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Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

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Lim, Stephen S, Allen, Kate, Bhutta, Zulfiqar A, Dandona, Lalit, Forouzanfar, Mohammad H, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Hay, Simon I, Holmberg, Mollie, Kinfu, Yohannes, Kutz, Michael J, Larson, Heidi J, Liang, Xiaofeng, Lopez, Alan D, Lozano, Rafael, McNellan, Claire R, Mokdad, Ali H, Mooney, Meghan D, Naghavi, Mohsen, Olsen, Helen E, Pigott, David M, Salomon, Joshua A, Vos, Theo, Wang, Haidong, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Kedir Yimam, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Uzma, Alasfoor, Deena, 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Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Volkow, Patricia, Vollset, Stein Emil, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Wanga, Valentine, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Wiysonge, Charles Shey, Wolfe, Charles D A, Wolfe, Ingrid, Won, Sungho, Woolf, Anthony D, Workie, Shimelash Bitew, Wubshet, Mamo, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zambrana-Torrelio, Carlos, Zapata, Tomas, Zegeye, Elias Asfaw, Zhao, Yi, Zhou, Maigeng, Zodpey, Sanjay, Zonies, David, Murray, Christopher J L·2016·The Lancet
DOI 10.1016/s0140-6736(16)31467-2PMC PMC5055583
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Abstract

BACKGROUND: In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). METHODS: We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. FINDINGS: =0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. INTERPRETATION: GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. FUNDING: Bill & Melinda Gates Foundation.

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Figures

Figure 1 Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.
Figure 1 Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.CC BY · PubMed Central
Figure 2 Map of health-related SDG index, by quintile, 2015 SDG=Sustainable Development Goal. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.
Figure 2 Map of health-related SDG index, by quintile, 2015 SDG=Sustainable Development Goal. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.CC BY · PubMed Central
Figure 3 Non-MDG index versus MDG index, by country, 2015 The dark blue line shows the equivalence line, such that values that fall on this line are equivalent for both the MDG index and non-MDG index. Countries are abbreviated according to the ISO3 code. MDG=Millennium Development Goal. SDI=Socio-demographic Index.
Figure 3 Non-MDG index versus MDG index, by country, 2015 The dark blue line shows the equivalence line, such that values that fall on this line are equivalent for both the MDG index and non-MDG index. Countries are abbreviated according to the ISO3 code. MDG=Millennium Development Goal. SDI=Socio-demographic Index.CC BY · PubMed Central
Figure 4 Relations (A) between the SDI and the health-related SDG index, (B) between the SDI and the MDG index, (C) between the SDI and the non-MDG index, and (D) between healthy life expectancy and the health-related SDG index, by country representing each of the seven GBD super regions, 2015 Each point represents a country and is colour coded according to the seven GBD super regions. The black lines were generated by spline regression. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. MDG=Millennium Development Goal. GBD=Global Burden of Disease.
Figure 4 Relations (A) between the SDI and the health-related SDG index, (B) between the SDI and the MDG index, (C) between the SDI and the non-MDG index, and (D) between healthy life expectancy and the health-related SDG index, by country representing each of the seven GBD super regions, 2015 Each point represents a country and is colour coded according to the seven GBD super regions. The black lines were generated by spline regression. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. MDG=Millennium Development Goal. GBD=Global Burden of Disease.CC BY · PubMed Central
Figure 5 Map of observed health-related SDG index minus expected health-related SDG index, on the basis of SDI alone, 2015 The difference between the observed health-related SDG index and expected index (on the basis of SDI) reflects whether a country has a health-related SDG index above or below the expected level. Values for this difference are colour coded such that dark red reflects an observed health-related SDG index that is much lower than expected on the basis of SDI, and dark blue indicates that observed levels are much higher than expected on the basis of SDI. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.
Figure 5 Map of observed health-related SDG index minus expected health-related SDG index, on the basis of SDI alone, 2015 The difference between the observed health-related SDG index and expected index (on the basis of SDI) reflects whether a country has a health-related SDG index above or below the expected level. Values for this difference are colour coded such that dark red reflects an observed health-related SDG index that is much lower than expected on the basis of SDI, and dark blue indicates that observed levels are much higher than expected on the basis of SDI. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.CC BY · PubMed Central
Figure 6 Median absolute change for health-related SDG index, MDG index, and 33 individual health-related SDG indicators (rescaled), (A) across all countries and in the (B) low-SDI quintile, (C) low-middle-SDI quintile, (D) middle-SDI quintile, (E) high-middle-SDI quintile, and (F) high-SDI quintile, 2000–15 Positive values indicate improvements between 2000–15, and negative values point to worsening performance for a given indicator during this time. Black stripes represent median absolute change and boxes represent IQR. Health-related indicators are colour coded according to the health-related goals they represent. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. SDI=Socio-demographic Index. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.
Figure 6 Median absolute change for health-related SDG index, MDG index, and 33 individual health-related SDG indicators (rescaled), (A) across all countries and in the (B) low-SDI quintile, (C) low-middle-SDI quintile, (D) middle-SDI quintile, (E) high-middle-SDI quintile, and (F) high-SDI quintile, 2000–15 Positive values indicate improvements between 2000–15, and negative values point to worsening performance for a given indicator during this time. Black stripes represent median absolute change and boxes represent IQR. Health-related indicators are colour coded according to the health-related goals they represent. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. SDI=Socio-demographic Index. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.CC BY · PubMed Central
Figure 7 Health-related SDG index in 2015 versus 2000, by country The blue line shows the equivalence line, such that values that fall on this line are equivalent for both the health-related SDG index in 2000 and health-related SDG index in 2015. Only the top five and bottom five improvers in each SDI quintile, as determined by the absolute change from 2000 to 2015, are labelled; full results are shown in the results appendix. Countries are abbreviated according to the ISO3 code. SDI=Socio-demographic Index. SDG=Sustainable Development Goal.
Figure 7 Health-related SDG index in 2015 versus 2000, by country The blue line shows the equivalence line, such that values that fall on this line are equivalent for both the health-related SDG index in 2000 and health-related SDG index in 2015. Only the top five and bottom five improvers in each SDI quintile, as determined by the absolute change from 2000 to 2015, are labelled; full results are shown in the results appendix. Countries are abbreviated according to the ISO3 code. SDI=Socio-demographic Index. SDG=Sustainable Development Goal.CC BY · PubMed Central

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  1. Hickel, 2015, The problem with saving the world, Jacobin (New York)
  2. 2015, The 169 commandments, The Economist (New York)
  3. 2015, Unsustainable goals, The Economist (New York)
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Lim, S. S., Allen, K., Bhutta, Z. A., Dandona, L., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Hay, S. I., Holmberg, M., Kinfu, Y., Kutz, M. J., Larson, H. J., Liang, X., Lopez, A. D., Lozano, R., McNellan, C. R., Mokdad, A. H., Mooney, M. D., Naghavi, M., Olsen, H. E., Pigott, D. M., Salomon, J. A., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M. E., Abyu, G. Y., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Afanvi, K. A., Afshin, A., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ahmadieh, H., Ahmed, K. Y., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, U., Alasfoor, D., AlBuhairan, F. S., Aldhahri, S. F., Aldridge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alkhateeb, M. A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Anderson, G. M., Antonio, C. A. T., Anwari, P., Ärnlöv, J., Artaman, A., Asayesh, H., Asghar, R. J., Atique, S., Avokpaho, E. F. G. A., Awasthi, A., Quintanilla, B. P. A., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barber, R., Barker-Collo, S. L., Bärnighausen, T., Barrero, L. H., Barrientos-Gutierrez, T., Basu, S., Bayou, T. A., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Béjot, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabé, E., Bernal, O. A., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhoff, K. A., Bikbov, B., Binagwaho, A., Bisanzio, D., Bjertness, E., Blore, J., Bourne, R. R. A., Brainin, M., Brauer, M., Brazinova, A., Breitborde, N. J. K., Broday, D. M., Brugha, T. S., Buchbinder, R., Butt, Z. A., Cahill, L. E., Campos-Nonato, I. R., Campuzano, J. 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University of Washington (US)
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Venue
The Lancet
Publisher
Elsevier BV
Published
2016-10
Volume
388
Issue
10053
Pages
1813-1850
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(16)31467-2
PMC
PMC5055583
OpenAlex
W2508424442
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en
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  • Sun Yat-sen University
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  • Seoul National University
  • Soonchunhyang University
  • Yonsei University
  • Kyung Hee University
  • Korea University
  • Banaras Hindu University
  • Universidad Nacional de Colombia
  • Central South University
  • Dalhousie University
  • Department for International Development
  • Universitat de València
  • Korea Health Industry Development Institute
  • Hospital de Clínicas de Porto Alegre
  • Ministry of Health and Medical Education
  • Jordan University of Science and Technology
  • Universidad Autónoma Metropolitana
  • Universiteit Gent
  • Universiteit Stellenbosch
  • Tehran University of Medical Sciences and Health Services
  • Universidad Autónoma de Madrid
  • Inyuvesi Yakwazulu-Natali
  • National Health Research Institutes
  • Haramaya University
  • Universidade Federal do Rio Grande do Sul
  • Sichuan University
  • Shanghai Jiao Tong University
  • Universitetet i Bergen
  • Universitair Medisch Centrum Groningen
  • North-West University
  • Universidad de Costa Rica
  • Hacettepe Üniversitesi
  • National Yang-Ming University
  • University of Haifa
  • Universität Bielefeld
  • Göteborgs Universitet
  • Universitat de Barcelona
  • Baqiyatallah University of Medical Sciences
  • Shahid Beheshti University of Medical Sciences
  • United Arab Emirates University
  • Universidad de la República Uruguay
  • National Taiwan University
  • Centro de Investigación Biomédica en Red de Salud Mental
  • Universidade do Porto
  • Università degli Studi di Salerno
  • Universidade Federal de Santa Catarina
  • University of Cape Town
  • Arak University of Medical Sciences
  • Universidade Federal de Minas Gerais
  • University of Gondar
  • Addis Ababa University
  • Golestan University of Medical Sciences
  • University of Peradeniya
  • Universität Ulm
  • International Centre for Diarrhoeal Disease Research, Bangladesh
  • International Medical University
  • Fakultet Medicinskih Nauka, Univerziteta U Kragujevcu
  • Università degli Studi di Perugia
  • Alborz University of Medical Sciences
  • Háskólinn í Reykjavík
  • INCLIVA Instituto de Investigación Sanitaria
  • Universidade Federal de Sergipe
  • Homi Bhabha National Institute
  • Ministry of Health of the Russian Federation
  • Western Sydney University
  • Rede de Química e Tecnologia
  • Laboratório Associado para a Química Verde
  • Indian Institute of Technology Ropar
  • Alfaisal University
  • Children's Hospital of Michigan
  • George Institute for Global Health
  • Muhimbili University of Health and Allied Sciences
  • Aswan University
  • University of Health and Allied Sciences
  • Robert Koch Institut
  • National Institutes of Health
  • University of North Carolina at Chapel Hill
  • University of California, San Diego
  • University of Oklahoma Health Sciences Center
  • Perelman School of Medicine, University of Pennsylvania
  • Feinberg School of Medicine
  • Johns Hopkins Bloomberg School of Public Health
  • Medical Center, University of Rochester
  • Research Institute, Nationwide Children's Hospital
  • School of Public Health and Family Medicine, University of Cape Town
  • Medical Research Council (MR/K010174/1, MR/K00669X/1, MC_UU_12011/1)
  • Russian Academy of Sciences
  • Wageningen University and Research
  • Bhabha Atomic Research Centre
  • National Drug and Alcohol Research Centre
  • School of Medicine, Shanghai Jiao Tong University
  • Erasmus Universitair Medisch Centrum Rotterdam
  • Norwegian Institute of Public Health
  • National Institute on Aging (R03AG043052, R21AG032572, R01AG030153)
  • National Human Genome Research Institute (U54HG007479)
  • National Cancer Institute
  • National Institute of Environmental Health Sciences (P30ES000260)
  • National Institute on Minority Health and Health Disparities
  • Mailman School of Public Health, Columbia University
  • Sandia National Laboratories
Topics
  • Social Sciences › Sociology and Political Science › Human Rights and Development
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords
Sustainable Development Goals, Millennium Development Goals, socio-demographic index, modern contraceptive methods, under-five mortality, neonatal mortality, HIV incidence, tuberculosis incidence, hepatitis B incidence, childhood overweight, universal health coverage, health equity, SDG Index
MeSH terms
Conservation of Natural Resources, Goals, Disabled Persons, Persons with Disabilities, Health Status, Health Status Indicators, Humans, Insurance, Health, Risk Factors, Global Health, Cost of Illness, Quality-Adjusted Life Years, Universal Health Insurance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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