Monitoring the progress of health-related sustainable development goals (SDGs) in Brazilian states using the Global Burden of Disease indicators

Abstract

Background: Measuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs.

Methods: As part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25).

Results: From 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast).

Conclusions: The majority of Brazil's health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.

Keywords: Health disparities; Health indicators; Inequalities; Middle-income countries; Poverty.

Fig. 1

Performance on the health-related SDG index and individual health-related indicators in Brazilian States in 2017. The numbers represent the rescaled indicators and combined indexes on a scale of 0 to 100, with 0 representing the worst value for each indicator or index among all 195 countries covered by GBD from 1990 to 2017, and 100 representing the best value among them within the same period. The colours represent a scale from the best (dark green) to the worse (red) indicator or index values (rows) within all Brazilian States in 2017

Fig. 2

SDG index in 1990 (a), in 2017 (b), and percentage change from 1990–2017 (c). For fig. 2a, b, the color was coded by the quintile of SDG Index in 1990, were the dark green represents the worst and the light green the best SDG index. The same quintile distribution was used for SDG index distribution in 2017 for comparability purposes. The third map shows the percentage of change in SDG index from 1990 to 2017. The colors also represent the quintile distribution of percent change of SDG index, were the dark green represent the lowest changes and the yellow represent the largest changes during the period

Fig. 3

SDI index in 1990(a), in 2017(b), and percentage change in SDI index from 1990–2017(c). For fig. 3a, b, the color was coded by the quintile of SDI Index in 1990, were the dark green represents the worst and the light green the best SDI index. The same quintiles distribution was used for SDI index distribution in 2017 for comparability purposes. The third map shows the percentage of change in SDI index from 1990 to 2017. The colors also represent the quintile distribution of percent change of SDI index, were the dark green represent the lowest changes and the yellow represent the largest changes during the period

Fig. 4

Trends of a under-5 mortality, b neonatal mortality, c HIV incidence, and d malaria incidence in 1990–2017. The boxplots represent the distribution of the four indicators across the Brazilian municipalities, for each year, from 1990–2017

Fig. 5

Trends of a smoking prevalence, b non-communicable diseases (NCD) mortality, c non-intimate partner sex violence, and d health workers density in 1990–2017. The boxplots represent the distribution of the four indicators across the Brazilian municipalities, for each year, from 1990–2017