Significant global action is still required to reach several key targets set for the 2015 deadline of the Millennium Development Goals (MDGs), says a UN report published today.
Despite major progress towards many of the eight goals, on current trends, member states will miss MDG targets related to reducing child and maternal mortality and increasing access to sanitation, according to an accompanying press release.
"We need bolder and focused action where significant gaps and disparities exist," says Ban Ki-moon, the UN secretary-general, in the opening paragraph of the report.
Overall, significant progress has been made across all goals. Many targets have been met, such as those related to decreasing extreme poverty, increasing access to drinking water and achieving gender parity in primary school. If trends continue, MDG targets on diseases such as malaria, HIV and tuberculosis are expected to be surpassed.
Andy Haines, a public health expert at the London School of Hygiene & Tropical Medicine, United Kingdom, says the report gives a "mixed picture of major advances towards some goals and worrying shortfalls in progress in the case of others".
Without significant change in the next year, all but one of the targets will be missed in Sub-Saharan Africa, according to the 2014 MDG progress report. Almost half the population there lives in extreme poverty, defined as earning less than US$1.25 a day, and a quarter are undernourished, the report shows.
The report sets out progress in many areas of health and undernourishment. But progress in tackling undernourishment has slowed in recent years and considerable effort is required to meet the target.
In 2012, one-in-four children under the age of five were moderately or severely stunted - being of inadequate height for their age - with 162 million suffering from chronic undernutrition. In Southern Asia, 30 per cent of children under five were moderately or severely underweight in 2012. Reducing stunting and other forms of undernutrition can be achieved through proven interventions such as improving maternal nutrition, according to the report.
There is still a high mortality rate from tuberculosis in some areas, particularly Oceania, the Pacific region rife with extreme poverty, it says.
Overall, the child mortality rate has almost halved since 1990 - but the target was to reduce it by two-thirds, says the report. Seven of the nine regions have still not met the target, and three of these are not expected to: Oceania, Southern Asia and Sub-Saharan Africa, it says.
Four of every five deaths of children under the age of five occur in Sub-Saharan Africa and Southern Asia, according to the report. The majority of these deaths are preventable, with the main killers being diarrhoea and pneumonia, diseases that are easily treatable in the developed world, it says.
Similarly, much more needs to be done to reduce maternal mortality, according to the report. Last year, 289,000 women died from pregnancy or childbirth related problems, and the majority of these were easily preventable with existing methods, but universal access to necessary care and effective interventions has not been achieved, it says.
Between 1990 and 2012, almost two billion people gained access to improved sanitation, the report shows, but, despite the increase, the MDG target of 75 per cent coverage is unlikely to be met if trends continue. One billion people still resorted to open defecation in 2012, with 82 per cent of them living in middle-income countries such as India and Nigeria, it says.
"It's getting better, but it's still got a long way to go," says Andrew Scott, research fellow in climate and the environment at UK think-tank the Overseas Development Institute. "We're making progress, but we aren't anyway near reaching all the targets."
He believes science and technology are a "necessary input" to reach the targets. Despite the need for science not being explicitly stated throughout the report, he says that "there is a general recognition that all of the goals need science and technology change and investment to happen".
Scott says he was surprised the report has no specific carbon emission targets, and explains that the parts dealing with climate change were more focused on mitigation compared with last year's version of the report. "They've come down on the more cautious approach at this stage," he says.
According to the UN, this year's report reflects "the most comprehensive, up-to-date data".
More countries submitted progress reports than ever before, which has successfully guided the focus of global efforts in some areas, the report says. HIV reports have increased from 102 in 2004 to 186 in 2012, which led to funding for HIV programmes more than tripling over this period, it adds.
But reliable statistics for monitoring development remain inadequate in many countries. Scott says more-specific indicators are needed to provide an accurate picture, but this will take time and money.
"How that information is collected and how the costs will be paid for, especially in developing countries, is a discussion which is yet to be had," he says.