Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

著者: Rafael Lozano, Nancy Fullman, Degu Abate, Solomón Mequanente Abay, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Omar Abdel‐Rahman, Alireza Abdi, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Nebiyu Dereje Abebe, Abebe Zegeye, Ayenew Negesse Abejie, Semaw Ferede Abera, Olifan Zewdie Abil, Victor Aboyans, Haftom Niguse Abraha, Aklilu Roba Abrham, Laith J. Abu‐Raddad, Niveen ME Abu-Rmeileh, Gebre Yitayih Abyu, Manfred Accrombessi, Dilaram Acharya, Pawan Acharya, Abdu A. Adamu, Oladimeji Adebayo, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji Adetokunboh, Beyene Meressa Adhena, Tara Ballav Adhikari, Mina G Adib, Arsène Kouablan Adou, José Carmelo Adsuar, Mohsen Afarideh, Mahdi Afshari, Ashkan Afshin, Gina Agarwal, Sargis A. Aghayan, Dominic Agius, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Sayem Ahmed, Temesgen Yihunie Akalu, A. S. Akanda, Mohammad Esmaeil Akbari, Mohammed Akibu, Rufus Akinyemi, Tomi Akinyemiju, Nadia Akseer, Fares Alahdab, Ziyad Al‐Aly, Khurshid Alam, Shazia Alam, Ammar Albujeer, Animut Alebel, Kefyalew Addis Alene, Ayman Al‐Eyadhy, Samia Alhabib, Raghib Ali, Mehran Alijanzadeh, Reza Alizadeh‐Navaei, Syed Mohamed Aljunid, Ala’a Alkerwi, François Alla, Peter Allebeck, Christine A. Allen, Ali Almasi, Fatma Al‐Maskari, Hesham M. Al‐Mekhlafi, Jordi Alonso, Rajaa Al‐Raddadi, Ubai Alsharif, Khalid A Altirkawi, Nelson Alvis‐Guzmán, Azmeraw T. Amare, Kebede Amenu, Erfan Amini, Walid Ammar, Nahla Anber, Jason A Anderson, Cătălina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Hossein Ansari, Ansariadi Ansariadi, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Palwasha Anwari, Lambert Appiah, Olatunde Aremu, Habtamu Abera Areri, Johan Ärnlöv, Monika Arora, Krishna K Aryal, Hamid Asayesh, Ephrem Tsegay Asfaw, Solomon Weldegebreal Asgedom, Rana Jawad Asghar, Reza Assadi, Zerihun Ataro, Suleman Atique, Sachin Atre, Madhu Sudhan Atteraya, Marcel Ausloos, Leticia Ávila‐Burgos, Euripide Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Henok Tadesse Ayele, Yohanes Ayele, Rakesh Ayer, Mahmoud Reza Azarpazhooh, Peter Azzopardi, Natasha Azzopardi‐Muscat, Tesleem Kayode Babalola, Arefeh Babazadeh, Hamid Badali, Alaa Badawi, Kalpana Balakrishnan, Ayele Geleto Bali, Maciej Banach, Amitava Banerjee, Joseph Adel Mattar Banoub, Amrit Banstola, Aleksandra Barać, Miguel A. Barboza, Suzanne Barker‐Collo, Till Bärnighausen, Lope H. Barrero, Celine M Barthelemy, Quique Bassat, Arindam Basu, Sanjay Basu, Robert J. Battista, Bernhard T. Baune, Habtamu Wondifraw Baynes, Shahrzad Bazargan‐Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Aregawi Gebreyesus Belay, Saba Abraham Belay, Yihalem Abebe Belay, Michelle L. Bell, Aminu K. Bello, Derrick Bennett, Isabela M. Benseñor, Habib Benzian, Adugnaw Berhane, Abadi Kidanemariam Berhe, Adam E. Berman, Eduardo Bernabé, Robert S. Bernstein, Gregory J Bertolacci, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Ashish Bhalla, Anil Bhansali, Suraj Bhattarai, Soumyadeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Molly H Biehl, Ali Bijani, Boris Bikbov, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Sait Mentes Birlik, Charles Birungi, Donal Bisanzio, Tuhin Biswas, Helen Bitew, Hailemichael Bizuneh, Espen Bjertness, Eshetu Mulisa Bobasa, Soufiane Boufous, Rupert Bourne, Kayvan Bozorgmehr, Nicola Luigi Bragazzi, Michael Brainin, Luísa Campos Caldeira Brant, Michael Bräuer, Alexandra Bražinová, Nicholas J. K. Breitborde, Paul Svitil Briant, Gabrielle B. Britton, Traolach Brugha, Gene Bukhman, Reinhard Busse, Zahid A Butt, Lucero Cahuana-Hurtado, Charlton Callender, Ismael Campos‐Nonato, Julio César Campuzano, Jorge Cano, Josip Car, Mate Car, Rosario Cárdenas, Juan Jesús Carrero, Austin Carter, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz Castro, Kate Causey, Alanur Çavlin, Kelly Cercy, Ester Cerin, Yazan Chaiah, Julian Chalek, Hsing‐Yi Chang, Jung‐Chen Chang, Aparajita Chattopadhyay, Vijay Kumar Chattu, Pankaj Chaturvedi, Peggy Pei-Chia Chiang, Ken Lee Chin, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Jee-Young Jasmine Choi, Rajiv Chowdhury, Hanne Christensen, Devasahayam Jesudas Christopher, Sheng‐Chia Chung, Flavia Cicuttini, Liliana G Ciobanu, Massimo Círillo, Rafael Moreira Claro, Thomas Claßen, Aaron J. Cohen, Daniel Collado‐Mateo, Cyrus Cooper, Leslie T. Cooper, Leslie Cornaby, Monica Cortinovis, Megan Costa, Ewerton Cousin, Elizabeth A. Cromwell, Christopher S. Crowe, Matthew Cunningham, Alemneh Kabeta Daba, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Paul I. Dargan, Ahmad Daryani, Siddharth Kumar Das, Rajat Das Gupta, José das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Adrian Davis, Dragoş Virgil Daviţoiu, Kairat Davletov, Anand Dayama, Barbora de Courten, Diego De Leo, Jan‐Walter De Neve, Hans De Steur, Meaza Girma Degefa, Louisa Degenhardt, Tizta Tilahun Degfie, Selina Deiparine, Robert P Dellavalle, Gebre Teklemariam Demoz, Balem Demtsu, Edgar Denova‐Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Getenet Dessie, Subhojit Dey, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Daniel Dicker, Mesfin Tadese Dinberu, Eric L. Ding, Shirin Djalalinia, Huyen Phuc, Клара Докова, David Teye Doku, Dirk Douwes‐Schultz, Tim Driscoll, Leilei Duan, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce Bartholow Duncan, André Rodrigues Durães, Soheil Ebrahimpour, David Edvardsson, Charbel El Bcheraoui, Erika Eldrenkamp, Ziad El‐Khatib, Iqbal Elyazar, Ahmadali Enayati, Aman Yesuf Endries, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati, Sadaf Esteghamati, Kara Estep, Mahdi Fakhar, Hamed Fakhim, Jessica Fanzo, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi, Talha Farid, Carla Sofia e Sá Farinha, Andrea Farioli, André Faro, Maryam S. Farvid, Farshad Farzadfar, Mohammad Hosein Farzaei, Hossein Farzam, Ali Akbar Fazaeli, Mir Sohail Fazeli, Valery L. Feigin, Andrea B Feigl, Wubalem Fekadu, Rachel Feldman, Netsanet Fentahun, Seyed‐Mohammad Fereshtehnejad, Eduarda Fernandes, João Carlos Fernandes, Garumma Tolu Feyissa, Daniel Obadare Fijabi, Irina Filip, Samuel Finegold, Jonas D. 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BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. FINDINGS: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. INTERPRETATION: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. FUNDING: Bill & Melinda Gates Foundation.