Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil.
Department of Health Management, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
PLoS One. 2024 Jul 24;19(7):e0305955. doi: 10.1371/journal.pone.0305955. eCollection 2024.
This study delves into the global evolution of 43 Sustainable Development Goals (SDG) indicators, spanning 7 major health themes across 185 countries to evaluate the potential progress loss due to the COVID-19 pandemic. Both the cross-country and temporal variability of the dataset are employed to estimate an empirical model based on an extended version of the Preston curve, which links well-being to income levels and other key socioeconomic health determinants. The approach reveals significant global evolution trends operating in each SDG indicator assessed. We extrapolate the model yearly between 2020 and 2030 using the IMF's pre-COVID-19 economic growth projections to show how each country in the dataset are expected to evolve in these health topics throughout the decade, assuming no other external shocks. The results of this baseline scenario are contrasted with a post-COVID-19 scenario, where most of the pandemic costs were already known. The study reveals that economic growth losses are, on average, estimated as 42% and 28% for low- and lower middle-income countries, and of 15% and 7% in high- and upper middle-income countries, respectively, according to the IMF's projections. These disproportional figures are shown to exacerbate global health inequalities revealed by the curves. The expected progress loss in infectious diseases in low-income countries, for instance, is an average of 34%, against a mean of 6% in high-income countries. The theme of Infectious diseases is followed by injuries and violence; maternal and reproductive health; health systems coverage; and neonatal and infant health as those with worse performance. Low-income countries can expect an average progress loss of 16% across all health indicators assessed, whereas in high-income countries the estimated loss is as low as 3%. The disparity across countries is even more pronounced, with cases where the estimated progress loss is as high as nine times worse than the average loss of 8%. Conversely, countries with greater fiscal capacity are likely to fare much better under the circumstances, despite their worse death count, in many cases. Overall, these findings support the critical importance of integrating the fight against inequalities into the global development agendas.
本研究深入探讨了 43 项可持续发展目标（SDG）指标在全球范围内的演变，这些指标涵盖了 185 个国家的 7 个主要健康主题，以评估 COVID-19 大流行导致的潜在进展损失。本研究利用数据集的跨国和时间可变性，基于扩展后的普雷斯顿曲线（Preston curve），对一个经验模型进行了估计，该模型将福利与收入水平和其他关键社会经济健康决定因素联系起来。该方法揭示了在所评估的每个 SDG 指标中运作的显著全球演变趋势。我们使用国际货币基金组织（IMF）在 COVID-19 之前的经济增长预测，对 2020 年至 2030 年之间的模型进行了每年的外推，以显示数据集中的每个国家在整个十年内如何在这些健康主题中演变，假设没有其他外部冲击。这一基准情景的结果与 COVID-19 后的情景进行了对比，后者已经知道了大流行的大部分成本。研究结果显示，根据国际货币基金组织的预测，中低收入国家的经济增长损失平均估计为 42%和 28%，高收入和上中等收入国家的经济增长损失分别为 15%和 7%。这些不成比例的数字被显示为加剧了曲线所揭示的全球健康不平等。例如，低收入国家在传染病方面的预期进展损失平均为 34%，而高收入国家的平均水平为 6%。传染病主题之后是伤害和暴力、孕产妇和生殖健康、卫生系统覆盖范围以及新生儿和婴儿健康，这些主题的表现更差。低收入国家预计所有评估的健康指标的平均进展损失为 16%，而高收入国家的估计损失低至 3%。各国之间的差距更加明显，在某些情况下，预计进展损失是平均损失的 8 倍的 9 倍。相反，在许多情况下，尽管财政能力更强的国家的死亡人数更多，但在这种情况下，它们的表现可能要好得多。总的来说，这些发现支持了将不平等斗争纳入全球发展议程的至关重要性。
