Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Abstract

Background: 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 towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises 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.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 1

Performance of the health-related SDG index, MDG index, and non-MDG index, and 33 individual health-related indicators, by country, 2015 Countries are ranked by their health-related SDG index from highest to lowest. Indicators have been scaled from 0 to 100. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 2

Map of health-related SDG index, by quintile, 2015 SDG=Sustainable Development Goal. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.

Figure 3

Non-MDG index versus MDG index, by country, 2015 The dark blue line shows the equivalence line, such that values that fall on this line are equivalent for both the MDG index and non-MDG index. Countries are abbreviated according to the ISO3 code. MDG=Millennium Development Goal. SDI=Socio-demographic Index.

Figure 4

Relations (A) between the SDI and the health-related SDG index, (B) between the SDI and the MDG index, (C) between the SDI and the non-MDG index, and (D) between healthy life expectancy and the health-related SDG index, by country representing each of the seven GBD super regions, 2015 Each point represents a country and is colour coded according to the seven GBD super regions. The black lines were generated by spline regression. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. MDG=Millennium Development Goal. GBD=Global Burden of Disease.

Figure 5

Map of observed health-related SDG index minus expected health-related SDG index, on the basis of SDI alone, 2015 The difference between the observed health-related SDG index and expected index (on the basis of SDI) reflects whether a country has a health-related SDG index above or below the expected level. Values for this difference are colour coded such that dark red reflects an observed health-related SDG index that is much lower than expected on the basis of SDI, and dark blue indicates that observed levels are much higher than expected on the basis of SDI. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.

Figure 6

Median absolute change for health-related SDG index, MDG index, and 33 individual health-related SDG indicators (rescaled), (A) across all countries and in the (B) low-SDI quintile, (C) low-middle-SDI quintile, (D) middle-SDI quintile, (E) high-middle-SDI quintile, and (F) high-SDI quintile, 2000–15 Positive values indicate improvements between 2000–15, and negative values point to worsening performance for a given indicator during this time. Black stripes represent median absolute change and boxes represent IQR. Health-related indicators are colour coded according to the health-related goals they represent. Definitions of health-related SDG indicators are shown in table 1. SDG=Sustainable Development Goal. MDG=Millennium Development Goal. SDI=Socio-demographic Index. MMR=maternal mortality ratio. SBA=skilled birth attendance. Mort=mortality. NN mort=neonatal mortality. NTDs=neglected tropical diseases. NCDs=non-communicable diseases. FP need met, mod=family planning need met, modern contraception. Adol=adolescent. UHC=universal health coverage. Air poll mort=mortality attributable to air pollution. WaSH=water, sanitation, and hygiene. IPV=intimate partner violence. HH air poll=household air pollution. Occ risk burden=burden attributable to occupational risks. PM2·5=fine particulate matter smaller than 2·5 μm.

Figure 7

Health-related SDG index in 2015 versus 2000, by country The blue line shows the equivalence line, such that values that fall on this line are equivalent for both the health-related SDG index in 2000 and health-related SDG index in 2015. Only the top five and bottom five improvers in each SDI quintile, as determined by the absolute change from 2000 to 2015, are labelled; full results are shown in the results appendix. Countries are abbreviated according to the ISO3 code. SDI=Socio-demographic Index. SDG=Sustainable Development Goal.