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THE LANCET: Projections to 2030 show much progress needed to meet health-related Sustainable Developments Goals

11 September 2017 The Lancet

* Singapore ranked 1st on overall health-related SDG index, with Afghanistan ranked last
* Top 20 made up of Nordic and European countries, with the exception of Singapore (1) Israel (7), Australia (11), Canada (12), Antigua and Barbuda (17). USA ranks 24th
* On the basis of past trends, more than 60% of countries are projected to meet targets on under-5, neonatal and maternal mortality and malaria, and fewer than 5% of countries are projected to meet targets on road injury mortality, childhood overweight and tuberculosis

A new analysis from the Global Burden of Disease study provides new estimates on where the world currently stands in terms of meeting the health-related Sustainable Development Goals (SDGs) by 2030, showing that while some countries have made significant improvements, much progress is needed. The study is the first comprehensive analysis of trends from 1990-2014 and projections to 2030 for 188 countries.

More than 60% of countries are projected to meet targets on under-5, neonatal and maternal mortality and malaria; and fewer than 5% of countries are projected to meet targets on childhood overweight, tuberculosis and road injury mortality. The analysis also ranks countries on an overall health-related SDG index, with Singapore ranking 1st, followed by Nordic and European countries.

Established in 2015, the SDG framework is in its infancy, and the authors say that the findings should now help shape policies and investment in order to address long-standing and emerging health challenges. The study is published in The Lancet ahead of the 72nd session of the United Nations General Assembly in New York, USA.

The SDGs include 232 individual indicators to monitor 17 goals and 169 targets, ranging from energy, climate change, economic growth, health and education. This study, part of the Global Burden of Disease enterprise coordinated by the Institute of Health Metrics and Evaluation at the University of Washington in Seattle (USA), estimates progress for 37 out of 50 health-related indicators included in the SDGs [1], as well as an overall health-related SDG index. Performance is ranked 1-100.

The first global baseline assessment of the SDGs was published last year, and this year's analysis includes additional data on all indicators and countries, as well as four new indicators for vaccine coverage, physical and sexual violence, childhood sexual abuse and well-certified death registration, and significant updates to the indicator on Universal Health Coverage (UHC).

Country ranking in 2016

Singapore, Iceland and Sweden were the highest performing countries in terms of the overall health-related SDGs. Somalia, Central African Republic, and Afghanistan ranked lowest.

The UK was ranked 10th but, in comparison to other countries, performed poorly on indicators of child sexual abuse, alcohol use, smoking prevalence and child overweight. The USA ranked 24th and performed poorly on indicators of suicide mortality, child sexual abuse, alcohol use and homicide. China ranked 74th with low scores on air pollution, road injury, poisoning and smoking. India ranked 128th with low scores on air pollution, sanitation, hepatitis B and child wasting (rankings for all 188 countries are listed in figure 1).

Some indicators saw significant improvements, including in some low and middle income countries. For instance, Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey and China recorded the greatest improvements on the UHC indicator between 2000 and 2016. Other countries, including Lesotho, Central African Republic, and the USA showed minimal improvement on the UHC indicator.

The authors point to policies that may have helped achieve progress, for instance China expanded its health insurance scheme to rural populations and unemployed urban residents in the 2000s and followed with further reforms in 2009-10, and Cambodia's health reforms from 1990 onwards have laid the way towards national health planning.

"China, Cambodia, and many other middle and low-income nations deserve recognition for improving their citizens' lives, as evidenced by impressive improvements in under-5 mortality, neonatal mortality, vaccine coverage, maternal mortality, and malaria," says Dr Christopher Murray, Director of IHME. "At this juncture, the global health community must be vigilant in accelerating progress toward and donors must remain committed to achieving the SDGs.." [1]

Projections to 2030

On the basis of current trends, Kazakhstan, Timor-Leste, Angola, Nigeria and Swaziland were projected to have the largest overall improvements on the overall health-related SDG index by 2030. For most of these countries, improvements were mainly driven by projected performance on child mortality, UHC, met need for family planning with modern contraceptive methods, and skilled birth attendance.

On the other hand, countries including Sri Lanka, Venezuela, Serbia, and Ukraine were projected to experience worsening performance by 2030 driven by current trends on childhood overweight, and harmful alcohol use.

More than 60% of countries were projected to meet the 2030 SDG targets on under-5, neonatal and maternal mortality, and malaria - although half of these countries had already met these targets by 2016. Skilled birth attendance, household air pollution and well-certified death registration were projected to be met by 48%, 40% and 35% of countries respectively.

Only 7% of countries were projected to meet the target on HIV/AIDS, and no country was projected to reach the SDG target on tuberculosis. A number of targets remained out of reach for most countries, with a total of 11 targets projected to be met by less than 5% of countries, including on childhood overweight, suicide mortality, and road injury mortality.

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