Journal article
Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
The Lancet (British edition), Vol.392(10159), pp.2091-2138
11/10/2018
DOI: 10.1016/S0140-6736(18)32281-5
PMCID: PMC6227911
PMID: 30496107
Abstract
Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health -related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.
Methods We measured progress on 41 health-related S DG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2.5th percentile and 100 as the 97.5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.
Findings The global median health-related SDG index in 2017 was 59.4 (IQR 35.4-67.3), ranging from a low of 11.6 (95% uncertainty interval 9.6-14.0) to a high of 84.9 (83.1-86.7). SDG index values in countries assessed at the subnational level varied substantially particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attaimnent by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.
Interpretation The GBD study offers a unique, robust platform for monitoring the health -related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health -related SDG indicators, NCDs, NCD-related risks, and violence -related indicators will require a concerted shift away from what might have driven past gains curative interventions in the case of NCDs towards multisectoral, prevention -oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the S DGs. What is clear is that our actions or inaction today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Details
- Title: Subtitle
- Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- Creators
- Rafael Lozano - University of WashingtonNancy Fullman - University of WashingtonDegu Abate - Haramaya UniversitySolomon M. Abay - Addis Ababa UniversityCristiana Abbafati - Univ Roma La Sapienza, Dept Law Philosophy & Econ Studies, Rome, ItalyNooshin Abbasi - University of TehranHedayat Abbastabar - University of TehranFoad Abd-Allah - Cairo UniversityJemal Abdela - Haramaya UniversityAhmed Abdelalim - Cairo UniversityOmar Abdel-Rahman - University of CalgaryAlireza Abdi - Kermanshah Univ Med Sci, Fac Nursing & Midwifery, Kermanshah, IranIbrahim Abdollahpour - Arak UniversityRizwan Suliankatchi Abdulkader - Manonmaniam Sundaranar UniversityNebiyu Dereje Abebe - Addis Ababa UniversityZegeye Abebe - University of GondarAyenew Negesse Abejie - Debre Markos UniversitySemaw P. Abera - Mekelle UniversityOlifan Zewdie Abil - Wollega UniversityVictor Aboyans - Dupuytren Univ Hosp, Dept Cardiol, Limoges, FranceHaftom Niguse AbrahaAklilu Rota Abrham - Haramaya UniversityLaith Jamal Abu-Raddad - Weill Cornell Med Coll Qatar, Dept Healthcare Policy & Res, Doha, QatarNiveen Me Abu-RmeilehGebre Y. Abyu - Mekelle UniversityManfred Mario Kokou Accrombessi - Benin Clin Res Inst, Cotonou, BeninDilaram Acharya - Dongguk University WISEPawan Acharya - Nepal Dev Soc, Pokhara, NepalAbdu A. Adamu - University of Cape TownOladinieji M. Adebayo - Univ Coll Hosp, Med, Ibadan, NigeriaIsaac Akinkumui Adedeji - Olabisi Onabanjo UniversityRufus Adesoji Adedoyin - Obafemi Awolowo Univ, Dept Med Rehabilitadoil, Ife, NigeriaVictor Adekanmbi - Cardiff UniversityOlatunji Adetokunboh - University of Cape TownBeyene Meressa Adhena - Mekelle UniversityTara Rattan Adhikari - Ctr Social Sci & Publ Hlth Res Nepal, Nepal Hlth Res Environm, Lalitpur, NepalMine G. AdibArsene Kouablan Adou - Lvorian Assoc Family Welf, Abidjan, Cote IvoireJose C. Adsuar - Univ Extremadura, Sport Sci Dept, Badajoz, SpainMohsen Afarideh - University of TehranMandi Afshari - Zabol UniversityAshkan Afshin - University of WashingtonGina Agarwal - McMaster UniversitySargis Aghasi Aghayan - Yerevan State UniversityDominic Agius - Directorate Hlth informat & Res, Dept Hlth, Pieta, MaltaAnurag Agrawal - CSIR, Inst Genom & Integrat Biol, Res Area Informat & Rig Data, Delhi, IndiaSutapa Agrawal - Vital StrategiesAlireza Ahmadi - Kermanshah Univ Med Sci, Dept Anesthesiol, Kermanshah, IranMeltdi Ahmadi - Alwaz Jundishapur Univ Med Sci, Environm Technol Res Ctr, Nhvaz, IranFlamid Ahmadieh - Shahid Beheshti UniversityMuktar Beshir Ahmed - Jimma UniversitySayem Ahmed - Int Ctr Diarrltoeal Dis Res, Hlth Syst & Populat Studies Div, Dhaka, BangladeshTemesgen Yihunie Akalu - University of GondarAli S. Akanda - Univ Rhode Isl, Dept Civil & Environm Engn, Kingston, RI 02881 USAMohammad Esmaeil Akbari - Shahid Beheshti UniversityMohammed Akibu - Debre Berhan UniversityRufus Olusola Akinyemi - University of IbadanTomi Akinyemiju - University of KentuckyNadia Akseer - University of TorontoTares AlandabZiyad Al-Aly - Washington Univ, Internal Med Dept, St Louis, MO USAKhurshid Alam - Univ Western Australia, Sch Populat & Global Hlth, Perth, WA, AustraliaTahiya AlamAmmar AbujeerAnimut AlebelKefyalew Addis Alene - University of GondarAyman Al-Eyadhy - King Saud UniversitySamia AthabibRaghib Ali - New York University Abu DhabiMehran Alijanzadeh - Qazvin Univ Med Sci, Qazvin, IranReza Alizadeh-Nayaei - Mazandaran Univ Med Sci, Gastrointestinal Canc Res Ctr, Sari, IranSyed Mohamed Aljunid - Kuwait UniversityAla'a Alkerwi - Luxembourg Inst Hlth, Dept Populat Hlth, Strassen, LuxembourgFrancois Alla - Natl Univ Malaysia, Int Ctr Casemix & Clin Coding, Bandar Tun Rezak, MalaysiaPeter Allebeck - Karolinska InstitutetChristine A. Allen - University of WashingtonAli Almasi - Kermanshah Univ Med Sci, Dept Environm Hlth Engn, Kermanshah, IranFatma Al-Maskari - United Arab Emirates UniversityHesham M. Al-Mekhlafi - Jazan UniversityJordi Alonso - Hosp del Mar, Med Res Inst, Res Program Epidemiol & Publ Hlth, Barcelona, SpainRajaa M. Al-Raddadi - King Abdulaziz UniversityUbai Alsharif - Charité - Universitätsmedizin BerlinKhalid Altirkawi - King Abdullah Bin Abdulaziz Univ Hosp, Riyadh, Saudi ArabiaNelson Alvis-Guzman - University of CartagenaAzmeraw T. Amare - Baltir Dar Univ, Baltir Dar, EthiopiaKebede Amenu - Addis Ababa UniversityErfan Amini - University of TehranWalid Ammar - Federal ReserveNahla Hamed Anber - Mansoura UniversityJason A. Anderson - University of WashingtonCatalina Liliana AndreiSofia Androudi - University of ThessalyMegbaru Debalkie AnimutMina Anjomshoa - University of TehranHossein Ansari - Zahedan Univ Med Sci, Zahedan, IranAnsariadi Ansariadi - Hasanuddin UniversityMustafa Geleto Ansha - Debre Berhan UniversityCarl Abelardo T. Antonio - University of the Philippines ManilaPalwasha AnwariLambert Tetteh Appiah - AdmitGBD 2017 SDG CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.392(10159), pp.2091-2138
- DOI
- 10.1016/S0140-6736(18)32281-5
- PMID
- 30496107
- PMCID
- PMC6227911
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 48
- Grant note
- Bill AMP; Melinda Gates Foundation; CGIAR U01AG009740 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) MR/M015084/1; G0400491; MC_UP_A620_1015; MR/L003120/1; MC_UU_12011/2; MC_U147585827; MC_U147585819 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC)
- Language
- English
- Date published
- 11/10/2018
- Academic Unit
- Research Administration
- Record Identifier
- 9984949187802771
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