2018
THE LANCET

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

01 Pubblicazione su rivista
Lozano Rafael, Fullman Nancy, Abate Degu, Abay Solomon M, Abbafati Cristiana, Abbasi Nooshin, Abbastabar Hedayat, Abd-Allah Foad, Abdela Jemal, Abdelalim Ahmed, Abdel-Rahman Omar, Abdi Alireza, Abdollahpour Ibrahim, Abdulkader Rizwan Suliankatchi, Abebe Nebiyu Dereje, Abebe Zegeye, Abejie Ayenew Negesse, Abera Semaw F, Abil Olifan Zewdie, Aboyans Victor, Abraha Haftom Niguse, Abrham Aklilu Roba, Abu-Raddad Laith Jamal, Abu-Rmeileh Niveen Me, Abyu Gebre Y, Accrombessi Manfred Mario Kokou, Acharya Dilaram, Acharya Pawan, Adamu Abdu A, Adebayo Oladimeji M, Adedeji Isaac Akinkunmi, Adedoyin Rufus Adesoji, Adekanmbi Victor, Adetokunboh Olatunji O, Adhena Beyene Meressa, Adhikari Tara Ballav, Adib Mina G, Adou Arsène Kouablan, Adsuar Jose C, Afarideh Mohsen, Afshari Mahdi, Afshin Ashkan, Agarwal Gina, Aghayan Sargis Aghasi, Agius Dominic, Agrawal Anurag, Agrawal Sutapa, Ahmadi Alireza, Ahmadi Mehdi, Ahmadieh Hamid, Ahmed Muktar Beshir, Ahmed Sayem, Akalu Temesgen Yihunie, Akanda Ali S, Akbari Mohammad Esmaeil, Akibu Mohammed, Akinyemi Rufus Olusola, Akinyemiju Tomi, Akseer Nadia, Alahdab Fares, Al-Aly Ziyad, Alam Khurshid, Alam Tahiya, Albujeer Ammar, Alebel Animut, Alene Kefyalew Addis, Al-Eyadhy Ayman, Alhabib Samia, Ali Raghib, Alijanzadeh Mehran, Alizadeh-Navaei Reza, Aljunid Syed Mohamed, Alkerwi Ala'A, Alla François, Allebeck Peter, Allen Christine A, Almasi Ali, Al-Maskari Fatma, Al-Mekhlafi Hesham M, Alonso Jordi, Al-Raddadi Rajaa M, Alsharif Ubai, Altirkawi Khalid, Alvis-Guzman Nelson, Amare Azmeraw T, Amenu Kebede, Amini Erfan, Ammar Walid, Anber Nahla Hamed, Anderson Jason A, Andrei Catalina Liliana, Androudi Sofia, Animut Megbaru Debalkie, Anjomshoa Mina, Ansari Hossein, Ansariadi Ansariadi, Ansha Mustafa Geleto, Antonio Carl Abelardo T, Anwari Palwasha, Appiah Lambert Tetteh, Aremu Olatunde, Areri Habtamu Abera, Ärnlöv Johan, Arora Monika, Aryal Krishna K, Asayesh Hamid, Asfaw Ephrem Tsegay, Asgedom Solomon Weldegebreal, Asghar Rana Jawad, Assadi Reza, Ataro Zerihun, Atique Suleman, Atre Sachin R, Atteraya Madhu Sudhan, Ausloos Marcel, Avila-Burgos Leticia, Avokpaho Euripide F G A, Awasthi Ashish, Ayala Quintanilla Beatriz Paulina, Ayele Henok Tadesse, Ayele Yohanes, Ayer Rakesh, Azarpazhooh Mahmoud Reza, Azzopardi Peter S, Azzopardi-Muscat Natasha, Babalola Tesleem Kayode, Babazadeh Arefeh, Badali Hamid, Badawi Alaa, Balakrishnan Kalpana, Bali Ayele Geleto, Banach Maciej, Banerjee Amitava, Banoub Joseph Adel Mattar, Banstola Amrit, Barac Aleksandra, Barboza Miguel A, Barker-Collo Suzanne Lyn, Bärnighausen Till Winfried, Barrero Lope H, Barthelemy Celine M, Bassat Quique, Basu Arindam, Basu Sanjay, Battista Robert J, Baune Bernhard T, Baynes Habtamu Wondifraw, Bazargan-Hejazi Shahrzad, Bedi Neeraj, Beghi Ettore, Behzadifar Masoud, Behzadifar Meysam, Béjot Yannick, Bekele Bayu Begashaw, Belachew Abate Bekele, Belay Aregawi Gebreyesus, Belay Saba Abraham, Belay Yihalem Abebe, Bell Michelle L, Bello Aminu K, Bennett Derrick A, Bensenor Isabela M, Benzian Habib, Berhane Adugnaw, Berhe Abadi Kidanemariam, Berman Adam E, Bernabe Eduardo, Bernstein Robert S, Bertolacci Gregory J, Beuran Mircea, Beyranvand Tina, Bhala Neeraj, Bhalla Ashish, Bhansali Anil, Bhattarai Suraj, Bhaumik Soumyadeep, Bhutta Zulfiqar A, Biadgo Belete, Biehl Molly H, Bijani Ali, Bikbov Boris, Bililign Nigus, Bin Sayeed Muhammad Shahdaat, Birlik Sait Mentes, Birungi Charles, Bisanzio Donal, Biswas Tuhin, Bitew Helen, Bizuneh Hailemichael, Bjertness Espen, Bobasa Eshetu Mulisa, Boufous Soufiane, Bourne Rupert, Bozorgmehr Kayvan, Bragazzi Nicola Luigi, Brainin Michael, Brant Luisa C, Brauer Michael, Brazinova Alexandra, Breitborde Nicholas J K, Briant Paul Svitil, Britton Gabrielle, Brugha Traolach, Bukhman G
ISSN: 0140-6736

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,

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