Abstract :
[en] [en] 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.
Funding text :
Ettore Beghi reports personal fees from Market Access Provider and grants from the Italian Ministry of Health, UCB, ALS Association, Eisai, and Shire. Yannick Bejot reports grants and personal fees from AstraZeneca and Boehringer Ingelheim and personal fees from Daiichi-Sankyo, Bristol-Myers Squibb, Pfizer, Medtronic, Bayer, Novex pharma, and Merck. Adam Berman reports personal fees from Philips. Louisa Degenhardt reports grants from Indivior, Mundipharma, and Seqirus. Cyrus Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GlaxoSmithKline (GSK), Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. Mir Sohail Fazeli reports personal fees from Doctor Evidence. Panniyammakal Jeemon reports a clinical and public health intermediate fellowship from the Wellcome Trust-DBT India Alliance (2015–20). Jacek Jóźwiak reports grants and personal fees from Valeant, personal fees from ALAB Laboratoria and Amgen, and non-financial support from Microlife and Servier. Nicholas Kassebaum reports personal fees and other support from Vifor Pharmaceuticals. Jeffrey Lazarus reports personal fees from Janssen and Cepheid and grants and personal fees from AbbVie, Gilead Sciences, and Merck. Stefan Lorkowski reports personal fees from Amgen, Berlin-Chemie, Merck, Novo Nordisk, Sanofi-Aventis, Synlab, and Unilever, and non-financial support from Preventicus. Walter Mendoza is currently a program analyst for population and development at the Peru Country Office of the UN Population Fund, which does not necessarily endorse this study. Ted Miller reports an evaluation contract from AB InBev Foundation. Constance Dimity Pond reports personal fees from Nutricia advisory board, acting as an unpaid consultant to the Wicking Dementia Research and Education Centre in Tasmania for development of general practitioner (GP) education on dementia (airfares and accommodation paid), payment for acting as a dementia clinical lead and dementia pathways adviser for the Sydney North Primary Health Network, and payment for acting as a GP educator for Presbyterian Aged Care. Maarten Postma reports grants from Mundipharma, Bayer, Bristol-Myers Squibb, AstraZeneca, Arteg, and AscA; grants and personal fees from Sigma Tau, Merck, GSK, Pfizer, Boehringer Ingelheim, Novavax, Ingress Health, AbbVie, and Sanofi; personal fees from Quintiles, Astellas, Mapi, OptumInsight, Novartis, Swedish Orphan, Innoval, Jansen, Intercept, and Pharmerit; and stock ownership in Ingress Health and Pharmacoeconomics Advice Groningen. Kazem Rahimi reports grants from National Institute for Health Research Biomedical Research Centre, Economic and Social Research Council, and Oxford Martin School. Miloje Savic is employed by GSK Biologicals. Kenji Shibuya reports grants from Japanese Ministry of Health, Labour and Welfare and Ministry of Education, Culture, Sports, Science and Technology. Mark Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation. Jasvinder Singh reports consulting for Horizon, Fidia, UBM, Medscape, WebMD, National Institutes of Health, and the American College of Rheumatology; serving as the principal investigator for an investigator-initiated study funded by Horizon Pharma through a grant to Dinora (a 501C3 non-profit organisation); and being on the steering committee of Outcome Measures in Rheumatology, an international organisation that develops measures for clinical trials and receives arms-length funding from 36 pharmaceutical companies. Jeffrey Stanaway reports a grant from Merck. Cassandra Szoeke reports a grant from the National Health and Medical Research Council (NHMRC), Lundbeck, Alzheimer's Association, and the Royal Australasian College of Practicioners; she holds patent PCT/AU2008/001556. Amanda Thrift reports grants NHMRC. Muthiah Vaduganathan receives research support from the National Heart, Lung and Blood Institute and serves as a consultant for Bayer and Baxter Healthcare. All other authors declare no competing interests.Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, St Jude Children's Research Hospital, the National Institute on Aging of the National Institutes of Health (award P30AG047845) , and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. We thank the Russia Longitudinal Monitoring Survey, done by the National Research University Higher School of Economics and ZAO Demoscope, together with Carolina Population Center, University of North Carolina at Chapel Hill, and the Institute of Sociology of the Russian Academy of Sciences, for making these data available. This analysis uses data or information from the Longitudinal Ageing Study in India (LASI). The development and release of the LASI pilot study was funded by the National Institute on Aging (R21AG032572, R03AG043052, and R01 AG030153) . Health Behaviour in School-aged Children (HBSC) is an international study performed in collaboration with the WHO Regional Office for Europe. The international coordinator of the 1997–98, 2001–02, 2005–06, and 2009–10 surveys was Candace Currie and the databank managers were Bente Wold for the 1997–98 survey and Oddrun Samdal for the following surveys. A list of principal investigators in each country can be found on the HBCS website . The Health and Retirement Study is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and done by the University of Michigan. This research uses data from Add Health, a programme project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Ronald R Rindfuss and Barbara Entwisle are acknowledged for their assistance in the original design of Add Health. People interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, Chapel Hill, NC, USA ( addhealth@unc.edu ). No direct support was received from grant P01-HD31921 for this analysis. Researchers interested in using data from the Irish Longitudinal Study on Ageing can access the data for free from the Irish Social Science Data Archive at University College Dublin (http://www.ucd.ie/issda/data/tilda) and Interuniversity Consortium for Political and Social Research at the University of Michigan (http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/34315). Data for this study was provided by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. This research used data from the National Health Survey 2003. We are grateful to the Ministry of Health of Chile, the copyright owner of the survey, for giving us access to the database. All results of the study are those of the authors and in no way committed to the Ministry. The Palestinian Central Bureau of Statistics granted the researchers of GBD 2017 access to relevant data in accordance with licence number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn from data from the Palestinian Central Bureau of Statistics. This paper uses data from SHARE waves 1, 2, 3 (SHARELIFE), 4, 5, and 6. Collection of data for that survey was primarily funded by the European Commission through framework programme (FP) 5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193; COMPARE: CIT5-CT-2005-028857; SHARELIFE: CIT4-CT-2006-028812), and FP7 (SHARE-PREP: number 211909; SHARE-LEAP: number 227822; SHARE M4: number 261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and various national funding sources is gratefully acknowledged by SHARE. The Costa Rican Longevity and Healthy Aging Study (CRELES) is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Población and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945–55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators of CRELES are Luis Rosero-Bixby and William H Dow, and the co-principal investigators are Xinia Fernández and Gilbert Brenes. We used data from the 2009–10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Center (EGC) at Yale University. It was funded by the EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. This study uses data from the WHO Study on global AGEing and adult health.
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