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.
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.
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DOI：
10.1016/s0140-6736(18)32281-5
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发表时间：
2018-11-10
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通讯作者：
GBD 2017 SDG Collaborators
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作者：
GBD 2017 SDG Collaborators
建立2015年基线和监测联合国可持续发展目标（SDG）早期实施情况的努力突出了到2030年改善健康的巨大潜力和威胁。为了充分实现"不让一个人掉队"的可持续发展目标，在国家层面的估计之外，审查与健康相关的可持续发展目标越来越重要。作为《2017年全球疾病、伤害和风险因素负担研究》（GBD 2017）的一部分，我们衡量了52个与健康相关的可持续发展目标指标中的41个的进展情况，并估计了195个国家和地区1990 - 2017年期间与健康相关的可持续发展目标指数，预测了到2030年的指标，并分析了全球实现情况。我们衡量了1990年至2017年41项与健康相关的可持续发展目标指标的进展情况，自2016年GBD以来增加了4项指标（新指标是卫生工作者密度、非亲密伴侣的性暴力、人口普查状况以及身体和性暴力的发生率[单独报告]）。我们还改进了以前报告的几个指标的衡量方法。我们构建了国家层面的估计值，并针对与健康相关的可持续发展目标的一个子集，按性别和社会人口指数（SDI）五分位数检查了指标层面的差异。我们还对选定的国家进行了国家以下一级的业绩评估。为了构建与健康相关的可持续发展目标指数，我们将每个指标的值转换为0 - 100的尺度，其中0为1990年至2030年计算的1000次抽取的第2.5百分位数，100为第97.5百分位数，并按目标取缩放指标的几何平均值。为了生成到2030年的预测，我们使用了一个预测框架，该框架从更广泛的GBD研究中得出估计值，并使用1990年至2017年特定指标和特定国家年化变化率的加权平均值来为未来的估计提供信息。我们通过两种方式评估了具有既定目标的指标的实现情况：首先，使用预测到2030年的平均值，然后使用根据1000次抽签计算出的2030年实现概率。我们还根据过去的趋势对实现可持续发展目标的可行性进行了全球实现分析。我们使用2015年全球指标平均值和已确定的可持续发展目标，计算了2015年至2030年实现这些目标所需的全球年化变化率，然后确定了1990年至2015年国家级变化率分布中所需的全球年化变化率。我们取这些指标的全球百分位数的平均值，并将该平均全球百分位数的过去变化率应用于所有与健康相关的可持续发展目标指标，无论目标定义如何，以估计2030年全球平均值和2015年至2030年每个指标的百分比变化。2017年全球与健康相关的SDG指数中位数为59.4（IQR 35.4 - 67.3），范围从最低的11.6（95%不确定性区间9.6 - 14.0）到最高的84.9（83.1 - 86.7）。在国家以下一级评估的国家的可持续发展目标指数值差异很大，特别是在中国和印度，尽管日本和英国的得分更为均匀。各项指标也因SDI五分位数和性别而异，男性在非传染性疾病死亡率、饮酒和吸烟等方面的结果比女性差。预计大多数国家在2030年与健康相关的可持续发展目标指数将高于2017年，而到2030年实现的国家一级概率因指标而异。在5岁以下儿童死亡率、新生儿死亡率、孕产妇死亡率和疟疾指标方面，实现目标的概率至少为95%的国家最多。其他指标，包括非传染性疾病死亡率和自杀死亡率，根据2030年的预测平均值，预计没有国家能够实现相应的可持续发展目标，但显示出到2030年实现的可能性。对于一些指标，包括儿童营养不良、几种传染病和大多数暴力措施，实现可持续发展目标所需的年化变化率远远超过了任何国家近年来取得的进展速度。我们发现，将全球平均年化变化率应用于没有明确目标的指标，相当于全球吸烟和饮酒量分别减少约19%和22%;青少年出生率下降47%;到2030年，每1000人的卫生工作者密度增加85%以上。GBD研究提供了一个独特的、强大的平台，用于监测人口和地理维度上与健康相关的可持续发展目标。我们的研究结果强调了增加分类数据收集和分析的重要性，并强调了更有针对性的干预措施可以加速实现可持续发展目标的进展。目前的预测表明，许多与健康相关的可持续发展目标指标、非传染性疾病、非传染性疾病相关风险和暴力相关指标将需要协调一致地从过去可能推动收益的措施-非传染性疾病的治疗性干预措施-转向多部门、以预防为导向的政策行动和投资，以实现可持续发展目标。值得注意的是，如果要在2030年前实现若干目标，就需要以一种近期没有任何国家实现的速度取得进展。未来从根本上说是不确定的，没有模型可以完全预测哪些突破或事件可能会改变可持续发展目标的进程。很明显，我们今天的行动或不行动将最终决定世界集体能够在2030年前实现不让任何人掉队的目标。比尔和梅林达·盖茨基金会。
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. 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. 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. 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. Bill & Melinda Gates Foundation.