Global study assesses countries on health-related Sustainable Development Goals

Worldwide, good progress has been made towards some of the health-related Sustainable Development Goals (SDGs) since 2000, particularly in reducing under-5 and neonatal mortality, family planning, and the rollout of universal health care. However, in areas beyond the Millennium Development Goals (MDGs) which came to an end in 2015, few inroads have been made. For example, there have been only minimal improvements in hepatitis B incidence rates, while childhood overweight, intimate partner violence, and harmful alcohol consumption have worsened.

The new estimates, published in The Lancet, mark the end of the MDG era and provide the first independent analysis of performance on health-related SDGs. The aim is to provide a tool for global accountability on progress towards the 2030 SDG targets, and equip governments, policy-makers, aid organisations, and health professionals with evidence to identify successes, gaps and priorities in health care delivery.

The study is the first annual assessment of SDG health performance and will be launched at a special event at the UN General Assembly in New York on Wednesday 21st September.

The SDGs are 17 universal goals, 169 targets, and 230 indicators set by the United Nations in 2015 to guide a range of pressing problems including food and water security, poverty, and climate change up to 2030. The SDGs follow and expand on the MDGs, which expired at the end of 2015. Health is at the core of the SDGs—the third SDG aims to “ensure healthy lives and promote wellbeing for all at all ages”, and health-related indicators are also present among 11 of the other 16 goals.

Using data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study between 1990 and 2015, Professor Stephen Lim from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, USA and colleagues estimated the current status of 33 of the 47 health-related SDG-indicators. To enable easier comparison, they created a health-related SDG index (with a rating of 0-100) that combines these 33 health-related indicators to measure progress for 188 countries between 1990 and 2015.

In 2015, the health-related SDG index was highest in Iceland, Singapore, and Sweden, with the UK ranking in 5^th place just ahead of Finland. The Central African Republic, Somalia, and South Sudan had the lowest values of the health-related SDG index. Despite rapid economic growth, India was ranked 143rd, below Comoros, and Ghana.

The USA ranked 28^th in the world. This relatively poor performance was mainly driven by deaths due to interpersonal violence, HIV, harmful alcohol consumption, childhood overweight, and suicide. The USA also did badly compared to other high-income countries on maternal, child, and neonatal mortality reflecting the large differences in access and quality of healthcare in the USA.

“With more than 1870 individual collaborators in 124 countries and three territories, our independent analysis identifies high- and low-performing countries to help guide national policies and donor investments, and provides a strong basis for monitoring progress towards the health-related SDGs for 188 countries over the next 15 years”, says Professor Lim.

Despite creating a single measure of health (the SDG-index), the authors note that the findings are based on available data, estimates, and modelling, and call for more investment in high-quality data collection systems including censuses and vital registration and health management information systems, to ensure progress towards the SDGs can be properly monitored.

“This paper on the SDGs represents a baseline that informs health policy and decision-makers in all countries—as well as the United Nations,” says IHME Director Dr Christopher Murray. “It is essential that each year, over the next 15 years, nations be held accountable for the goals their leaders have committed to meet. This report contributes an important element to that accountability.”

Number of countries already meeting health-related SDG targets in 2015

Progress varied widely depending on the indicators. For instance, over 60% of countries have already met the 2030 targets on reducing maternal (less than 70 deaths per 100000 live births) and child mortality (25 deaths per 1000 live births). No countries have met any of the nine targets on the full elimination of diseases like tuberculosis and HIV, or reducing prevalence of health outcomes like childhood overweight and intimate partner violence to 0%.

The authors warn that given the modest progress in HIV and tuberculosis over the last 25 years, the vision of ending these epidemics in the next 15 years is highly unrealistic. They write, “A substantial change in the current trajectory of HIV and tuberculosis incidence will be needed—likely requiring major technological leaps coupled with universal delivery—to meet this target.”

Additionally, less than a fifth of countries have met the 2030 target to eliminate stunting and wasting in children under 5, whilst only around a quarter of countries have achieved the target to substantially reduce exposure to household air pollution, and less than a fifth of countries have achieved universal access to safe and affordable water and sanitation.

Expected vs observed progress on health related SDGs

The researchers created the Socio Demographic Index (SDI) as a measure of development in order to differentiate progress made on the SDG index from progress that countries would have been otherwise expected to make as they develop. The SDI is based on income per capita, educational attainment and total fertility rate – key indices of a country’s development status.

A number of regions recorded greater than expected improvement in the health-related SDG index between 2000 and 2015, including Timor-Leste, Tajikistan, Columbia, Taiwan, and Iceland,

The authors point to a range of policies and interventions that may have been a factor in the progress of these countries. In Timor Leste, for example, access to health services for the poor was improved and under 5 and neonatal death rates, childhood stunting, and exposure to unsafe water and sanitation was dramatically reduced likely thanks to heavy government investment in health care reform; while Iceland’s comprehensive tobacco control policies and long-standing publicly funded health system may have contributed to the large falls in non-communicable disease death rates and smoking prevalence.

At the other end of the spectrum, five countries performed much worse than expected, including Libya and Syria, mainly as a result of war and violence.

While the SDI was highly predictive of the overall health-related SDG index, it did not impact on some key indicators such as interpersonal violence, self-harm, particulate matter pollution, and childhood obesity. The authors therefore conclude that prioritising increases in personal income, investing in education and family planning alone will not be sufficient to meet the ambitious SDG targets for 2030.

According to Professor Lim:

Our study is a starting point for further investigation on how and why countries are under performing or performing well compared to the average. This will be an annual effort to ensure progress is maintained and that lessons from successes are learned and rapidly transferred to other countries where progress is less impressive.

Writing in a linked Comment, Devi Sridhar, Professor of Global Health at the University of Edinburgh, Edinburgh, UK discusses whether the SDG index is relevant and useful to donors, academics, governments in middle- and low-income countries, and poor communities. She concludes:

The SDGs, and the assessment of their progress in health, are incredibly complex even for the most astute development and health experts. But whether we like it or not, the SDGs have been agreed on. The best we can do is to acknowledge (as the GBD 2015 SDG Collaborators do in their conclusion) that they are mostly vague, largely immeasurable, somewhat attainable, and definitely relevant, and then put together the smartest minds and resources to communicate their importance through one index.

Source: http://www.thelancet.com/