Progressing towards the 2030 health-related SDGs in ASEAN: A systematic analysis

Abstract

Background: The Sustainable Development Goals (SDGs) articulate an ambitious global agenda and set of targets to achieve by 2030. Among the health-related SDGs, many formidable challenges remain in settings like the Association of Southeast Asian Nations (ASEAN) which face wide-ranging social, economic and health inequalities. In advance of the 2030 horizon, charting the trajectory of the health SDGs is critical for informing policy and programmatic course corrections to advance health and well-being among ASEAN's 10 member countries with its 667 million people.

Methods and findings: We used estimates from the Global Burden of Disease (GBD) Study 2021 and surveillance data to identify 27 health-related SDG indicators. The indicators were classified into 7 thematic areas: (i) nutrition, (ii) maternal, child and reproductive health (MCH), (iii) infectious diseases, (iv) non-communicable diseases (NCDs), (v) environmental health, (vi) universal health coverage (UHC), and (vii) road injuries. We developed an attainment index ranging from 0 to 100 for each SDG indicator by referencing the SDG targets and projected their progress to 2030. We find an overall positive progress towards the health-related SDG targets in ASEAN from 1990 to 2030. At the aggregate level by 2030, 2 member countries, Singapore and Brunei, are projected to achieve their targets (attainment score ≥ 90). At a wider regional level, ASEAN is projected to make substantial progress in nutrition, MCH, and UHC, with a majority of countries projected to come close to or achieve their targets. However, progress is projected to be slower in the areas of reducing the incidence of infectious disease (i.e., HIV and AIDs, hepatitis B, TB, and neglected tropical diseases), NCD-related mortality and its risk factors (i.e., harmful alcohol use and smoking), environment-related mortality and its risk factors (i.e., unsafe water and poor hygiene, and air pollution), and road injuries. Substantial disparities are identified in the region, with Singapore, Brunei, Malaysia and Thailand generally performing better than elsewhere. A limitation of our study was its reliance on historical trends which may not fully capture future political, social, or technological changes.

Conclusions: As a regional bloc, ASEAN faces persistent challenges in achieving health-related SDG targets by 2030, with unequal progress between countries. Moreover, epidemiological transitions and worsening environmental threats further compound potential gains. At the country level, efforts to enhance health system financing, quality and equity will need to be coupled with wider approaches that address structural drivers of disease. Furthermore, coordinated regional efforts will be essential to effectively respond to emerging threats posed by pollution and environmental risks.

Fig 1. Aggregated trends of SDG indicators from 1990 to 2030 over ASEAN member countries.

Note: MCH denotes maternal and child health; NCD denotes non-communicable diseases; UHC denotes universal health coverage. The dash red lines indicate the year 2017, distinguishing between past estimates and future projections. In the legend, the countries are ranked in human development index in 2015, with darker blue indicating higher index.

Fig 2. Thematic trends of SDG indicators from 1990 to 2030 over ASEAN member countries.

Note: MCH denotes maternal and child health; NCD denotes non-communicable diseases; UHC denotes universal health coverage. The dash red lines indicate the year 2017, distinguishing between past estimates and future projections. In the legend, the countries are ranked in human development index in 2015, with darker blue indicating higher index. The detailed trends for each specific indicator are presented in Fig A1 in S1 Appendix.

Fig 3. Geographic plot of overall attainment index in ASEAN in 2030.

Note: Areas in green indicate a value ranging from 0 to 100. Darker green indicates a higher value. Map data courtesy of https://www.microsoft.com/en-us/maps; Available under a Creative Commons Attribution (CC BY) license.

Fig 4. The colorful MAP for attainment index by country/indicators (2015 versus 2030).

Note: MCH denotes maternal and child health; NCD denotes non-communicable diseases; UHC denotes universal health coverage. Grids in red indicate a value less than 60 and darker further away from 60. Grids in light blue indicate a value bigger than 60 but smaller than 90. Darker nearer to 90. Grids in dark blues indicate a value bigger than 90.

Fig 5. Annual change rate in the attainment index of health-related SDG indicators between 1990 and 2030.

Note: Grids in red indicate an increase lower than the 50th percentile of all annual change rates from 1990 to 2030, while grids in blue indicate an increase higher than the 50th percentile of all annual change rates from 1990 to 2030. Grids in while indicate the 50th percentile of all annual change rates from 1990 to 2030 and darker colors indicate further away from the 50th percentile. The dots indicate missing historical values between 1990 and 2030.

Fig 6. Disparities in attainment index over years and countries.

Note: MCH denotes maternal and child health; NCD denotes non-communicable diseases; UHC denotes universal health coverage. HDI denotes human development index. Low HDI countries include Philippines, Indonesia, Vietnam, Laos, Cambodia, Myanmar using 0.800 as a cutoff. High HDI countries include Singapore, Brunei, Malaysia, Thailand. The center line inside the box represents the median. The box itself represents the interquartile range (IQR). Whiskers extend to the smallest and largest values within 1.5 × IQR from Q1 (25th percentile) and Q3 (75th percentile). Dots placed past the line edges to indicate outliers.