Turkish Health System Research Papers (original) (raw)

Background 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.
Methods 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.
Findings 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.
Interpretation 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.