Kate Hodal
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| Somali mothers wait for their children to receive a five-in-one vaccine against potentially fatal childhood diseases at a health centre in Mogadishu. Photograph: Ben Curtis/AP |
Study calls on international community to alter approach to global epidemics if 2030 deadline laid down by sustainable development agenda is to be met
Substantial change will be required in the way global epidemics such as tuberculosis and HIV are treated if the international community is to eliminate them completely by 2030, a study has found.
According to the report, published in the Lancet, no country has met any of the nine global health targets – including the elimination of major disease epidemics and the reduction of health issues like childhood obesity and intimate partner violence – laid down as part of the UN’s sustainable development agenda.
The study provides the first independent analysis of performance on sustainable development goal three, which calls on the world to “Ensure healthy lives and promote wellbeing for all at all ages”. The health SDG is one of 17 universal goals that replaced the millennium development goals (MDGs) after they expired at the end of 2015. Health-related indicators are present in 12 of the 17 goals, which have a 2030 deadline and consist of 169 targets and 230 indicators.
“This paper on the SDGs represents a baseline that informs health policy and decision-makers in all countries, as well as the UN,” said Dr Christopher Murray, director of Seattle’s Institute for Health Metrics and Evaluations (IHME), which led the study.
“It is essential that each year, over the next 15 years, nations be held accountable for the goals their leaders have committed to meet. This report contributes an important element to that accountability.”
Using data compiled by the Global Burden of Diseases, Injuries and Risk Factors study between 1990 and 2015, IHME researchers rated the progress of 188 nations on a score of 0-100. Their aim was to help governments, donors, health professionals and policymakers better identify successes and gaps in global healthcare delivery.
A median health-related SDG index of 59.3% was established, with countries in the highest quintile (over 71.5%) clustering in western Europe, high-income North America, and parts of Asia and Australasia. Iceland, Singapore and Sweden ranked highest overall; Iceland scored 85.5%, thanks largely to tobacco controls and a well-established public health system.
The bottom three countries – Somalia, South Sudan and Central African Republic – were all in Africa. Central African Republic scored 20.4% overall, recording 0% for hygiene, 2% for water, and 3% for malaria indicators.
Even developed countries, including the UK and US, did badly in certain areas. The UK, though fifth overall, fared poorly on childhood overweight, HIV and harmful alcohol consumption. The US scored far worse, ranking 28th overall, a result shaped partly by deaths due to interpersonal violence and suicide. The US also ranked poorly among high-income countries on maternal, child and neonatal mortality.
A number of countries did better than expected between 2000 and 2015, including Timor-Leste, Tajikistan and Colombia. Others, including Syria and Libya, fared extremely badly, due to war.
The report also indicated that rapid economic growth alone did not necessarily make countries meet targets better. India came 143rd of the 188 countries included in the study, behind Comoros and Ghana.
“Our study is a starting point for further investigation on how and why countries are underperforming, or performing well, compared to the average,” said Professor Steven Lim of IHME, one of the report’s authors.
“This will be an annual effort to ensure progress is maintained and that lessons from successes are learned and rapidly transferred to other countries where progress is less impressive.”
The data showed varied progress among nations. More than 60% of countries have already met the 2030 targets on reducing maternal mortality (less than 70 deaths for every 100,000 live births) and child mortality (25 deaths per 1,000 live births).
But no country has met – or is likely to meet – the goal to completely eliminate tuberculosis or HIV by 2030. The authors warned that a “substantial change” in the current trajectory of HIV and tuberculosis indices, as well as “major technological leaps coupled with universal delivery”, would be required to meet the deadline.
Researchers developed a socio-demographic index in order to differentiate progress made on the SDG index from progress that countries would have been otherwise expected to make. Based on income per capita, educational attainment and total fertility rate – key indices of a country’s development status – the index was highly predictive of health-related SDG indices. But it failed to predict interpersonal violence, self-harm and childhood obesity, with the authors warning that more research is required to understand what helps or hinders progress in such cases.
Devi Sridhar, professor of global public health at the University of Edinburgh, said that the SDGs may be more useful to donors and aid organisations than poor countries, warning that “global priorities risk over-riding local concerns and priorities”.
“Governments find it a tricky balancing act to manage pleasing donors with what their citizens are calling for, and ensuring that they are paying particular attention to marginalised communities who might have even specific needs to be met,” she said. “In the end, governments should be responsible to their communities rather than to external entities.”
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