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

Shanshan Li, GBD 2017 SDG Collaborators

Research output: Contribution to journalArticleResearchpeer-review

34 Citations (Scopus)

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 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.

Original languageEnglish
Pages (from-to)2091-2138
Number of pages48
JournalThe Lancet
Volume392
Issue number10159
DOIs
Publication statusPublished - 10 Nov 2018

Cite this

@article{7febebb7032c4b35ac62d71a43d9d4fc,
title = "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",
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 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.",
author = "Rafael Lozano and Nancy Fullman and Degu Abate and Abay, {Solomon M.} and Cristiana Abbafati and Nooshin Abbasi and Hedayat Abbastabar and Foad Abd-Allah and Jemal Abdela and Ahmed Abdelalim and Omar Abdel-Rahman and Alireza Abdi and Ibrahim Abdollahpour and Abdulkader, {Rizwan Suliankatchi} and Abebe, {Nebiyu Dereje} and Zegeye Abebe and Abejie, {Ayenew Negesse} and Abera, {Semaw F.} and Abil, {Olifan Zewdie} and Victor Aboyans and Abraha, {Haftom Niguse} and Abrham, {Aklilu Roba} and Abu-Raddad, {Laith Jamal} and Abu-Rmeileh, {Niveen Me} and Abyu, {Gebre Y.} and Accrombessi, {Manfred Mario Kokou} and Dilaram Acharya and Pawan Acharya and Adamu, {Abdu A.} and Adebayo, {Oladimeji M.} and Adedeji, {Isaac Akinkunmi} and Adedoyin, {Rufus Adesoji} and Victor Adekanmbi and Adetokunboh, {Olatunji O.} and Adhena, {Beyene Meressa} and Adhikari, {Tara Ballav} and Adib, {Mina G.} and Adou, {Ars{\`e}ne Kouablan} and Adsuar, {Jose C.} and Mohsen Afarideh and Mahdi Afshari and Ashkan Afshin and Gina Agarwal and Aghayan, {Sargis Aghasi} and Dominic Agius and Anurag Agrawal and Sutapa Agrawal and Alireza Ahmadi and Mehdi Ahmadi and Hamid Ahmadieh and Ahmed, {Muktar Beshir} and Sayem Ahmed and Akalu, {Temesgen Yihunie} and Akanda, {Ali S.} and Akbari, {Mohammad Esmaeil} and Mohammed Akibu and Akinyemi, {Rufus Olusola} and Tomi Akinyemiju and Nadia Akseer and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Tahiya Alam and Ammar Albujeer and Animut Alebel and Alene, {Kefyalew Addis} and Ayman Al-Eyadhy and Samia Alhabib and Raghib Ali and Mehran Alijanzadeh and Reza Alizadeh-Navaei and Aljunid, {Syed Mohamed} and Ala'a Alkerwi and Fran{\cc}ois Alla and Peter Allebeck and Allen, {Christine A.} and Ali Almasi and Fatma Al-Maskari and Al-Mekhlafi, {Hesham M.} and Jordi Alonso and Al-Raddadi, {Rajaa M.} and Ubai Alsharif and Khalid Altirkawi and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Kebede Amenu and Erfan Amini and Walid Ammar and Anber, {Nahla Hamed} and Anderson, {Jason A.} and Andrei, {Catalina Liliana} and Sofia Androudi and Animut, {Megbaru Debalkie} and Mina Anjomshoa and Hossein Ansari and Ansariadi Ansariadi and Ansha, {Mustafa Geleto} and Antonio, {Carl Abelardo T.} and Palwasha Anwari and Appiah, {Lambert Tetteh} and Olatunde Aremu and Areri, {Habtamu Abera} and Johan {\"A}rnl{\"o}v and Monika Arora and Aryal, {Krishna K.} and Hamid Asayesh and Asfaw, {Ephrem Tsegay} and Asgedom, {Solomon Weldegebreal} and Asghar, {Rana Jawad} and Reza Assadi and Zerihun Ataro and Suleman Atique and Atre, {Sachin R.} and Atteraya, {Madhu Sudhan} and Marcel Ausloos and Leticia Avila-Burgos and Avokpaho, {Euripide F.G.A.} and Ashish Awasthi and {Ayala Quintanilla}, {Beatriz Paulina} and Ayele, {Henok Tadesse} and Yohanes Ayele and Rakesh Ayer and Azarpazhooh, {Mahmoud Reza} and Azzopardi, {Peter S.} and Natasha Azzopardi-Muscat and Babalola, {Tesleem Kayode} and Arefeh Babazadeh and Hamid Badali and Alaa Badawi and Kalpana Balakrishnan and Bali, {Ayele Geleto} and Maciej Banach and Amitava Banerjee and Banoub, {Joseph Adel Mattar} and Amrit Banstola and Aleksandra Barac and Barboza, {Miguel A.} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Barrero, {Lope H.} and Barthelemy, {Celine M.} and Quique Bassat and Arindam Basu and Sanjay Basu and Battista, {Robert J.} and Baune, {Bernhard T.} and Baynes, {Habtamu Wondifraw} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Ettore Beghi and Masoud Behzadifar and Meysam Behzadifar and Yannick B{\'e}jot and Bekele, {Bayu Begashaw} and Belachew, {Abate Bekele} and Belay, {Aregawi Gebreyesus} and Belay, {Saba Abraham} and Belay, {Yihalem Abebe} and Bell, {Michelle L.} and Bello, {Aminu K.} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Habib Benzian and Adugnaw Berhane and Berhe, {Abadi Kidanemariam} and Berman, {Adam E.} and Eduardo Bernabe and Bernstein, {Robert S.} and Bertolacci, {Gregory J.} and Mircea Beuran and Tina Beyranvand and Neeraj Bhala and Ashish Bhalla and Anil Bhansali and Suraj Bhattarai and Soumyadeep Bhaumik and Bhutta, {Zulfiqar A.} and Belete Biadgo and Biehl, {Molly H.} and Ali Bijani and Boris Bikbov and Nigus Bililign and {Bin Sayeed}, {Muhammad Shahdaat} and Birlik, {Sait Mentes} and Charles Birungi and Donal Bisanzio and Tuhin Biswas and Helen Bitew and Hailemichael Bizuneh and Espen Bjertness and Bobasa, {Eshetu Mulisa} and Soufiane Boufous and Rupert Bourne and Kayvan Bozorgmehr and Bragazzi, {Nicola Luigi} and Michael Brainin and Brant, {Luisa C.} and Michael Brauer and Alexandra Brazinova and Breitborde, {Nicholas J.K.} and Briant, {Paul Svitil} and Gabrielle Britton and Traolach Brugha and Gene Bukhman and Reinhard Busse and Butt, {Zahid A.} and Lucero Cahuana-Hurtado and Callender, {Charlton SKH} and Campos-Nonato, {Ismael R.} and {Campuzano Rincon}, {Julio Cesar} and Jorge Cano and Josip Car and Mate Car and Rosario C{\'a}rdenas and Carrero, {Juan J.} and Austin Carter and F{\'e}lix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and {Castillo Rivas}, Jacqueline and Franz Castro and Kate Causey and Alanur {\cC}avlin and Cercy, {Kelly M.} and Ester Cerin and Yazan Chaiah and Julian Chalek and Chang, {Hsing Yi} and Chang, {Jung Chen} and Aparajita Chattopadhyay and Chattu, {Vijay Kumar} and Pankaj Chaturvedi and Chiang, {Peggy Pei Chia} and Chin, {Ken Lee} and Chisumpa, {Vesper Hichilombwe} and Abdulaal Chitheer and Choi, {Jee Young J.} and Rajiv Chowdhury and Hanne Christensen and Christopher, {Devasahayam J.} and Chung, {Sheng Chia} and Cicuttini, {Flavia M.} and Ciobanu, {Liliana G.} and Massimo Cirillo and Claro, {Rafael M.} and Cla{\ss}en, {Thomas Khaled Dwayne} and {de Courten}, Barbora and Driscoll, {Tim Robert} and Richard Ofori-Asenso and Renzaho, {Andre M.N.} and Thrift, {Amanda G.} and Shanshan Li and {GBD 2017 SDG Collaborators}",
year = "2018",
month = "11",
day = "10",
doi = "10.1016/S0140-6736(18)32281-5",
language = "English",
volume = "392",
pages = "2091--2138",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier",
number = "10159",

}

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. / Li, Shanshan; GBD 2017 SDG Collaborators.

In: The Lancet, Vol. 392, No. 10159, 10.11.2018, p. 2091-2138.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories

T2 - a systematic analysis for the Global Burden of Disease Study 2017

AU - Lozano, Rafael

AU - Fullman, Nancy

AU - Abate, Degu

AU - Abay, Solomon M.

AU - Abbafati, Cristiana

AU - Abbasi, Nooshin

AU - Abbastabar, Hedayat

AU - Abd-Allah, Foad

AU - Abdela, Jemal

AU - Abdelalim, Ahmed

AU - Abdel-Rahman, Omar

AU - Abdi, Alireza

AU - Abdollahpour, Ibrahim

AU - Abdulkader, Rizwan Suliankatchi

AU - Abebe, Nebiyu Dereje

AU - Abebe, Zegeye

AU - Abejie, Ayenew Negesse

AU - Abera, Semaw F.

AU - Abil, Olifan Zewdie

AU - Aboyans, Victor

AU - Abraha, Haftom Niguse

AU - Abrham, Aklilu Roba

AU - Abu-Raddad, Laith Jamal

AU - Abu-Rmeileh, Niveen Me

AU - Abyu, Gebre Y.

AU - Accrombessi, Manfred Mario Kokou

AU - Acharya, Dilaram

AU - Acharya, Pawan

AU - Adamu, Abdu A.

AU - Adebayo, Oladimeji M.

AU - Adedeji, Isaac Akinkunmi

AU - Adedoyin, Rufus Adesoji

AU - Adekanmbi, Victor

AU - Adetokunboh, Olatunji O.

AU - Adhena, Beyene Meressa

AU - Adhikari, Tara Ballav

AU - Adib, Mina G.

AU - Adou, Arsène Kouablan

AU - Adsuar, Jose C.

AU - Afarideh, Mohsen

AU - Afshari, Mahdi

AU - Afshin, Ashkan

AU - Agarwal, Gina

AU - Aghayan, Sargis Aghasi

AU - Agius, Dominic

AU - Agrawal, Anurag

AU - Agrawal, Sutapa

AU - Ahmadi, Alireza

AU - Ahmadi, Mehdi

AU - Ahmadieh, Hamid

AU - Ahmed, Muktar Beshir

AU - Ahmed, Sayem

AU - Akalu, Temesgen Yihunie

AU - Akanda, Ali S.

AU - Akbari, Mohammad Esmaeil

AU - Akibu, Mohammed

AU - Akinyemi, Rufus Olusola

AU - Akinyemiju, Tomi

AU - Akseer, Nadia

AU - Alahdab, Fares

AU - Al-Aly, Ziyad

AU - Alam, Khurshid

AU - Alam, Tahiya

AU - Albujeer, Ammar

AU - Alebel, Animut

AU - Alene, Kefyalew Addis

AU - Al-Eyadhy, Ayman

AU - Alhabib, Samia

AU - Ali, Raghib

AU - Alijanzadeh, Mehran

AU - Alizadeh-Navaei, Reza

AU - Aljunid, Syed Mohamed

AU - Alkerwi, Ala'a

AU - Alla, François

AU - Allebeck, Peter

AU - Allen, Christine A.

AU - Almasi, Ali

AU - Al-Maskari, Fatma

AU - Al-Mekhlafi, Hesham M.

AU - Alonso, Jordi

AU - Al-Raddadi, Rajaa M.

AU - Alsharif, Ubai

AU - Altirkawi, Khalid

AU - Alvis-Guzman, Nelson

AU - Amare, Azmeraw T.

AU - Amenu, Kebede

AU - Amini, Erfan

AU - Ammar, Walid

AU - Anber, Nahla Hamed

AU - Anderson, Jason A.

AU - Andrei, Catalina Liliana

AU - Androudi, Sofia

AU - Animut, Megbaru Debalkie

AU - Anjomshoa, Mina

AU - Ansari, Hossein

AU - Ansariadi, Ansariadi

AU - Ansha, Mustafa Geleto

AU - Antonio, Carl Abelardo T.

AU - Anwari, Palwasha

AU - Appiah, Lambert Tetteh

AU - Aremu, Olatunde

AU - Areri, Habtamu Abera

AU - Ärnlöv, Johan

AU - Arora, Monika

AU - Aryal, Krishna K.

AU - Asayesh, Hamid

AU - Asfaw, Ephrem Tsegay

AU - Asgedom, Solomon Weldegebreal

AU - Asghar, Rana Jawad

AU - Assadi, Reza

AU - Ataro, Zerihun

AU - Atique, Suleman

AU - Atre, Sachin R.

AU - Atteraya, Madhu Sudhan

AU - Ausloos, Marcel

AU - Avila-Burgos, Leticia

AU - Avokpaho, Euripide F.G.A.

AU - Awasthi, Ashish

AU - Ayala Quintanilla, Beatriz Paulina

AU - Ayele, Henok Tadesse

AU - Ayele, Yohanes

AU - Ayer, Rakesh

AU - Azarpazhooh, Mahmoud Reza

AU - Azzopardi, Peter S.

AU - Azzopardi-Muscat, Natasha

AU - Babalola, Tesleem Kayode

AU - Babazadeh, Arefeh

AU - Badali, Hamid

AU - Badawi, Alaa

AU - Balakrishnan, Kalpana

AU - Bali, Ayele Geleto

AU - Banach, Maciej

AU - Banerjee, Amitava

AU - Banoub, Joseph Adel Mattar

AU - Banstola, Amrit

AU - Barac, Aleksandra

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Barrero, Lope H.

AU - Barthelemy, Celine M.

AU - Bassat, Quique

AU - Basu, Arindam

AU - Basu, Sanjay

AU - Battista, Robert J.

AU - Baune, Bernhard T.

AU - Baynes, Habtamu Wondifraw

AU - Bazargan-Hejazi, Shahrzad

AU - Bedi, Neeraj

AU - Beghi, Ettore

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Béjot, Yannick

AU - Bekele, Bayu Begashaw

AU - Belachew, Abate Bekele

AU - Belay, Aregawi Gebreyesus

AU - Belay, Saba Abraham

AU - Belay, Yihalem Abebe

AU - Bell, Michelle L.

AU - Bello, Aminu K.

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Benzian, Habib

AU - Berhane, Adugnaw

AU - Berhe, Abadi Kidanemariam

AU - Berman, Adam E.

AU - Bernabe, Eduardo

AU - Bernstein, Robert S.

AU - Bertolacci, Gregory J.

AU - Beuran, Mircea

AU - Beyranvand, Tina

AU - Bhala, Neeraj

AU - Bhalla, Ashish

AU - Bhansali, Anil

AU - Bhattarai, Suraj

AU - Bhaumik, Soumyadeep

AU - Bhutta, Zulfiqar A.

AU - Biadgo, Belete

AU - Biehl, Molly H.

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Bililign, Nigus

AU - Bin Sayeed, Muhammad Shahdaat

AU - Birlik, Sait Mentes

AU - Birungi, Charles

AU - Bisanzio, Donal

AU - Biswas, Tuhin

AU - Bitew, Helen

AU - Bizuneh, Hailemichael

AU - Bjertness, Espen

AU - Bobasa, Eshetu Mulisa

AU - Boufous, Soufiane

AU - Bourne, Rupert

AU - Bozorgmehr, Kayvan

AU - Bragazzi, Nicola Luigi

AU - Brainin, Michael

AU - Brant, Luisa C.

AU - Brauer, Michael

AU - Brazinova, Alexandra

AU - Breitborde, Nicholas J.K.

AU - Briant, Paul Svitil

AU - Britton, Gabrielle

AU - Brugha, Traolach

AU - Bukhman, Gene

AU - Busse, Reinhard

AU - Butt, Zahid A.

AU - Cahuana-Hurtado, Lucero

AU - Callender, Charlton SKH

AU - Campos-Nonato, Ismael R.

AU - Campuzano Rincon, Julio Cesar

AU - Cano, Jorge

AU - Car, Josip

AU - Car, Mate

AU - Cárdenas, Rosario

AU - Carrero, Juan J.

AU - Carter, Austin

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Castillo Rivas, Jacqueline

AU - Castro, Franz

AU - Causey, Kate

AU - Çavlin, Alanur

AU - Cercy, Kelly M.

AU - Cerin, Ester

AU - Chaiah, Yazan

AU - Chalek, Julian

AU - Chang, Hsing Yi

AU - Chang, Jung Chen

AU - Chattopadhyay, Aparajita

AU - Chattu, Vijay Kumar

AU - Chaturvedi, Pankaj

AU - Chiang, Peggy Pei Chia

AU - Chin, Ken Lee

AU - Chisumpa, Vesper Hichilombwe

AU - Chitheer, Abdulaal

AU - Choi, Jee Young J.

AU - Chowdhury, Rajiv

AU - Christensen, Hanne

AU - Christopher, Devasahayam J.

AU - Chung, Sheng Chia

AU - Cicuttini, Flavia M.

AU - Ciobanu, Liliana G.

AU - Cirillo, Massimo

AU - Claro, Rafael M.

AU - Claßen, Thomas Khaled Dwayne

AU - de Courten, Barbora

AU - Driscoll, Tim Robert

AU - Ofori-Asenso, Richard

AU - Renzaho, Andre M.N.

AU - Thrift, Amanda G.

AU - Li, Shanshan

AU - GBD 2017 SDG Collaborators

PY - 2018/11/10

Y1 - 2018/11/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85056168651&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(18)32281-5

DO - 10.1016/S0140-6736(18)32281-5

M3 - Article

VL - 392

SP - 2091

EP - 2138

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10159

ER -