“Although nearly all countries were projected to have improved health-related SDG index scores by 2030, progress varied by country and across individual indicators. Performance on health-related SDG indicators differed subnationally for several countries, as well as by sex and across SDI quintiles, highlighting the need for disaggregated data to ensure that no one is left behind. For many indicators, the annualised rate of change required to meet defined targets far exceeded the pace of progress achieved by any country in the recent past. Yet, even for those indicators with a mean projected value that fell short of the 2030 target, there was some probability of attainment by 2030, highlighting the potential for future SDG achievements if progress can be accelerated in the coming years. These results highlight the need for more rapid yet strategic implementation of programmes and continued monitoring of inequalities in the health-related SDGs within populations.

“SDG indicator progress and challenges
“Health-related SDG index scores were projected to be higher in 2030 than in 2017 in almost all countries; however, improved index performance does not inherently reflect whether or not countries will attain individual SDG targets. The composite nature of the index means that many factors have a part in determining a country’s overall score, and ensuring that progress on the index score translates into progress across indicators and equitably across populations will continue to be a challenge for countries.

“Countries that performed well on the health-related SDG index commonly scored worse on the individual indicators of childhood overweight and alcohol use than on other indicators. Among countries that performed worst on the health-related SDG index, well-certified death registration was a frequent challenge. As populations age, all countries will need to strengthen health information systems to ensure death registration keeps pace with increasing mortality in older populations.²³ Although suicide mortality and alcohol use prevalence appeared to be lowest in many countries in north Africa and the Middle East, in places where these practices are deemed illegal or shameful, our results might reflect a dearth of accurate data rather than true circumstances.^39,40

“Without a concerted scale-up of efforts to prevent and treat NCDs, most countries will fall short of the 2030 SDG target.⁹ The NCDs included in SDG indicator 3.4.1—cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases—accounted for 82·8% of all deaths due to NCDs in 2017.21 Total deaths due to NCDs increased from 9·5 million in the population aged 30–69 years in 1990 to 12·9 million in 2017 (or 62·9% of all deaths in that age group).²³ Of those 12·9 million deaths, 6·3 million were due to cardiovascular diseases, 4·9 million to cancers, 1·1 million to chronic respiratory diseases, and 0·6 million to diabetes.²³ Although the absolute number of deaths due to NCDs is rising annually, in most countries, this increase is the result of population ageing and growth; with the exception of diabetes, age-standardised NCD mortality rates for NCDs included in the SDG indicator have generally decreased.²³ Nonetheless, many NCD-related risk exposures have seen minimal changes over time or are increasing, portending future challenges if more deliberate action is not taken against NCDs.²¹

“In many countries, reductions in mortality due to cardiovascular diseases have been driven by improved access to antihypertensives and statins for addressing high cholesterol.^41,42 Investing in programmes that promote the early diagnosis and control of such metabolic risks should be prioritised by national governments and development partners.⁴³ Furthermore, prevention of other modifiable risk factors, such as smoking, harmful alcohol consumption, and obesity, should also be a priority, as advocated by WHO’s best buys for NCD control, including taxation of alcohol and tobacco and reduced salt intake.⁴⁴ Yet, national financing of NCD programmes remains low, with patients often paying out-of-pocket for related services,45 and surveillance and reporting of NCDs are still sparse in many regions.46 The lack of action against NCDs is a current paradox of global health: despite numerous high-profile commitments and robust evidence underscoring the impact of NCDs, the actual scale-up and maintenance of NCD-related interventions and programmes is lacklustre at best.⁹ Inadequate access to affordable diagnostics and treatment, poor prioritisation of NCD risk-prevention programmes, and low overall UHC are among challenges facing many low-SDI and middle-SDI countries.^42,47 Political influences and corporate interests might also affect the effectiveness of NCD programmes and policies, particularly those targeting sugar and alcohol consumption.^48,49

“Our estimates from 2017 indicate that 47·2% of countries and territories have less than one physician per 1000 population and 46·2% have less than three nurses or midwives per 1000 population. The largest gaps in health worker density were found in sub-Saharan Africa, although density was also low in southeast Asia, south Asia, and some countries in Oceania. GBD 2017 provides consistently estimated time series across locations for health worker density as an SDG indicator and by cadre, which supports supplementary analyses of the types and numbers of health workers required to deliver particular sets of interventions or health programmes. For instance, the threshold of 23 physicians, nurses, or midwives per 10,000 population, which was set by WHO in 2006, was a widely referenced minimum required to provide essential maternal and child health services during the Millennium Development Goals era.⁵⁰ 12 years later, this recommendation persists, despite it being likely that very different health workforce quantities, composition, and quality of training are needed to provide a broader range of effective health-care services—particularly as more countries aim to make progress towards UHC.

“With their explicit emphasis on eliminating violence, the SDGs offer an opportunity to reduce and prevent violence against females and children.⁵¹ This is the first time that a global development agenda has prioritised all forms of violence, including violence against females and children, homicides, and armed conflicts. Reliable information and evidence are required to develop programmes and policies to prevent violence, as well as to demand accountability and resources from governments, civil society, and international institutions when violent acts occur. As a result, it is vital to strengthen routine reporting of violence across all ages, and to ensure that accurate, timely measures of violence are accompanied by effective support and systems for survivors of violent acts to enable long-term recovery.”

Source: GBD 2017 SDG Collaborators. “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.” Lancet (London, England) vol. 392,10159 (2018): 2091-2138. doi:10.1016/S0140-6736(18)32281-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6227911/