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Abstract

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

In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8–61.8) and varied widely by country, ranging from 85.5 (84.2–86.5) in Iceland to 20.4 (15.4–24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r²=0.88) and the MDG index (r²=0.92), whereas the non-MDG index had a weaker relation with SDI (r²=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 toward the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasizes 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.

Citation: 

Lim SS, Allen K, Bhutta ZA, Dandona L, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Hay SI, Holmberg M, Kinfu Y, Kutz MJ, Larson HJ, Liang X, Lopez AD, Lozano R, McNellan CR, Mokdad AH, Mooney MD, Naghavi M, Olsen HE, Pigott DM, Salomon JA, Vos T, Wang H, Abajobir AA*, Abate KH*, Abbafati C*, Abbas KM*, Abd-Allah F*, Abdulle AM*, Abraham B*, Abubakar I*, Abu-Raddad LJ*, Abu-Rmeileh NME*, Abyu GY*, Achoki T*, Adebiyi AO*, Adedeji IA*, Afanvi KA*, Afshin A*, Agarwal A*, Agrawal A*, Ahmad Kiadaliri A*, Ahmadieh H*, Ahmed KY*, Akanda AS*, Akinyemi RO*, Akinyemiju TF*, Akseer N*, Al-Aly Z*, Alam K*, Alam U*, Alasfoor D*, AlBuhairan FS*, Aldhahri SF*, Aldridge RW*, Alemu ZA*, Ali R*, Alkerwi A*, Alkhateeb MAB*, Alla F*, Allebeck P*, Allen C*, Al-Raddadi R*, Altirkawi KA*, Alvarez Martin E*, Alvis-Guzman N*, Amare AT*, Amberbir A*, Amegah AK*, Amini H*, Ammar W*, Amrock SM*, Andersen HH*, Anderson BO*, Anderson GM*, Antonio CAT*, Anwari P*, Ärnlöv J*, Artaman A*, Asayesh H*, Asghar RJ*, Atique S*, Avokpaho EFGA*, Awasthi A*, Ayala Quintanilla BP*, Azzopardi P*, Bacha U*, Badawi A*, Balakrishnan K*, Banerjee A*, Barac A*, Barber R*, Barker-Collo SL*, Bärnighausen T*, Barrero LH*, Barrientos-Gutierrez T*, Basu S*, Bayou TA*, Bazargan-Hejazi S*, Beardsley J*, Bedi N*, Beghi E*, Béjot Y*, Bell ML*, Bello AK*, Bennett DA*, Bensenor IM*, Benzian H*, Berhane A*, Bernabé E*, Bernal OA*, Betsu BD*, Beyene AS*, Bhala N*, Bhatt S*, Biadgilign S*, Bienhoff KA*, Bikbov B*, Binagwaho A*, Bisanzio D*, Bjertness E*, Blore J*, Bourne RRA*, Brainin M*, Brauer M*, Brazinova A*, Breitborde NJK*, Broday DM*, Brugha TS*, Buchbinder R*, Butt ZA*, Cahill LE*, Campos-Nonato IR*, Campuzano JC*, Carabin H*, Cárdenas R*, Carrero JJ*, Carter A*, Casey D*, Caso V*, Castañeda-Orjuela CA*, Castillo Rivas J*, Catalá-López F*, Cavalleri F*, Cecílio P*, Chang H*, Chang J*, Charlson FJ*, Che X*, Chen AZ*, Chiang PP*, Chibalabala M*, Chisumpa VH*, Jasmine Choi JJ*, Chowdhury R*, Christensen H*, Ciobanu LG*, Cirillo M*, Coates MM*, Coggeshall M*, Cohen AJ*, Cooke GS*, Cooper C*, Cooper LT*, Cowie BC*, Crump JA*, Damtew SA*, Dandona R*, Dargan PI*, das Neves J*, Davis AC*, Davletov K*, de Castro EF*, De Leo D*, Degenhardt L*, Del Gobbo LC*, Deribe K*, Derrett S*, Des Jarlais DC*, Deshpande A*, deVeber GA*, Dey S*, Dharmaratne SD*, Dhillon PK*, Ding EL*, Dorsey ER*, Doyle KE*, Driscoll TR*, Duan L*, Dubey M*, Duncan BB*, Ebrahimi H*, Endries AY*, Ermakov SP*, Erskine HE*, Eshrati B*, Esteghamati A*, Fahimi S*, Farid TA*, Farinha CSS*, Faro A*, Farvid MS*, Farzadfar F*, Feigin VL*, Felicio MM*, Fereshtehnejad S*, Fernandes JG*, Fernandes JC*, Ferrari AJ*, Fischer F*, Fitchett JRA*, Fitzmaurice C*, Foigt N*, Foreman K*, Fowkes FGR*, Franca EB*, Franklin RC*, Fraser M*, Friedman J*, Frostad J*, Fürst T*, Gabbe B*, Garcia-Basteiro AL*, Gebre T*, Gebrehiwot TT*, Gebremedhin AT*, Gebru AA*, Gessner BD*, Gillum RF*, Ginawi IAM*, Giref AZ*, Giroud M*, Gishu MD*, Godwin W*, Gona P*, Goodridge A*, Gopalani SV*, Gotay CC*, Goto A*, Gouda HN*, Graetz N*, Greenwell KF*, Griswold M*, Guo Y*, Gupta R*, Gupta R*, Gupta V*, Gutiérrez RA*, Gyawali B*, Haagsma JA*, Haakenstad A*, Hafezi-Nejad N*, Haile D*, Hailu GB*, Halasa YA*, Hamadeh RR*, Hamidi S*, Hammami M*, Hankey GJ*, Harb HL*, Haro JM*, Hassanvand MS*, Havmoeller R*, Heredia-Pi* IB, Hoek HW*, Horino M*, Horita N*, Hosgood HD*, Hoy DG*, Htet AS*, Hu G*, Huang H*, Iburg KM*, Idrisov BT*, Inoue M*, Islami F*, Jacobs TA*, Jacobsen KH*, Jahanmehr M*, Jakovljevic MB*, James P*, Jansen HAFM*, Javanbakht M*, Jayatilleke AU*, Jee SH*, Jeemon P*, Jha V*, Jiang Y*, Jibat T*, Jin Y*, Jonas JB*, Kabir Z*, Kalkonde Y*, Kamal R*, Kan H*, Kandel A*, Karch A*, Karema CK*, Karimkhani C*, Karunapema P*, Kasaeian A*, Kassebaum NJ*, Kaul A*, Kawakami N*, Kayibanda JF*, Keiyoro PN*, Kemmer L*, Kemp AH*, Kengne AP*, Keren A*, Kesavachandran CN*, Khader YS*, Khan AR*, Khan EA*, Khan G*, Khang YH*, Khoja TAM*, Khosravi A*, Khubchandani J*, Kieling C*, Kim C*, Kim D*, Kim S*, Kim YJ*, Kimokoti RW*, Kissoon N*, Kivipelto M*, Knibbs LD*, Kokubo Y*, Kolte D*, Kosen S*, Kotsakis GA*, Koul PA*, Koyanagi A*, Kravchenko M*, Krueger H*, Kuate Defo B*, Kuchenbecker RS*, Kuipers EJ*, Kulikoff XR*, Kulkarni VS*, Kumar GA*, Kwan GF*, Kyu HH*, Lal A*, Lal DK*, Lalloo R*, Lam H*, Lan Q*, Langan SM*, Larsson A*, Laryea DO*, Latif AA*, Leasher JL*, Leigh J*, Leinsalu M*, Leung J*, Leung R*, Levi M*, Li Y*, Li Y*, Lind M*, Linn S*, Lipshultz SE*, Liu PY*, Liu S*, Liu Y*, Lloyd BK*, Lo L*, Logroscino G*, Lotufo PA*, Lucas RM*, Lunevicius R*, Magdy Abd El Razek M*, Magis-Rodriguez C*, Mahdavi M*, Majdan M*, Majeed A*, Malekzadeh R*, Malta DC*, Mapoma CC*, Margolis DJ*, Martin RV*, Martinez-Raga J*, Masiye F*, Mason-Jones AJ*, Massano J*, Matzopoulos R*, Mayosi BM*, McGrath JJ*, McKee M*, Meaney PA*, Mehari A*, Mekonnen AB*, Melaku YA*, Memiah P*, Memish ZA*, Mendoza W*, Mensink GBM*, Meretoja A*, Meretoja TJ*, Mesfin YM*, Mhimbira FA*, Micha R*, Miller TR*, Mills EJ*, Mirarefin M*, Misganaw A*, Mitchell PB*, Mock CN*, Mohammadi A*, Mohammed S*, Monasta L*, Monis JD*, Montañez Hernandez JC*, Montico M*, Moradi-Lakeh M*, Morawska L*, Mori R*, Mueller UO*, Murdoch ME*, Murimira B*, Murray J*, Murthy GVS*, Murthy S*, Musa KI*, Nachega JB*, Nagel G*, Naidoo KS*, Naldi L*, Nangia V*, Neal B*, Nejjari C*, Newton CR*, Newton JN*, Ngalesoni FN*, Nguhiu P*, Nguyen G*, Nguyen QL*, Nisar MI*, Nkamedjie Pete PM*, Nolte S*, Nomura M*, Norheim OF*, Norrving B*, Obermeyer CM*, Ogbo FA*, Oh I*, Oladimeji O*, Olivares PR*, Olusanya BO*, Olusanya JO*, Opio JN*, Oren E*, Ortiz A*, Osborne RH*, Ota E*, Owolabi MO*, Mahesh PA*, Park E*, Park H*, Parry CD*, Parsaeian M*, Patel T*, Patel V*, Paternina Caicedo AJ*, Patil ST*, Patten SB*, Patton GC*, Paudel D*, Pedro JM*, Pereira DM*, Perico N*, Pesudovs K*, Petzold M*, Phillips MR*, Piel FB*, Pillay JD*, Pinho C*, Pishgar F*, Polinder S*, Poulton RG*, Pourmalek F*, Qorbani M*, Rabiee RHS*, Radfar A*, Rahimi-Movaghar V*, Rahman M*, Ur Rahman MH*, Ur Rahman S*, Rai RK*, Rajsic S*, Raju M*, Ram U*, Rana SM*, Ranabhat CL*, Ranganathan K*, Rao PC*, Refaat AH*, Reitsma MB*, Remuzzi G*, Resnikoff S*, Ribeiro AL*, Rios Blancas MJ*, Roba HS*, Roberts B*, Rodriguez A*, Rojas-Rueda D*, Ronfani L*, Roshandel G*, Roth GA*, Rothenbacher D*, Roy A*, Roy N*, Sackey BB*, Sagar R*, Saleh MM*, Sanabria JR*, Santomauro DF*, Santos IS*, Sarmiento-Suarez R*, Sartorius B*, Satpathy M*, Savic M*, Sawhney M*, Sawyer SM*, Schmidhuber J*, Schmidt MI*, Schneider IJC*, Schutte AE*, Schwebel DC*, Seedat S*, Sepanlou SG*, Servan-Mori EE*, Shackelford K*, Shaheen A*, Shaikh MA*, Shamah Levy T*, Sharma R*, She J*, Sheikhbahaei S*, Shen J*, Sheth KN*, Shey M*, Shi P*, Shibuya K*, Shigematsu M*, Shin M*, Shiri R*, Shishani K*, Shiue I*, Sigfusdottir ID*, Silpakit N*, Silva DAS*, Silverberg JI*, Simard EP*, Sindi S*, Singh A*, Singh GM*, Singh JA*, Singh OP*, Singh PK*, Skirbekk V*, Sligar A*, Soneji S*, Søreide K*, Sorensen RJD*, Soriano JB*, Soshnikov S*, Sposato LA*, Sreeramareddy CT*, Stahl H*, Stanaway JD*, Stathopoulou V*, Steckling N*, Steel N*, Stein DJ*, Steiner C*, Stöckl H*, Stranges S*, Strong M*, Sun J*, Sunguya BF*, Sur P*, Swaminathan S*, Sykes BL*, Szoeke CEI*, Tabarés-Seisdedos R*, Tabb KM*, Talongwa RT*, Tarawneh MR*, Tavakkoli M*, Taye B*, Taylor HR*, Tedla BA*, Tefera W*, Tegegne TK*, Tekle DY*, Shifa GT*, Terkawi AS*, Tessema GA*, Thakur JS*, Thomson AJ*, Thorne-Lyman AL*, Thrift AG*, Thurston GD*, Tillmann T*, Tobe-Gai R*, Tonelli M*, Topor-Madry R*, Topouzis F*, Tran BX*, Tsala Dimbuene Z*, Tura AK*, Tuzcu EM*, Tyrovolas S*, Ukwaja KN*, Undurraga EA*, Uneke CJ*, Uthman OA*, van Donkelaar A*, Varakin YY*, Vasankari T*, Vasconcelos AMN*, Veerman JL*, Venketasubramanian N*, Verma RK*, Violante FS*, Vlassov VV*, Volkow P*, Vollset SE*, Wagner GR*, Wallin MT*, Wang L*, Wanga V*, Watkins DA*, Weichenthal S*, Weiderpass E*, Weintraub RG*, Weiss DJ*, Werdecker A*, Westerman R*, Whiteford HA*, Wilkinson JD*, Wiysonge CS*, Wolfe CDA*, Wolfe I*, Won S*, Woolf AD*, Workie SB*, Wubshet M*, Xu G*, Yadav AK*, Yakob B*, Yalew AZ*, Yan LL*, Yano Y*, Yaseri M*, Ye P*, Yip P*, Yonemoto N*, Yoon S*, Younis MZ*, Yu C*, Zaidi Z*, Zaki MES*, Zambrana-Torrelio C*, Zapata T*, Zegeye EA*, Zhao Y*, Zhou M*, Zodpey S*, Zonies D*, Murray CJL†. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. The Lancet. 2016 Sep 21. doi: 10.1016/S0140-6736(16)31467-2.

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