This is based on measurements of 37 of 50 health-related targets proposed by the United Nations that include infant mortality, vaccination, rates of various diseases (tuberculosis, HIV, and malaria, among them), smoking, child abuse, violence and universal health coverage.
, published Tuesday in the journal The Lancet, also ranks 188 nations. Singapore is at the top of the list, followed by Iceland, Sweden, Norway, the Netherlands, Finland, Israel, Malta, Switzerland and the UK. The United States trails these standout nations, landing in the 24th spot on the index.
At the opposite end were Afghanistan, which ranked last, preceded by Central African Republic, Somalia, South Sudan, Chad, Niger, Democratic Republic of the Congo, Lesotho, Burundi, Sierra Leone and Ethiopia.
The 2030 Agenda for Sustainable Development
, which seeks to end poverty, protect the planet, and ensure prosperity for all, was unanimously adopted by 193 member states of the United Nations in 2015.
The goals not only set a clear agenda, they also help “create accountability among all countries and help to spur action by key decision makers,” said Nancy Fullman, lead author of the study and scientific adviser at Institute of Health Metrics and Evaluation at University of Washington in Seattle.
The UN plan includes 17 separate goals — concerning everything from climate change to education — with 169 specific targets.
To monitor progress, 232 individual indicators of success were established by Fullman and her co-authors. Next, a small army of researchers around the globe — coordinated by the Institute of Health Metrics and Evaluation — measured 37 of the 50 health-related indicators for the period of 1990 though 2016.
Finally, based on these past trends, Fullman and her co-authors projected the world’s ability to meet each target goal by the third decade of this century.
More than 60% of the total 188 nations analyzed will meet the target for malaria and the goals for under-5 mortality, neonatal mortality and maternal mortality, the study found. However, fewer than 5% of countries will attain road injury mortality, tuberculosis and childhood overweight objectives, according to the research.
Measuring overall performance on a scale from 1 to 100, the authors of the study also ranked the ability of individual countries to meet the goals. “The intention is not to create ‘horse-race rankings,’ ” said Fulman. The aim is to provide a “scientifically strong, independent monitoring mechanism” against which countries can “benchmark their progress and identify priority areas for investment.”
“Neither a ‘one-size-fits-all’ solution nor a silver bullet exists,” said Fullman.
The countries with the lowest performance “have experienced ongoing conflict and/or recent resurgences in civil unrest, which can radically destabilize a country’s health system and overall development,” she said. However, many African countries with low scores are among those that have received relatively little development assistance to date, she noted.
From 2000 through 2016, universal health coverage measurements generally improved throughout the world, the authors noted, with significant improvements achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey and China. By contrast, other countries — including the low-income nations of Lesotho and the Central African Republic as well as the high-income countries of the United States and Andorra — showed minimal gains.
The US showed its poorest performance on indicators for suicide mortality, child sex abuse, alcohol use and homicide. As Fullman sees it, despite having good performance overall in 2016, the US has made “minimal progress” since 2000 on the measure for universal health coverage, “which represents coverage of essential health services.”
“The US spends more than any other nation on health care, but often has similar, or even worse, health outcomes than many high-income countries,” Fullman said.
Last year saw the first publication of this global assessment. This year’s analysis, funded by the Bill and Melinda Gates Foundation, was published ahead of the 72nd session of the United Nations General Assembly in the hopes that it might shape policy — and investments — addressing global health challenges.
‘If you don’t measure it, you won’t achieve it’
The cornerstone of the goals is “leaving no one behind.”
“Children are at the center of achieving the sustainable development goals,” said Shannon O’Shea, Agenda 2030 partnership manager in the public partnership division at UNICEF. O’Shea was not involved in the study.
“The governments around the world recognize that we needed a really big, ambitious plan to deal with the pressing and, frankly, existential issues of our time,” said O’Shea. “That can be anything from making sure children aren’t dying of preventable diseases, and that they grow up healthy and safe and educated and equipped to enter the workforce, to making sure we are dealing with issues of climate change and polluting oceans and land.”
The goals also focus on economic issues, she said, so that “people who want to be employed and need to be employed are finding work that pays them a livable wage and that economic growth is not only benefiting those at the very top.”
What’s “unique” and “exciting” about these goals is the attempt to bring in many different partners and stakeholders, said O’Shea. The work is “not only to help children, but to engage children and youth as change agents and drivers of sustainable development,” she said.
Dr. Georges Benjamin, executive director of American Public Health Association, said that what often doesn’t get recognized is the “interdependency across these goals” makes it “tough” to monitor progress.
“So, for example, there’s a peace goal,” said Benjamin, who was not involved in the study. Without peace, you see an enormous amount of infant mortality and maternal mortality, he said. Conflict results in dislocation and migration of people and a destruction of infrastructure, which cause disrupt to environmental and economic systems.
“If you’re going to measure infant mortality as a target, then the ultimate goal of poverty and the nutrition goals have to be addressed,” said Benjamin.
Ultimately, the goals serve a fundamental purpose.
“If you don’t measure it, you won’t achieve it,” he said. While individual nations must do a lot of this work on their own, said Benjamin, “there’s also opportunities to do this across sectors.”
With the United States spending a certain amount of money on international assistance, the analysis of progress made can help policy-makers target support for those nations in which the US is investing.
“It’s not just about money — it is also about other factors,” said Benjamin, adding that Haiti, which in recent years has been hit by earthquakes and hurricanes, is an interesting example.
“Haiti tells you a lot about what happens when you are already a challenged nation and then you get a major environmental insult, your ability to recover is less and your ability to grow is less,” said Benjamin.
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“While the countries in sub-Saharan Africa, as an example, are very resilient, have populations that have been there for thousands of years, and they’re loaded with natural resources, but the investment in infrastructure hasn’t been made and they still have real challenges,” said Benjamin.
“I’m glad to see the world making progress, I just wish it was faster than it is.”