The era of sustainable development that is currently being debated for post-2015 represents a revolutionary change that goes beyond the current framework of the Millennium Development Goals (MDGs) and the driving ideal of ending poverty. It is a tremendous window of opportunity, since sustainable development is about all of us, not just some of us. It is about the interdependence we all share one with another. It is about the common threats we face and the solutions we have to find together.

However, it is also about intensifying the work begun during the past decade because on Jan 1, 2016, people will still be dying from many of today's priority diseases. There is a huge amount of unfinished business to complete before the world can move to sustainable development. For example, each year around 7 million children younger than 5 years die from preventable diseases, the number of maternal deaths is 273 500, around 7 million people living with HIV/AIDS still need anti-retroviral treatment, there are 8·7 million new cases of tuberculosis, and as many as 1·2 million malaria deaths. Furthermore, progress has been hindered by newer predicaments, such as antimicrobial resistance.

As we look to the future, we see five priorities. The first is women, who remain the dominant face of poverty. Extending women's reproductive rights is crucial, and includes not only access to contraception but also provision of quality reproductive health care and safe abortion services. Putting women first also means making their education a priority. As much as half of the reductions in under-5 mortality in recent years can be attributed to women's educational achievements. Second, early child development. Michael Marmot's work on social determinants of health has clearly shown that focusing on the early years is critical to solving the problem of health inequalities in adulthood. Third, adolescent health. Adolescence bridges the era of childhood with adulthood. Young people are the future for every society, and huge benefits to their health and development can be won through better education and preventive public health measures.

People living with non-communicable diseases (NCDs) are our fourth priority. Worldwide, NCDs are the leading cause of death and disability and have a huge socio-economic impact. They account for nearly 80% of deaths in low-income and middle-income countries (LMIC), and this situation is predicted to worsen substantially by 2020 and beyond. Managing and treating cardiovascular disease, cancer, diabetes, and chronic respiratory disease will need continued action, as will mental health and neurological conditions such as epilepsy and dementia, which still get marginalised in global policy debates. Finally, a globally ageing population. By 2016, there will be more people older than 65 years than children younger than 5 years. More than 80% of people older than 60 years will be living in a LMIC. Provision of age-appropriate health-care services, long term care and support, and the creation of sustainable cities will be key to enable older people to participate in society fully.

Progress on all of these priorities will only happen if important cross-cutting issues are also addressed at the same time. First, increasing access to high-quality health care—universal health coverage. Second, ensuring equity. The MDGs have seen disturbingly insufficient progress among the poorest and most marginalised populations worldwide. Addressing inequities must be central to any new framework of sustainable development. Third, tackling the social determinants of health, including the multiplicity of sectors affecting health—eg, water and sanitation. Fourth, establishing systematic accountability mechanisms that will hold countries and donors to their promises and commitments. One model is the independent Expert Review Group (iERG) which was created to ensure that commitments to the UN Secretary-General's Global Strategy for Women's and Children's Health are being delivered on time and with impact. Fifth, the need to defeat stigma and discrimination that limits people's access to health care—eg, among men who have sex with men and people who inject drugs. Changing society's attitudes and recognising individual's rights and freedoms through legal and policy reform is crucial.

There is one final objective, perhaps the most important of all—confronting the escalating threat to human health, even to human survival, from climate change. The era of sustainable development is perhaps the last opportunity our species has to engage with this catastrophic danger—solving the challenge of climate change is the most important foundation for our planet's sustainability, bar none.

Copyright © 2012 Anthony Asael/Art in All of Us/Corbis

Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(12)62092-3 Copyright © 2012 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect