Global health gains since 2000: How colonial legacies, corporate power, and austerity shaped MDG progress—and what SDGs must disrupt
Original framing: “From MDGs to SDGs, WHO launches new report” — WHO News
The MDGs and SDGs operate from a Western biomedical paradigm that pathologizes Indigenous ways of knowing, such as the Māori *te whare tapa whā* (four dimensions of health: physical, mental, spiritual, family) or the Navajo *Hózhǫ́* (harmony). These frameworks were excluded from MDG metrics, yet Indigenous-led health systems (e.g., the First Nations Health Authority in Canada) demonstrate that cultural continuity improves outcomes. The SDGs could adopt a ‘rights-based’ approach by centering Indigenous data sovereignty (e.g., Māori-led health research in Aotearoa) and land remediation as health determinants, but the report treats these as ‘cultural barriers’ rather than solutions. For instance, the 2015 *Truth and Reconciliation Commission* in Canada documented how residential schools destroyed Indigenous health—yet this is framed as a ‘historical’ issue, not a structural driver of today’s disparities.
The WHO’s report frames the MDGs and SDGs as a linear progression of ‘global cooperation,’ but the systemic reality is one of *colonial continuity*—where neoliberal health architectures, corporate capture, and austerity have shaped outcomes far more than ‘good governance.
’ The MDGs were not a neutral framework but a tool to justify structural adjustment, privatization, and pharmaceutical monopolies, while the SDGs risk repeating this under a ‘universalist’ guise. Cross-cultural examples—from Cuba’s community health model to Māori *oranga*—prove that equity requires dismantling extractive systems, yet these are treated as ‘alternative’ rather than essential. The trickster’s role here is to expose how the SDGs’ ‘new’ goals are old wine in new bottles: the same power structures (donor agencies, corporations, technocrats) control the narrative, while marginalized voices (Indigenous communities, sex workers, the homeless) are sidelined. The solution lies in *radical decolonization*—of metrics, of funding, and of power—grounded in Indigenous sovereignty, feminist care economies, and climate-health integration. Without this, the SDGs will be another chapter in the same story: progress for the few, under the guise of universality.