| dc.description.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 healthrelated
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. | en_US |
