other sector during those years. health aid has seen an expansion through multiple channels including private philanthropy, non-governmental organizations, private foundations such as the rockefeller foundation or the bill & melinda gates foundation, bilateral donors, and multilateral donors such as the world bank or unicef. the result has been a sharp rise in uncoordinated and fragmented funding of an ever-increasing number of initiatives and projects. to promote better strategic cooperation and coordination between partners, particularly among bilateral development agencies and funding organizations, the swedish international development cooperation agency (sida) spearheaded the establishment of essence, an initiative to facilitate dialogue between donors/funders, allowing them to identify synergies. essence brings together a wide range of funding agencies to coordinate funding efforts. in 2009 health aid from the oecd amounted to $12.47 billion which amounted to 11.4% of its total bilateral aid. in 2009, multilateral donors were found to spend 15.3% of their total aid on bettering public healthcare. international health aid debates debates exist questioning the efficacy of international health aid. supporters of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the poverty trap. opponents of health aid claim that international health aid actually disrupts developing countries' course of development, causes dependence on aid, and in many cases the aid fails to reach its recipients. for example, recently, health aid was funneled towards initiatives such as financing new technologies like antiretroviral medication, insecticide-treated mosquito nets, and new vaccines. the positive impacts of these initiatives can be seen in the eradication of smallpox and polio; however, critics claim that misuse or misplacement of funds may cause many of these efforts to never come into achievement. economic modeling based on the institute for health metrics and evaluation and the world health organization has shown a link between international health aid in developing countries and a reduction in adult mortality rates. however, a 2014–2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement. that same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011. sustainable development goals for 2030 further information: sustainable development goals § health to address current and future challenges in addressing health issues in the world, the united nations have developed the sustainable development goals to be completed by 2030. these goals in their entirety encompass the entire spectrum of development across nations, however goals 1–6 directly address health disparities, primarily in developing countries. these six goals address key issues in global public health, poverty, hunger and food security, health, education, gender equality and women's empowerment, and water and sanitation. public health officials can use these goals to set their own agenda and plan for smaller scale initiatives for their organizations. these goals are designed to lessen the burden of disease and inequality faced by developing countries and lead to a healthier future. the links between the various sustainable development goals and public health are numerous and well established. history further information: history of water supply and sanitation until the 18th century mass burials during the second plague pandemic (a.k.a. the black death; 1346–1353) intensified urban responses to disaster on the basis of earlier practices. miniature from "the chronicles of gilles li muisis" (1272–1352). bibliothèque royale de belgique, ms 13076–77, f. 24v. from the beginnings of human civilization, communities promoted health and fought disease at the population level. definitions of health as well as methods to pursue it differed according to the medical, religious and natural-philosophical ideas groups held, the resources they had, and the changing circumstances in which they lived. yet few early societies displayed the hygienic stagnation or even apathy often attributed to them. the latter reputation is mainly based on the absence of present-day bioindicators, especially immunological and statistical tools developed in light of the germ theory of disease transmission. public health was born neither in europe nor as a response to the industrial revolution. preventive health interventions are attested almost anywhere historical communities have left their mark. in southeast asia, for instance, ayurvedic medicine and subsequently buddhism fostered occupational, dietary and sexual regimens that promised balanced bodies, lives and communities, a notion strongly present in traditional chinese medicine as well. among the mayans, aztecs and other early civilizations in the americas, population centers pursued hygienic programs, including by holding medicinal herbal markets. and among aboriginal australians, techniques for preserving and protecting water and food sources, micro-zoning to reduce pollution and fire risks, and screens to protect people against flies were common, even in temporary camps. a depiction of aztec smallpox victims western european, byzantine and islamicate civilizations, which generally adopted a hippocratic, galenic or humoral medical system, fostered preventive programs as well. these were developed on the basis of evaluating the quality of local climates, including topography, wind conditions and exposure to the sun, and the properties and availability of water and food, for both humans and nonhuman animals. diverse authors of medical, architectural, engineering and military manuals explained how to apply such theories to groups of different origins and under different circumstances. this was crucial, since under galenism bodily constitutions were thought to be heavily shaped by their material environments, so their balance required specific regimens as they traveled during different seasons and between climate zones. in complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders. for instance, in greek and roman antiquity, army generals learned to provide for soldiers' wellbeing, including off the battlefield, where most combatants died prior to the twentieth century. in christian monasteries across the eastern mediterranean and western europe since at least the fifth century ce, monks and nuns pursued strict but balanced regimens, including nutritious diets, developed explicitly to extend their lives. and royal, princely and papal courts, which were often mobile as well, likewise adapted their behavior to suit environmental conditions in the sites they occupied. they could also choose sites they considered salubrious for their members and sometimes had them modified. in cities, residents and rulers developed measures to benefit the general population, which faced a broad array of recognized health risks. these provide some of the most sustained evidence for preventive measures in earlier civilizations. in numerous sites the upkeep of infrastructures, including roads, canals and marketplaces, as well as zoning policies, were introduced explicitly to preserve residents' health. officials such as the muhtasib in the middle east and the road master in italy, fought the combined threats of pollution through sin, ocular intromission and miasma. craft guilds were important agents of waste disposal and promoted harm reduction through honesty and labor safety among their members. medical practitioners, including public physicians, collaborated with urban governments in predicting and preparing for calamities and identifying and isolating people perceived as lepers, a disease with strong moral connotations. neighborhoods were also active in safeguarding local people's health, by monitoring at-risk sites near them and taking appropriate social and legal action against artisanal polluters and neglectful owners of animals. religious institutions, individuals and charitable organizations in both islam and christianity likewise promoted moral and physical wellbeing by endowing urban amenities such as wells, fountains, schools and bridges, also in the service of pilgrims. in western europe and byzantium, religious processions commonly took place, which purported to act as both preventive and curative measures for the entire community. urban residents and other groups also developed preventive measures in response to calamities such as war, famine, floods and widespread disease. during and after the black death (1346–53), for instance, inhabitants of the eastern mediterranean and western europe reacted to massive population decline in part on the basis of existing medical theories and protocols, for instance concerning meat consumption and burial, and in part by developing new ones. the latter included the establishment of quarantine facilities and health boards, some of which eventually became regular urban (and later national) offices. subsequent measures for protecting cities and their regions included issuing health passports for travelers, deploying guards to create sanitary cordons for protecting local inhabitants, and gathering morbidity and mortality statistics. such measures relied in turn on better transportation and communication networks, through which news on human and animal disease was efficiently spread. after the 18th century with the onset of the industrial revolution, living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions. in the first four decades of the 19th century alone, london's population doubled and even greater growth rates were recorded in the new industrial towns, such as leeds and manchester. this rapid urbanization exacerbated the spread of disease in the large conurbations that built up around the workhouses and factories. these settlements were cramped and primitive with no organized sanitation. disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. unavailable housing led to the rapid growth of slums and the per capita death rate began to rise alarmingly, almost doubling in birmingham and liverpool. thomas malthus warned of the dangers of overpopulation in 1798. his ideas, as well as those of jeremy bentham, became very influential in government circles in the early years of the 19th century. the latter part of the century brought the establishment of the basic pattern of improvements in public health over the next two centuries: a social evil was identified, private philanthropists brought attention to it, and changing public opinion led to government action. the 18th century saw rapid growth in voluntary hospitals in england. the practice of vaccination began in the 1800s, following the pioneering work of edward jenner in treating smallpox. james lind's discovery of the causes of scurvy amongst sailors and its mitigation via the introduction of fruit on lengthy voyages was published in 1754 and led to the adoption of this idea by the royal navy. efforts were also made to promulgate health matters to the broader public; in 1752 the british physician sir john pringle published observations on the diseases of the army in camp and garrison, in which he advocated for the importance of adequate ventilation in the military barracks and the provision of latrines for the soldiers. public health legislation in england sir edwin chadwick was a pivotal influence on the early public health campaign. the first attempts at sanitary reform and the establishment of public health institutions were made in the 1840s. thomas southwood smith, physician at the london fever hospital, began to write papers on the importance of public health, and was one of the first physicians brought in to give evidence before the poor law commission in the 1830s, along with neil arnott and james phillips kay. smith advised the government on the importance of quarantine and sanitary improvement for limiting the spread of infectious diseases such as cholera and yellow fever. the poor law commission reported in 1838 that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". it recommended the implementation of large scale government engineering projects to alleviate the conditions that allowed for the propagation of disease. the health of towns association was formed at exeter hall london on 11 december 1844, and vigorously campaigned for the development of public health in the united kingdom. its formation followed the 1843 establishment of the health of towns commission, chaired by sir edwin chadwick, which produced a series of reports on poor and insanitary conditions in british cities. these national and local movements led to the public health act, finally passed in 1848. it aimed to improve the sanitary condition of towns and populous places in england and wales by placing the supply of water, sewerage, drainage, cleansing and paving under a single local body with the general board of health as a central authority. the act was passed by the liberal government of lord john russell, in response to the urging of edwin chadwick. chadwick's seminal report on the sanitary condition of the labouring population was published in 1842 and was followed up with a supplementary report a year later. during this time, james newlands (appointed following the passing of the 1846