Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016.
Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016.
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DOI：
10.1016/s0140-6736(17)32336-x
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发表时间：
2017-09-16
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通讯作者：
GBD 2016 SDG Collaborators
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作者：
GBD 2016 SDG Collaborators
联合国可持续发展目标（sdg）以“不让任何人掉队”的全球目标为基础。了解与卫生相关的可持续发展目标目前取得的成就和差距对于决策者至关重要，因为他们的目标是改善人口健康。作为《2016年全球疾病、伤害和风险因素负担研究》（GBD 2016）的一部分，我们测量了1990年至2016年期间188个国家50项与健康相关的可持续发展目标指标中的37项，然后根据这些过去的趋势，我们预测了到2030年的指标。我们使用标准化的GBD 2016方法测量了1990年至2016年的37项与健康相关的指标，自GBD 2015以来增加了4项指标。我们对全民健康覆盖（UHC）措施进行了大幅修订，该措施侧重于基本卫生服务的覆盖，同时也代表了几种非传染性疾病的个人卫生保健获取和质量。我们将每个指标转换为0 - 100的范围，其中0为1990年至2030年期间估计的第2.5个百分位数，100为该期间的第97个百分位数。通过按目标取标度指标的几何平均值，构建了代表所有37项与健康相关的可持续发展目标指标的指数。在过去趋势的基础上，我们使用指标的加权平均值和1990年至2016年的特定国家年化变化率，以及基于样本外有效性的每个年变化率的权重，对指标值进行了预测。目前衡量的与健康有关的可持续发展目标指标中有24项确定了可持续发展目标，我们根据这些目标评估了实现情况。在全球范围内，2016年与健康相关的可持续发展目标指数中位数为56.7 (IQR为31.9 - 66.8)，国家层面的表现存在显著差异，2016年新加坡（88.6,95%不确定性区间为84.6 - 88.9）、冰岛（88.6 - 84.1 - 87.6）和瑞典（85.6,88.1 - 88.7）的水平最高，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）的水平最低。2000年至2016年期间，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全民健康覆盖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，以及高收入国家，如美国，显示出最小的收益。根据对过去趋势的预测，在目前衡量的24项确定具体目标中，到2030年实现可持续发展目标具体目标的中位数为5个（IQR 2-8）。在全球范围内，预计实现的具体目标因可持续发展目标指标而异，从60%以上的国家预计实现5岁以下儿童死亡率、新生儿死亡率、孕产妇死亡率和疟疾的具体目标，到不到5%的国家预计实现与11个指标具体目标相关的具体目标，包括儿童超重、结核病和道路伤害死亡率的具体目标。对于若干与卫生有关的可持续发展目标而言，实现确定的具体目标取决于比大多数国家过去取得的进展快得多的进展。《GBD 2016》提供了更新和扩展的证据基础，说明世界目前在与卫生有关的可持续发展目标方面所处的位置。我们改进的全民健康覆盖措施为监测为实现可持续发展目标所必需的卫生服务的扩大提供了基础。根据过去的进展速度，许多地方在实现与卫生相关的可持续发展目标具体目标方面面临挑战，特别是在情况最差的国家。然而，鉴于可持续发展目标实施的早期阶段，仍有机会采取行动加速进展，2000年后通过千年发展目标的催化作用表明了这一点。随着可持续发展目标更广泛、更大胆的发展议程，多部门承诺和投资对于使所有人口都能实现与卫生有关的可持续发展目标至关重要。比尔和梅林达·盖茨基金会。
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. 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. 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. 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. Bill & Melinda Gates Foundation.