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

Rafael Lozano, Nancy Fullman, Degu Abate, Solomon M. Abay, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Omar Abdel-Rahman, Alireza Abdi, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Nebiyu Dereje Abebe, Zegeye Abebe, Ayenew Negesse Abejie, Semaw F. Abera, Olifan Zewdie Abil, Victor Aboyans & 1146 others Haftom Niguse Abraha, Aklilu Roba Abrham, Laith Jamal Abu-Raddad, Niveen Me Abu-Rmeileh, Gebre Y. Abyu, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Pawan Acharya, Abdu A. Adamu, Oladimeji M. Adebayo, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O. Adetokunboh, Beyene Meressa Adhena, Tara Ballav Adhikari, Mina G. Adib, Arsène Kouablan Adou, Jose C. Adsuar, Mohsen Afarideh, Mahdi Afshari, Ashkan Afshin, Gina Agarwal, Sargis Aghasi Aghayan, Dominic Agius, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Sayem Ahmed, Temesgen Yihunie Akalu, Ali S. Akanda, Mohammad Esmaeil Akbari, Mohammed Akibu, Rufus Olusola Akinyemi, Tomi Akinyemiju, Nadia Akseer, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Tahiya Alam, Ammar Albujeer, Animut Alebel, Kefyalew Addis Alene, Ayman Al-Eyadhy, Samia Alhabib, Raghib Ali, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Syed Mohamed Aljunid, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine A. Allen, Ali Almasi, Fatma Al-Maskari, Hesham M. Al-Mekhlafi, Jordi Alonso, Rajaa M. Al-Raddadi, Ubai Alsharif, Khalid Altirkawi, Nelson Alvis-Guzman, Azmeraw T. Amare, Kebede Amenu, Erfan Amini, Walid Ammar, Nahla Hamed Anber, Jason A. Anderson, Catalina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Hossein Ansari, Ansariadi Ansariadi, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Palwasha Anwari, Lambert Tetteh Appiah, Olatunde Aremu, Habtamu Abera Areri, Johan Ärnlöv, Monika Arora, Krishna K. Aryal, Hamid Asayesh, Ephrem Tsegay Asfaw, Solomon Weldegebreal Asgedom, Rana Jawad Asghar, Reza Assadi, Zerihun Ataro, Suleman Atique, Sachin R. Atre, Madhu Sudhan Atteraya, Marcel Ausloos, Leticia Avila-Burgos, Euripide F.G.A. Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Henok Tadesse Ayele, Yohanes Ayele, Rakesh Ayer, Mahmoud Reza Azarpazhooh, Peter S. Azzopardi, Natasha Azzopardi-Muscat, Tesleem Kayode Babalola, Arefeh Babazadeh, Hamid Badali, Alaa Badawi, Kalpana Balakrishnan, Ayele Geleto Bali, Maciej Banach, Amitava Banerjee, Joseph Adel Mattar Banoub, Amrit Banstola, Aleksandra Barac, Miguel A. Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Lope H. Barrero, Celine M. Barthelemy, Quique Bassat, Arindam Basu, Sanjay Basu, Robert J. Battista, Bernhard T. Baune, Habtamu Wondifraw Baynes, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Aregawi Gebreyesus Belay, Saba Abraham Belay, Yihalem Abebe Belay, Michelle L. Bell, Aminu K. Bello, Derrick A. Bennett, Isabela M. Bensenor, Habib Benzian, Adugnaw Berhane, Abadi Kidanemariam Berhe, Adam E. Berman, Eduardo Bernabe, Robert S. Bernstein, Gregory J. Bertolacci, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Ashish Bhalla, Anil Bhansali, Suraj Bhattarai, Soumyadeep Bhaumik, Zulfiqar A. Bhutta, Belete Biadgo, Molly H. Biehl, Ali Bijani, Boris Bikbov, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Sait Mentes Birlik, Charles Birungi, Donal Bisanzio, Tuhin Biswas, Helen Bitew, Hailemichael Bizuneh, Espen Bjertness, Eshetu Mulisa Bobasa, Soufiane Boufous, Rupert Bourne, Kayvan Bozorgmehr, Nicola Luigi Bragazzi, Michael Brainin, Luisa C. Brant, Michael Brauer, Nicholas J.K. Breitborde, Paul Svitil Briant, Gabrielle Britton, Traolach Brugha, Gene Bukhman, Reinhard Busse, Zahid A. Butt, Lucero Cahuana-Hurtado, Charlton SKH Callender, Ismael R. Campos-Nonato, Julio Cesar Campuzano Rincon, Jorge Cano, Josip Car, Mate Car, Rosario Cárdenas, Juan J. Carrero, Austin Carter, Félix Carvalho, Carlos A. Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz Castro, Kate Causey, Alanur Çavlin, Kelly M. Cercy, Ester Cerin, Yazan Chaiah, Julian Chalek, Hsing Yi Chang, Jung Chen Chang, Aparajita Chattopadhyay, Vijay Kumar Chattu, Pankaj Chaturvedi, Peggy Pei Chia Chiang, Ken Lee Chin, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Jee Young J. Choi, Rajiv Chowdhury, Hanne Christensen, Devasahayam J. Christopher, Sheng Chia Chung, Flavia M. Cicuttini, Liliana G. Ciobanu, Massimo Cirillo, Rafael M. Claro, Thomas Khaled Dwayne Claßen, Aaron J. Cohen, Daniel Collado-Mateo, Cyrus Cooper, Leslie Trumbull Cooper, Leslie Cornaby, Monica Cortinovis, Megan Costa, Ewerton Cousin, Elizabeth A. Cromwell, Christopher Stephen Crowe, Matthew Cunningham, Alemneh Kabeta Daba, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Paul I. Dargan, Ahmad Daryani, Siddharth Kumar Das, Rajat Das Gupta, José Das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Adrian C. Davis, Dragos Virgil Davitoiu, Kairat Davletov, Anand Dayama, Barbora De Courten, Diego De Leo, Jan Walter De Neve, Hans De Steur, Meaza Girma Degefa, Louisa Degenhardt, Tizta Tilahun Degfie, Selina Deiparine, Robert P. Dellavalle, Gebre Teklemariam Demoz, Balem Demtsu, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Getenet Ayalew Dessie, Subhojit Dey, Samath Dharmaratne, Meghnath Dhimal, Daniel Dicker, Mesfin Tadese Dinberu, Eric Ding, Shirin Djalalinia, Huyen Phuc Do, Klara Dokova, David Teye Doku, Dirk Douwes-Schultz, Tim Robert Driscoll, Leilei Duan, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce B. Duncan, Andre R. Duraes, Soheil Ebrahimpour, David Edvardsson, Charbel El Bcheraoui, Erika Eldrenkamp, Ziad El-Khatib, Iqbal Elyazar, Ahmadali Enayati, Aman Yesuf Endries, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati, Sadaf Esteghamati, Kara Estep, Mahdi Fakhar, Hamed Fakhim, Jessica Fanzo, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi, Talha A. Farid, Carla Sofia e.Sa Farinha, Andrea Farioli, André Faro, Maryam S. Farvid, Farshad Farzadfar, Mohammad Hosein Farzaei, Hossein Farzam, Mir Sohail Fazeli, Valery L. Feigin, Andrea B. Feigl, Wubalem Fekadu, Rachel Feldman, Netsanet Fentahun, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Garumma Tolu Feyissa, Daniel Obadare Fijabi, Irina Filip, Samuel Finegold, Jonas David Finger, Florian Fischer, Christina Fitzmaurice, Luisa Sorio Flor, Nataliya Foigt, Kyle J. Foreman, Tahvi Frank, Richard Charles Franklin, Takeshi Fukumoto, Kai Fukutaki, John E. Fuller, Thomas Fürst, João Furtado, Emmanuela Gakidou, Silvano Gallus, Fortuné Gankpé, Ron T. Gansevoort, Ana Garcia, Alberto L. Garcia-Basteiro, Miguel A. Garcia-Gordillo, William Gardner, Abadi Gebre, Teshome Gebre, Gebremedhin Berhe Gebregergs, Tsegaye Telwelde Gebrehiwot, Bereket Gebremichael, Teklu Gebremichael, Tilayie Gelano, Johanna Geleijnse, Yilma Geramo, Sefonias Getachew, Peter W. Gething, Kebede Gezae, Mohamnmad Ghadami, Keyghobad Ghadiri, Maryam Ghasemi-Kasman, Hesam Ghiasvand, Mamata Ghimire, Aloke Ghoshal, Simona Giampaoli, Paramjit Gill, Tiffany Gill, Giorgia Giussani, Elena Gnedovskaya, Ellen M. Goldberg, Srinivas Goli, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Taren Gorman, Atsushi Goto, Alessandra Goulart, Bárbara Goulart, Ayman Grada, Max Griswold, Giuseppe Grosso, Harish Chander Gugnani, Francis Guillemin, Andre Luiz Sena Guimaraes, Yuming Guo, Prakash Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Giang Hai Ha, Juanita A. Haagsma, Vladimir Hachinski, Nima Hafezi-Nejad, Hassan Haghparast Bidgoli, Tekleberhan B. Hagos, Michael Tamene Haile, Tewodros Hailegiyorgis, Gessessew Hailu, Arvin Haj-Mirzaian, Arya Haj-Miraian, Randah Hamadeh, Samer Hamidi, Graeme J. Hankey, Hilda L. Harb, Sivadasanpillai Harikrishnan, Hamidreza Haririan, Josep Maria Haro, Mehedi Hasan, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Caitlin Hawley, Simon I Hay, Yihua He, Akbar Hedayaizadeh-Omran, Mohmed Hegazy, Behzad Heibati, Behnam Heibari, Mohsen Heidari, Delia Hendrie, Andualem Henok, Ileana Beatriz Heredia-Pi, Claudia Herteliu, Behzad Heydarpour, Fatemah Heydarpour, Sousan Heydarpour, Desalegn T Hibstu, Martha Híjar, Hans W. Hoek, Daniel J. Hoffman, Michael K. Hole, Enayatollah Homaie Rad, Praveen Hoogar, Nobuyuki Horita, H. Dean Hosgood, Seyed Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Peter J. Hotez, Damian Hoy, Mohamed Hsairi, Thomas Hsiao, Guoqing Hu, John Huang, Caitlyn Hughes, Chantal K Huynh, Ehimario Igumbor, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine, Sheikh Mohammed Shariful Islam, Farhad Islami, Rebecca Q Ivers, Neda Izadi, Kathryn H. Jacobsen, Leila Jahangiry, Nader Jahanmehr, Sudhir Kumar Jain, Mihajlo B. Jakovljevic, Moti Tolera Jalu, Amr A Jamal, Spencer L James, Simerjot K Jassal, Mehdi Javanbakht, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Catherine O Johnson, Sarah C Johnson, Jost B. Jonas, Jitendra Jonnagaddala, Zahra Jorjoran Shushtari, Mikk Jürisson, Madhanraj K, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Molla Kahssay, Rizwan Kalani, Umesh Kapil, Manoochehr Karami, Behzad Karami Matin, Marina Karanikolos, Narges Karimi, Seyed M Karimi, Hamidreza Karimi-Sari, Amir Kasaeian, Dessalegn H Kassa, Getachew Mullu Kassa, Tesfaye Dessale Kassa, Zemenu Yohannes Kassa, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Zhila Kazemi, Ali Kazemi Karyani, Dhruv Satish Kazi, Prakash KC, Seifu Kebede, Peter Njenga Keiyoro, Laura Kemmer, Grant Rodgers Kemp, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Behzad Khafaei, Morteza Abdullatif Khafaie, Alireza Khajavi, Nauman Khalid, Ibrahim Khalil, Ejaz Ahmad Khan, Muhammad Shahzeb Khan, Muhammad Ali Khan, Young-Ho Khang, Tripti Khanna, Mona M Khater, Alireza Khatony, Zahra Khazaeipour, Habibolah Khazaie, Abdullah T Khoja, Ardeshir Khosravi, Mohammad Hossein Khosravi, Jagdish Khubchandani, Aliasghar Ahmad Kiadaliri, Helen W. Kiarie, Getiye D Kibret, Daniel N. Kiirithio, Daniel Kim, Jun Y Kim, Young-Eun Kim, Ruth W Kimokoti, Yohannes KINFU, Sanjay Kinra, Adnan Kisa, Katarzyna Kissimova-Skarbek, Niranjan Kissoon, Mika Kivimäki, Jonathan M Kocarnik, Sonali Kochhar, Yoshihiro Kokubo, Tufa Kolola, Jacek A Kopec, Margaret N Kosek, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Kristopher J Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Andreas A Kudom, Xie Rachel Kulikoff, G Anil Kumar, Manasi Kumar, Pushpendra Kumar, Michael J Kutz, Hmwe Hmwe Kyu, Carl Lachat, Deepesh P Lad, Sheetal D Lad, Alessandra Lafranconi, Abraham K Lagat, Dharmesh Kumar Lal, Ratilal Lalloo, Hilton Lam, Faris Hasan Lami, Prabhat Lamichhane, Qing Lan, Justin J Lang, Van C Lansingh, Sonia Lansky, Heidi J Larson, Anders O Larsson, Dennis Odai Laryea, Zohra S Lassi, Arman Latifi,, Kathryn Mei-Ming Lau, Avula Laxmaiah, Jeffrey V Lazarus, Janet L Leasher, Georgy Lebedev, Jorge R Ledesma, James B Lee, Paul H Lee, Andrew T Leever, James Leigh, Mall Leinsalu, Cheru Tesema Leshargie, Janni Leung, Sonia Lewycka, Shanshan Li, Xiaohong Li, Yichong Li, Juan Liang, Xiaofeng Liang, Misgan Legesse Liben, Lee-Ling Lim, Miteku Andualem Limenih, Shai Linn, Shiwei Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Lydia R Lucchesi, Ronan A Lyons, Erlyn Rachelle King Macarayan, Mark T Mackay, Emilie R Maddison, Fabiana Madotto, Dhaval P Maghavani, Carlos Magis-Rodriguez, Narayan Bahadur Mahotra, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Abdullah A Mamun, Ana-Laura Manda, Luiz Garcia Mandarano-Filho, Srikanth Mangalam, Helena Manguerra, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Joemer C Maravilla, Wagner Marcenes, Ashley Marks, Randall V Martin, Sheila C O Martins, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Tivani Phosa Mashamba-Thompson, Benjamin Ballard Massenburg, Manu Raj Mathur, Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Martin McKee, Brian J McMahon, Suresh Mehata, Man Mohan Mehndiratta, Ravi Mehrotra, Kala M Mehta, Varshil Mehta, Fabiola Mejia-Rodriguez, Tesfa Mekonen, Tefera C Chane Mekonnen, Hagazi Gebre Meles, Addisu Melese, Mulugeta Melku, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, George A Mensah, Gert B M Mensink, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Haftay Berhane Mezgebe, Bartosz Miazgowski, Tomasz Miazgowski, Anoushka I Millear, Ted R Miller, Molly Katherine Miller-Petrie, George J Milne, G K Mini, Shawn P Minnig, Parvaneh Mirabi, Mojde Mirarefin, Erkin M Mirrakhimov, Awoke Temesgen Misganaw, Philip B Mitchell,, Babak Moazen, Ali Akbar Moghadamnia, Bahram Mohajer, Karzan Abdulmuhsin Mohammad, Moslem Mohammadi, Noushin Mohammadifard, Mousa Mohammadnia-Afrouzi, Mohammed A Mohammed, Shafiu Mohammed, Murali B V Mohan, Viswanathan Mohan, Farnam Mohebi, Modhurima Moitra, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Julio Cesar Montañez, Mahmood Moosazadeh, Ghobad Moradi, Mahmoudreza Moradi, Maziar Moradi-Lakeh, Paula Moraga, Lidia Morawska, Joana Morgado-da-Costa, Naho Morisaki,, Shane Douglas Morrison, Abbas Mosapour, Marilita M Moschos, W Cliff Mountjoy-Venning, Simin Mouodi, Seyyed Meysam Mousavi, Achenef Asmamaw Muche, Kindie Fentahun Muchie, Ulrich Otto Mueller, Oumer Sada S Muhammed, Satinath Mukhopadhyay, Erin C Mullany, Kate Muller, John Everett Mumford, Manoj Murhekar, G V S Murthy, Srinivas Murthy, Jonah Musa, Kamarul Imran Musa, Ghulam Mustafa, Saravanan Muthupandian, Ashraf F Nabhan, Jean B. Nachega, Ahamarshan Jayaraman Nagarajan, Gabriele Nagel, Mohsen Naghavi, Aliya Naheed, Azin Nahvijou, Kovin Naidoo, Gurudatta Naik, Nitish Naik, Farid Najafi, Luigi Naldi, Hae Sung Nam, Vinay Nangia, Jobert Richie Nansseu, Bruno Ramos Nascimento, Haseeb Nawaz, Nahid Neamati, Ionut Negoi, Ruxandra Irina Negoi, Subas Neupane, Charles Richard James Newton, Frida Ngalesoni, Josephine W. Ngunjiri, Anh Nguyen, Grant Nguyen, Ha Nguyen, Huong Lan Thi Nguyen, Huong Thanh Nguyen, Minh NGUYEN, Emma Nichols, Solomon Gedlu Nigatu, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Muhammad Imran Nisar, Molly R. Nixon, Nomonde Nolutshungu, Marika Nomura, Ole F Norheim, Mehdi Noroozi, Bo Norrving, Jean Jacques Noubiap, Hamid Reza Nouri, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi, Peter S Nyasulu, Carla Makhlouf Obermeyer, Richard Ofori-Asenso, Okechukwu Samuel Ogah, Felix Akpojene Ogbo, In-Hwan Oh, Anselm Okoro, Kelechi E Oladimeji, Andrew Toyin Olagunju, Tinuke Oluwasefunmi Olagunju, Pedro R Olivares, Helen Elizabeth Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin L Ong, Sok King Ong, Anu Mary Oommen, John Nelson Opio, Eyal Oren, Andrei Oros, Doris D V Ortega-Altamirano, Alberto Ortiz, Justin R Ortiz, Eduardo Ortiz-Panozo, Erika Ota, Stanislav S Otstavnov, Mayowa Ojo Owolabi, P. A. Mahesh, Smita Pakhale, Abhijit P Pakhare, Wen-Harn Pan, Adrian Pana, Basant Kumar Panda, Songhomitra Panda-Jonas, Jeyaraj Durai Pandian, Nikolaos Papantoniou, Eun Kee Park, Charles D H Parry, Hadi Parsian, Shanti Patel, Sanghamitra Pati, Ajay Patle, George C Patton, Vishnupriya Rao Paturi, Deepak Paudel, Katherine R. Paulson, Neil Pearce, Emmanuel Kwame Peprah, David M Pereira, Norberto Perico, Aslam Pervaiz, Konrad Pesudovs, William A Petri, Max Petzold, Michael R Phillips, David M. Pigott, Julian David Pillay, Meghdad Pirsaheb, Martin Pletcher, Constance Dimity Pond, Maarten J. Postma, Akram Pourshams, Hossein Poustchi, Dorairaj Prabhakaran, Swayam Prakash, Narayan Prasad, Caroline A. Purcell, Manita Pyakurel, Mostafa Qorbani, Reginald Quansah, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Maria Jesus Rios-Blancas, Kedir Teji Roba, Nicholas L S Roberts, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Ali Rostami, Gregory A. Roth, Ambuj Roy, Enrico Rubagotti, George Mugambage Ruhago, Yogesh Damodar Sabde, Perminder S Sachdev, Basema Saddik, Ehsan Sadeghi, Hosein Safari, Yahya Safari, Roya Safari-Faramani, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, Haniye Sadat Sajadi, Nasir Salam, Joseph S Salama, Payman Salamati, Raphael de Freitas Saldanha, Zikria Saleem, Yahya Salimi, Hamideh Salimzadeh, Joshua A Salomon, Sundeep Santosh Salvi, Inbal Salz, Evanson Zondani Sambala, Abdallah M. Samy, Juan R Sanabria, Maria Dolores Sanchez-Niño, Itamar S Santos, Milena M. Santric Milicevic, Mayank Sardana, Abdur Razzaque Sarker, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Miloje Savic, Arundhati R Sawant, Monika Sawhney, Sonia Saxena, Mete Saylan, Mehdi Sayyah, Elke Schaeffner, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, David C. 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Shrime, Sharvari Rahul Shukla, Si Si, Soraya Siabani, Abla Mehio Sibai, Tariq J Siddiqi, Inga Dora Sigfusdottir, Naris Silpakit, Diego Augusto Santos Silva, João Pedro Silva, Natacha Torres da Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Narinder Pal Singh, Om Prakash Singh, Prashant Kumar Singh, Virendra Singh, Dhirendra Narain Sinha, Eirini Skiadaresi, Karen Sliwa, Amanda E Smith, Mari Smith, Adauto Martins Soares Filho, Badr Hasan Sobaih, Soheila Sobhani, Michael Soljak, Moslem Soofi, Masoud Soosaraei, Reed J. D Sorensen, Joan B. Soriano, Sergey Soshnikov, Ireneous N Soyiri, Angela Spinelli, Luciano Sposato, Chandrashekhar T. Sreeramareddy, Raghavendra Guru Srinivasan, Vinay Srinivasan, Jeffrey D. Stanaway, Vladimir I Starodubov, Vasiliki Stathopoulou, Nadine Steckling, Dan J. Stein, Leo G Stewart, Leo Stockfelt, Mark STOKES, Kurt Straif, Agus Sudaryanto, Mu’awiyyah Babale Sufiyan, Bruno F Sunguya, Patrick John Sur, Ipsita Sutradhar, Bryan L. 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51 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)2091-2138
Number of pages48
JournalThe Lancet
Volume392
Issue number10159
DOIs
Publication statusPublished - 10 Nov 2018

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