Lancet. 2017 Sep 16;390(10100):1423-1459. doi: 10.1016/S0140-6736(17)32336-X. Epub 2017 Sep 12.
BACKGROUND: The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. METHODS: We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. FINDINGS: Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. INTERPRETATION: GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. FUNDING: Bill & Melinda Gates Foundation.
背景:联合国可持续发展目标(SDGs)基于“不让任何人掉队”的全球目标。了解当前与健康相关的 SDG 的成果和差距对于决策者至关重要,因为他们旨在改善人口健康。作为全球疾病、伤害和危险因素研究 2016 年(GBD 2016)的一部分,我们在 1990 年至 2016 年期间测量了与健康相关的 50 个 SDG 指标中的 37 个,然后根据这些过去的趋势,我们将指标预测到 2030 年。
方法:我们使用 GBD 2016 的标准方法,从 1990 年至 2016 年测量了 37 个与健康相关的指标,比 GBD 2015 多了 4 个指标。我们对通用卫生覆盖(UHC)措施进行了实质性修订,该措施侧重于基本卫生服务的覆盖范围,还代表了几种非传染性疾病的个人医疗保健机会和质量。我们将每个指标转换为 0-100 的比例,0 表示在 1990 年至 2030 年期间估计的 2.5 分位数,100 表示在此期间的 97.5 分位数。通过对目标进行几何平均,构建了一个代表所有 37 个与健康相关的 SDG 指标的指数。根据过去的趋势,我们使用从 1990 年至 2016 年的指标和国家特定年化变化率的加权平均值来生成指标值的预测,其中每年的变化率的权重基于样本外有效性。目前测量的与健康相关的 24 个 SDG 指标有明确的 SDG 目标,我们根据这些目标评估实现情况。
结果:全球范围内,2016 年与健康相关的 SDG 指数中位数为 56.7(IQR 31.9-66.8),各国表现差异显著,新加坡(86.8,95%置信区间 84.6-88.9)、冰岛(86.0,84.1-87.6)和瑞典(85.6,81.8-87.8)在 2016 年的得分最高,而阿富汗(10.9,9.6-11.9)、中非共和国(11.0,8.8-13.8)和索马里(11.3,9.5-13.1)的得分最低。2000 年至 2016 年间,包括柬埔寨、卢旺达、赤道几内亚、老挝、土耳其和中国在内的几个国家在 UHC 指数方面取得了显著改善;然而,一些国家,如莱索托和中非共和国,但也包括高收入国家,如美国,几乎没有取得进展。根据过去趋势的预测,到 2030 年,24 个目前测量的目标中预计将实现五个(IQR 2-8)目标。全球范围内,根据不同的 SDG 指标,预测的目标实现情况差异很大,预计超过 60%的国家将达到 5 岁以下儿童死亡率、新生儿死亡率、孕产妇死亡率和疟疾等指标的目标,而预计不到 5%的国家将实现与 11 个指标目标相关的目标,包括儿童超重、结核病和道路交通伤害死亡率等目标。对于一些与健康相关的 SDG 而言,实现既定目标取决于比大多数国家过去取得的进展更快。
解释:GBD 2016 提供了一个更新和扩展的证据基础,说明世界目前在与健康相关的 SDG 方面的情况。我们对 UHC 的改进衡量标准为监测必要的卫生服务扩展提供了基础,以实现 SDG。根据过去的进展速度,许多地方在实现既定的与健康相关的 SDG 目标方面面临挑战,尤其是那些情况最差的国家。然而,鉴于实施 SDG 的早期阶段,仍然有机会采取行动加快进展,正如 2000 年后采用千年发展目标所产生的催化作用所示。随着 SDG 的更广泛、更大胆的发展议程,多部门的承诺和投资对于实现所有人的健康相关 SDG 至关重要。
资金:比尔和梅琳达·盖茨基金会。
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