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

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Résumé

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 SDG 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 attainment 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 SDGs. 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. FUNDING: Bill & Melinda Gates Foundation.

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La notice

Revue

The Lancet

Thématique

Global Public Health Policies and Epidemiology

Domaine

Business, Management and Accounting

Établissements canadiens

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Organismes subventionnaires

Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Cancer InstituteNational Institute of Mental HealthNational Heart, Lung, and Blood InstituteUniversité de LimogesDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaLee Kong Chian School of Medicine, Nanyang Technological UniversityCenter for International HealthResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesZabol University of Medical SciencesRussian Academy of SciencesFundação para a Ciência e a TecnologiaMedical Research CouncilWeill Cornell Medicine - QatarInjury Prevention Research CenterEuropean CommissionUniversity of North Carolina at Chapel HillPublic Health EnglandUniversity of TorontoCochrane South AfricaUniwersytet OpolskiPolitechnika CzestochowskaDirectorate for Biological SciencesDebre Markos UniversityGeorge Institute for Global HealthEmory UniversityMoscow Institute of Physics and TechnologyMinistry of Health of the Russian FederationStudent Research Committee, Tabriz University of Medical SciencesFrankfurt University of Applied SciencesKurdistan University Of Medical SciencesNational Institute of Child Health and Human DevelopmentLorestan University of Medical SciencesUniversity of ColomboBabol University of Medical SciencesJomo Kenyatta University of Agriculture and TechnologyBall State UniversityAddis Ababa UniversityUnited Arab Emirates UniversityUniversity of GondarCollege of Engineering, Michigan State UniversityWestern Sydney UniversityTartu ÜlikoolAdigrat UniversityMadras Diabetes Research FoundationChungnam National University HospitalUniversità degli Studi di MilanoPomorski Uniwersytet Medyczny W SzczecinieUniversidade Federal de Minas GeraisNational Research University Higher School of EconomicsUniversity of Cape TownI.M. Sechenov First Moscow State Medical UniversityAcademia SinicaHospital for Sick ChildrenDebre Tabor UniversityUniversità di BolognaShahid Beheshti University of Medical SciencesUnited States Agency for International DevelopmentBaqiyatallah University of Medical SciencesGöteborgs UniversitetUniversidade de São PauloDalhousie UniversityAkademiska SjukhusetUniversitetet i OsloUniversity of New South WalesUniversidad del ValleKermanshah University of Medical SciencesUniversity of GhanaUniversity of MichiganQueensland University of TechnologyUniversidad de Costa RicaQazvin University of Medical SciencesGuilan University of Medical SciencesUniversitair Medisch Centrum GroningenSyddansk UniversitetYale UniversityJimma UniversityWollega UniversityBanaras Hindu UniversityNational Institutes of HealthNational Institute on AgingChinese University of Hong KongHaramaya UniversityWeill Cornell Medical CollegeXiamen UniversityUniversité de BourgogneUniversiti Sains MalaysiaYork UniversityTehran University of Medical Sciences and Health ServicesKuwait UniversityAmerican University of BeirutVetenskapsrådetMax-Planck-GesellschaftSwansea UniversityKing Abdulaziz UniversityKarolinska InstitutetUppsala UniversitetAugusta UniversityUniversity of the Western CapeUniversity of CanberraCairo UniversityLunds UniversitetSouth African Medical Research CouncilBundesministerium für GesundheitUniversität UlmUniversity of EmbuUniwersytet Jagielloński Collegium MedicumChalmers Tekniska HögskolaIslamic Azad UniversityWellcome TrustKorea UniversityKyung Hee UniversityU.S. Department of Veterans AffairsKosin UniversityDuke Kunshan UniversityTulane UniversityArak University of Medical SciencesEuropean Observatory on Health Systems and PoliciesNational and Kapodistrian University of AthensUniversitätsklinikum HeidelbergNova Southeastern UniversityUniversitetet i BergenSimmons CollegeKing Saud UniversityShiraz University of Medical SciencesAin Shams UniversityNational Drug and Alcohol Research CentreFriedrich-Schiller-Universität JenaUniversity of MelbourneUniversity of WashingtonRijksuniversiteit GroningenShanghai Jiao Tong UniversityTaipei Medical UniversityUniversity College CorkDongguk UniversityUniversité de BordeauxPublic Health Foundation of IndiaIndian Council of Medical ResearchUniversidad de ExtremaduraUniverzita Komenského v BratislaveCardiff UniversityShiraz UniversityKing's College LondonBirzeit UniversityNSW Ministry of HealthBritish Heart FoundationLomonosov Moscow State UniversityUniversity of QueenslandNational Institute for Health and Care ResearchMazandaran University of Medical SciencesUniversity of AlbertaAhmadu Bello UniversityUniversity of California, San DiegoVital StrategiesUniversitat Pompeu FabraUniversity of PittsburghTribhuvan UniversityTarbiat Modares UniversityQueensland Brain InstituteNewcastle UniversityUniversitas Negeri SemarangSichuan UniversityAnglia Ruskin UniversityQueen Elizabeth Hospital Birmingham CharityMcMaster UniversityNew York University Abu DhabiOhio State UniversityAix-Marseille UniversitéFaculty of Medicine and Health, University of SydneyUniversiti Brunei DarussalamUniversiti Kebangsaan MalaysiaLondon School of Economics and Political ScienceCentral South UniversitySeattle Children's Research InstituteUniversity of HaifaChungnam National UniversityUniversita degli Studi di Bari Aldo MoroSouth Australian Health and Medical Research InstituteSamara UniversityJordan University of Science and TechnologyNational Cerebral and Cardiovascular CenterUniversity of West FloridaCarolina Population Center, University of North Carolina at Chapel HillUniversität HohenheimUniversity of OxfordAhvaz Jundishapur University of Medical SciencesJazan UniversityUniversity of South FloridaInternational Centre for Diarrhoeal Disease Research, BangladeshWashington University in St. LouisIran University of Medical SciencesBill and Melinda Gates FoundationBahir Dar UniversityNational Center for Child Health and DevelopmentAarhus UniversitetDurban University of TechnologyHormozgan University of Medical SciencesUniversity of NamibiaMaragheh University of Medical SciencesMekelle UniversityUniversity of DhakaUniversiteit StellenboschSavitribai Phule Pune UniversityUniversità degli Studi di GenovaUniversiti MalayaIsfahan University of Medical SciencesSan Diego State UniversityUniversity College DublinMcGill UniversityOklahoma State UniversitySeoul National UniversityDonau-Universität KremsNorthwestern UniversityMichigan State UniversityNorwegian Institute of Public HealthInstitute of Biomedical Sciences, Academia SinicaUnited Nations Population FundUniversity of GlasgowGeorge Mason UniversityDeakin UniversityHelsingin YliopistoHebrew University of Jerusalem

Mots-clés

Sustainable developmentBurden of diseaseGlobal healthEconomic growthDevelopment economicsPolitical scienceEnvironmental healthMedicineEconomicsHealth carePopulation

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