay (IFMSA-Paraguay)

Ukraine (UMSA)

Chile (IFMSA-Chile)

Iraq (IFMSA-Iraq)

Peru (IFMSA-Peru)

United Arab Emirates

China (IFMSA-China)

Iraq – Kurdistan (IFMSA-

Peru (APEMH)

(EMSS)

China – Hong Kong

Kurdistan)

Philippines (AMSA-

(AMSAHK)

Ireland (AMSI)

Philippines)

Colombia (ASCEMCOL)

Israel (FIMS)

Poland (IFMSA-Poland)

Costa Rica (ACEM)

Italy (SISM)

Portugal (ANEM)

Croatia (CroMSIC)

Ivory Coast (NOHSS)

Qatar (QMSA)

Cyprus (CyMSA)

Jamaica (JAMSA)

Republic of Moldova (ASRM)

Czech Republic

Japan (IFMSA-Japan)

Republic of North

(IFMSA-CZ)

Jordan (IFMSA-Jo)

Macedonia (MMSA)

Democratic Republic of the

Kazakhstan (KazMSA)

Romania (FASMR)

Congo (MSA-DRC)

Kenya (MSAKE)

Russian Federation (HCCM)

Denmark (IMCC)

Korea (KMSA)

Russian Federation –

Dominica (IFMSA Commonwealth of

Kosovo - Serbia (KOMS)

www.ifmsa.org

United Kingdom of Great Britain and Northern Ireland (SfGH) United States of America (AMSA-USA) Uruguay (IFMSA-Uruguay) Uzbekistan (Phenomenon) Venezuela (FEVESOCEM) Yemen (NAMS) Zambia (ZaMSA) Zimbabwe (ZIMSA)

medical students worldwide 52 | SDG Report 2021