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

Lozano, R. and Fullman, N. and Abate, D. and Abay, S. M. and Abbafati, C. and Abbasi, N. and Abbastabar, H. and Abd-Allah, F. and Abdela, J. and Abdelalim, A. and Abdel-Rahman, O. and Abdi, A. and Abdollahpour, I. and Abdulkader, R. S. and Abebe, N. D. and Abebe, Z. and Abejie, A. N. and Abera, S. F. and Abil, O. Z. and Aboyans, V. and Abraha, H. N. and Abrham, A. R. and Abu-Raddad, L. J. and Abu-Rmeileh, N. M. and Abyu, G. Y. and Accrombessi, M. M. K. and Acharya, D. and Acharya, P. and Adamu, A. A. and Adebayo, O. M. and Adedeji, I. A. and Adedoyin, R. A. and Adekanmbi, V. and Adetokunboh, O. O. and Adhena, B. M. and Adhikari, T. B. and Adib, M. G. and Adou, A. K. and Adsuar, J. C. and Afarideh, M. and Afshari, M. and Afshin, A. and Agarwal, G. and Aghayan, S. A. and Agius, D. and Agrawal, A. and Agrawal, S. and Ahmadi, A. and Ahmadi, M. and Ahmadieh, H. and Ahmed, M. B. and Ahmed, S. and Akalu, T. Y. and Akanda, A. S. and Akbari, M. E. and Akibu, M. and Akinyemi, R. O. and Akinyemiju, T. and Akseer, N. and Alahdab, F. and Al-Aly, Z. and Alam, K. and Alam, T. and Albujeer, A. and Alebel, A. and Alene, K. A. and Al-Eyadhy, A. and Alhabib, S. and Ali, R. and Alijanzadeh, M. and Alizadeh-Navaei, R. and Aljunid, S. M. and Alkerwi, A. and Alla, F. and Allebeck, P. and Allen, C. A. and Almasi, A. and Al-Maskari, F. and Al-Mekhlafi, H. M. and Alonso, J. and Al-Raddadi, R. M. and Alsharif, U. and Altirkawi, K. and Alvis-Guzman, N. and Amare, A. T. and Amenu, K. and Amini, E. and Ammar, W. and Anber, N. H. and Anderson, J. A. and Andrei, C. L. and Androudi, S. and Animut, M. D. and Anjomshoa, M. and Ansari, H. and Ansariadi, A. and Ansha, M. G. and Antonio, C. A. T. and Anwari, P. and Appiah, L. T. (2018) 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, 392 (10159). pp. 2091-2138.

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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 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 chan e 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. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Item Type: Article
Additional Information: Cited By :46 Export Date: 16 February 2020 CODEN: LANCA Correspondence Address: Lozano, R.; University of Washington, Institute for Health Metrics and EvaluationUnited States; email: rlozano@uw.edu
Uncontrolled Keywords: adolescent adult alcohol consumption Article birth rate child childhood mortality China demography feasibility study female health care concepts health care personnel health related sustainable development goal index human India international cooperation Japan major clinical study malaria male malnutrition maternal mortality newborn newborn mortality non communicable disease physical violence population prevalence priority journal sex factor sexual violence smoking United Kingdom global disease burden global health health status health status indicator mortality motivation risk factor sexual crime statistics and numerical data sustainable development trends United Nations Global Burden of Disease Goals Health Status Indicators Humans Risk Factors Sex Offenses
Subjects: WA Public Health
W General medicine- Health professions
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 11 May 2020 03:37
Last Modified: 11 May 2020 03:37
URI: http://eprints.mums.ac.ir/id/eprint/17378

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