Halfway to 2030, the target year for achieving the Sustainable Development Goals, the world is far off track: 30% of the targets have stagnated or regressed, 50% have made insufficient progress and only 20% of the 169 targets are on track to be met by 2030.

While it is true that the COVID-19 pandemic and its social, economic and health consequences have had a major impact on the achievement of these targets, the situation leading up to the pandemic was far from ideal.

Back in 2019, the UN Secretary-General warned that countries would either need to take exceptional measures or there would be a risk that the expected outcomes would not be achieved

SDG 3, ensuring healthy lives and promoting well-being for all, is experiencing significant setbacks. Just 10% of targets have been met or are on track to be met, 60% are in need of accelerated action, 20% are at risk of not being met and 10% have insufficient data.

The SDG3 targets were drastically affected by the consequences of the COVID-19 pandemic, causing setbacks and stagnation in many indicators, even though they were also nowhere near being on course before the pandemic.

The international community will need to significantly step up its efforts in terms of both resourcing and implementing equitable health policies to meet all the health-related SDG indicators, without overlooking the fact that people's health also depends on trends in other SDGs like gender, water, the environment and the economy, for example.

The international commitment to UHC was reaffirmed in 2023, but it will only become a reality if the $328 billion investment per year needed to scale up a primary health care approach in low- and middle-income countries is me.

The WHO/World Bank Global Monitoring Report 2023 on progress towards universal health coverage (UHC) finds a backward trend, in some cases even before the pandemic, in the indicators that mark the evolution of UHC around the world.

Improvements in health services have stagnated and the proportion of the population suffering from catastrophic levels of health costs has increased.

In fact, since 2000, only 42 of the 138 countries for which figures are available have improved service coverage and decreased the number of people burdened with catastrophic health costs.

The concept of One Health—"the collaborative effort of multiple disciplines (medical workers, veterinarians, researchers, etc.) working locally, nationally, and globally to attain optimal health for people, animals, and our environment”—can serve as an alternative to the traditional way of tackling global health problems.

However, this requires addressing a series of issues and reaffirming the concept of One Health as working across three areas of health: human health, animal health and environmental health, with the ultimate goal of holistic health that provides for the mid- and long-term sustainability of the planet, animals and people.

The One Health approach is able to help us tackle many infectious diseases, as well as non-communicable diseases and other health challenges such as antimicrobial resistance, one of the biggest threats to global health, which is rooted in the misuse of medicines by humans as well as in animals.

Official development assistance (ODA) from Development Assistance Committee (DAC) countries reached a historic $203.995 billion in 2022, up 13.6% from 2021. ODA increased in 26 of the 30 DAC member countries.

Total ODA from DAC members represents 0.36% of gross national income (GNI), up slightly from 0.33% in the previous year, but well below the UN commitment of 0.7%. This is a slight increase from the previous year's 0.33%, but well below the UN commitment of 0.7%.

Only five countries (Denmark, Germany, Luxembourg, Norway and Sweden) met the 0.7% target.

The war in Ukraine and the fight against the COVID-19 pandemic were largely responsible for the increase in ODA. For the former, exceptional contributions earmarked for taking in refugees in donor countries following Russia's aggression against Ukraine represent 14.4% of all DAC funding.

In the latter case, despite a 45% decrease in spending compared to 2021, the funds allocated to COVID-19 amounted to $11.2 billion.

The funds currently allocated to cooperation in general and health in particular are on the rise, but they fail to meet the current needs to achieve the goals proposed in the SDGs.

The upward trend in ODA for health continued in 2021, reaching $35.283 billion, $5 billion more than in 2020, up 14.6%. Of this figure, 55% was for controlling the COVID-19 pandemic.

COVID-19 efforts totalled $11.2 billion in 2022, 45% less than in 2021. Vaccine donations accounted for $1.53 billion, a drop of 74.1% compared to 2021.

Of this amount, only $16 million went to donations of doses purchased specifically for developing countries, with the remainder going to donations of leftover vaccines from wealthy countries.

In 2022, Spanish ODA increased by 31.9%, reaching €4.12 billion, 0.30% of gross national income (GNI), figures not seen in Spanish cooperation since 2010.

Percentage-wise, it closes the gap compared to the average of all Development Assistance Committee (DAC) donors but is still well short of the 0.56% average for EU countries and the 0.7% commitment made more than 50 years ago at the United Nations (UN)

Trend in Spanish Gross ODA and as percentage of GNI, 2006-2022

Despite remaining relevant, the COVID-19 pandemic is no longer the top priority for international cooperation, which in Spain is reflected in a reduction of €124 million in the budget earmarked for health, a sector that still received €402 million.

In percentage terms, the funds earmarked for health dropped from 16.8% in 2021 to 9.76% in 2022, once again increasing the gap with the average for neighbouring countries.

These figures mean that Spain is once again lagging behind the 15% average that needs to be allocated to health to tackle the world’s complex problems and illustrates that the increase in 2021 was largely circumstantial.

For the second consecutive year, the Spanish Ministry of Health ranks as the top donor in health cooperation, with 43.8% of all Spanish ODA allocated to health (€176.3 million).

However, 99.6% of this amount was in the form of donations of COVID-19 vaccines, in some cases to upper- to middle-income countries.

Trend in Spanish Gross health ODA, 2006-2022

From a humanitarian perspective, 2022 has been marked by the war in Ukraine, the escalation of other conflicts and a deepening food crisis, leading to an unprecedented surge in humanitarian needs, all against a backdrop of ever-increasing forced displacement.

Todo ello en un contexto en el que los desplazamientos forzosos no paran de crecer, más del 1% de la población mundial se ha visto obligada a huir y a abandonar su hogar, es decir, 1 de cada 74 personas en el mundo, el doble que hace una década.

More than 1% of the world’s population has been forced to flee and leave their homes – one in every 74 people in the world, twice as many as a decade ago.

There were 274 million people in need of humanitarian assistance in early 2022; a year later, the figure rose to 339 million people, which means that one in every 23 people in the world is in need of humanitarian assistance, more than twice as many as four years ago.

Interconnected and mutually exacerbating factors have caused recent food crises: conflict, violence and insecurity, economic crises and extreme weather events.

In 2022, these problems were compounded by the economic and social impacts associated with the COVID-19 pandemic, the repercussions of the war in Ukraine, increasingly long-lasting droughts, torrential rains and floods and other extreme weather events, leading to an unprecedented global food crisis.

According to the latest Global Food Crisis Report, the number of acutely food insecure people in need of urgent food, nutrition and livelihood assistance increased for the fourth consecutive year, from 112 million to 258 million people in 58 countries.

Access to people in crisis situations is increasingly complex and, in some cases, virtually impossible: civilians are used as weapons of war and hospitals and health centres are targeted.

Protecting humanitarian and health workers in conflict zones therefore remains both a challenge and a necessity. Two hundred and twenty-two health workers were killed, 298 were abducted and 294 were detained in 2022.

These figures confirm the need to improve security risk management not only for humanitarian staff, but also for local and national actors who continue to be the most exposed and least protected.

Humanitarian crises mean that millions of people in the world face serious health threats such as disease outbreaks, malnutrition and lack of access to essential health services.

This is coupled with an increase in the number of attacks on health infrastructure and health workers, further complicating access to health services.

Against this backdrop, international assistance is essential, yet international community funding for the health sector remains insufficient. As of 2022, only 48.5% of the funds requested for the sector in UN appeals for aid have been received.

The underfunding of humanitarian action continues to be one of the main challenges for the humanitarian sector.

Only $29.692 billion of the $51.699 billion requested by the UN was received, meeting only 57.4% of the sector's needs.

While this is a record amount, it falls short of what is needed to meet a similarly unprecedented increase in humanitarian needs.

In 2022, the total amount Spanish Development Cooperation allocated to humanitarian action increased significantly to €158 million

Despite the fact that this is a substantial increase in absolute terms, in percentage terms it is only 3.88%, three tenths of a percentage point more than in 2021 and a far cry from the commitment to allocate 10% to HA and from the average of DAC countries, which allocated 10.93% in 2022.

Trend in Spanish Gross ODA devoted to HA, 2005-2022