The end is in sight. Or more accurately the beginning. Following three lengthy years of negotiations, we have a new (and improved) sustainable development agenda for global action—The Global Goals. The world has agreed on our global priorities, and only time will tell whether we can hold—and be held—to our promises.

As momentum gathers at 70th UN General Assembly, we celebrate this historic occasion filled with inspirational speeches, and carefully worded promises. World leaders have committed to 17 Global Goals to achieve three things—end extreme poverty, fight inequality and injustice, and fix climate change. In all countries. For all people. What makes this set of goals different, aside from doubling in number and quadrupling in indicators? “Inclusiveness.” The promise of inclusion “Leave no-one behind,” extends to wealthy states too marking a giant shift from its lesser relative—the Millennium Development Goals (MDGs). The convergence of several threads within international development—from people to planet—and governments striving to reach the “furthest behind” first is a powerful promise. As the last party popper pops, and the drinks run dry… attention turns to what next? Can we take them from aspiration to reality? Do we have the correct structures, solidarity, and “will” to govern the goals? Solidarity—certainly. But what about structures?

When Kofi Annan unveiled the MDGs, which were endorsed at the UN Millennium Declaration Summit, he said “We must put people at the centre of everything we do. No calling is more noble, and no responsibility greater, than that of enabling men, women, and children, in cities and villages around the world, to make their lives better. Only when that begins to happen will we know that globalization is indeed becoming inclusive, allowing everyone to share its opportunities. If we are to capture the promises of globalization while managing its adverse effects, we must learn to govern better, and we must learn how better to govern together.” Today, and since the millennial promise, we face a number of global crises and a changing world order. Crumbling under the weight of successive crises—economic, environmental, and nutrition—we have learned (perhaps the hard way) that global problems cannot be solved in any one region, country, or continent alone. Looking at the landscape today we see we have a disrupted and cumbersome institutional arrangement, which still scream “pick me, pick me” vying for prominence on the political agenda, and funding. Taking the recent Ebola virus outbreak in West Africa as a grave reminder of our vulnerability, it exposed gaping holes in our ability to respond to global crises in a timely and efficient manner. But like all mistakes, we learn from them.

The Global Goals are calling for a new era of partnership—”the nutcracker effect” combining top-down political commitment and policy action with bottom-up action from communities and civil society groups. The challenges to be addressed are too complex for any one sector to tackle on one’s own—and requires a broad based coalition which embeds equity across global, regional, national and local policy priorities. For health what would this look like—we need resilient and equitable systems that enable all people to realise their right to health. Building this system requires future proofing for impending health challenges—an ageing population and the rising burden of non-communicable diseases, growing urban populations and the need to enhance global disease surveillance and detection capacities, and the growing threat of antimicrobial resistance calling for investment in research and development.

We need to be confident that the new promise is translated into decisive action and brings about a long overdue reform of global governance. The United Nations is the guardian of these goals, and of course have a central role to play. The primary responsibility, however, will rest with national leaders. As the agreement is not legally binding, we must hold our governments to account and ensure that the Global Goals frame each government’s agenda for sustainable development.

Arthy Santhakumar is a senior research officer in the international division of the BMA. Her current focus is global health and international development, and she leads on the BMA’s Medical Fair and Ethical Trade campaign.

Competing interests: None declared.