Mexico's path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030

Abstract

Background: The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico's mortality to assess the feasibility of reducing premature (0-69 years) mortality and propose a path to meet SDG3.

Methods: We developed a baseline scenario applying 2010 age-specific and cause-specific mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specific and cause-specific trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantified shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries.

Findings: UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffic accidents and homicides, are the main health challenge for young adults (aged 20-49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50-69 years).

Interpretation: Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting national health priorities. Further analysis of the equity implications of following the suggested pathway remains a subject of future research.

Funding: Mexico's Ministry of Health, University of California, San Francisco, and Bill & Melinda Gates Foundation.

Figure 1

Mortality trends by major disease group, Mexico 1990–2014 Own estimates using combined data from the United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects, 2015 Revision, and the National Institute of Statistics and Geography, Statistics of mortality (INEGI; 1990–2014). Lines correspond to the 2000–2014 trends based on a simple linear regression. The shaded area around each fitted regression corresponds to the 95% CI. The list of ICD-9 and ICD-10 codes used to group deaths by major cause is included in the appendix.

Figure 2

Mexico's potential to converge in life expectancy by 2030 Japan and USA estimates are based on UNPD data. Mexico's inertial forecast takes into account linear projections of trends in cause-specific mortality rates and United Nations population projections. Mexico's SDG 40 × 30 scenario considers an overall reduction of 40% in premature mortality (for individuals aged 0–69 years) by 2030. Own estimates using combined data from the United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects, 2015 Revision, and the National Institute of Statistics and Geography (INEGI), Statistics of mortality (1990–2014).

Figure 3

Mexico's potential to converge in mortality by age group, 1990, 2010, and 2030 Own estimates using data from: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects, 2015 Revision.