In 2000, the United Nations Development Programme rolled out the Sustainable Development Goals. This week, The Lancet publishes the first analysis showing which countries are progressing toward these goals and which are struggling.

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Some countries performed substantially better against the Sustainable Development Goals than predicted.

The Sustainable Development Goals (SDGs) build on the Millennium Development Goals (MDGs), which expired in 2015.

Consisting of 17 goals, 169 targets, and 230 targets, the SDGs were set by the United Nations (UN) in 2015.

According to the UN Development Programme's website, the SDGs are a:

"Universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity."

The SDGs cover issues such as poverty, climate change, and water availability up to the year 2030. Health is an important facet of the SDGs, present in 11 of the 16 goals; for instance, the third goal aims to "ensure healthy lives and promote well-being for all at all ages."

The current study marks the first annual assessment of SDG health performance and will be launched at the UN General Assembly in New York on September 21.

The Lancet's report shows that, overall, good progress has been made toward health-related SDGs. For instance, under-5 neonatal mortality, universal healthcare, and family planning have all shown improvement.

On the other side of the coin, some areas beyond the MDGs have not shown such improvements. Areas such as hepatitis B rates, childhood overweight, intimate partner violence, and rates of harmful alcohol consumption have worsened.

As the MDG era comes to a close, The Lancet's report aims to provide a tool for global accountability as we head toward the 2030 SDG targets. With some solid numbers in place, governments, aid organizations, and other official bodies will be better able to identify the wins and the gaps, allowing them to prioritize intelligently.

Prof. Stephen Lim led a team from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington; they used data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study completed between 1990 and 2015.

Using this data, they estimated the current status of 33 of the 47 health-related SDG indicators. They created an SDG index, ranked from 0-100 to help make comparisons easier.

"With more than 1,870 individual collaborators in 124 countries and three territories, our independent analysis identifies high- and low-performing countries to help guide national policies and donor investments, and provides a strong basis for monitoring progress towards the health-related SDGs for 188 countries over the next 15 years."

Prof. Stephen Lim

Comparing country's SDG performance

According to the IHME Director Dr. Christopher Murray: "This paper on the SDGs represents a baseline that informs health policy and decision-makers in all countries - as well as the United Nations."

It will help hold nations accountable for the goals that leaders have agreed to meet. The authors are clear that the reports are, in part, based on estimates and models, but state that they provide a firm starting point.

Iceland, Singapore, and Sweden fared best in the health-related SDG index, with the United Kingdom picking up fifth place. The lowest scorers were the Central African Republic, Somalia, and South Sudan.

The United States ranked 28th in the world; this surprisingly poor performance was predominantly due to HIV, interpersonal violence, childhood overweight, suicide, and harmful alcohol consumption.

Compared with other high-income countries, the U.S. also fared poorly in areas such as maternal, child, and neonatal mortality; this is thought to be due to the disparity in access and quality of healthcare across the population.

[SDG infographic]

Early wins and difficult targets

As predicted, progress varied widely across the range of indicators. As an example, more than 60 percent of countries have already hit the 2030 goal of reducing maternal and child mortality (70 deaths per 100,000 live births and 25 deaths per 1,000 live births, respectively).

Conversely, no countries have so far met any of the nine targets aimed at eliminating diseases such as tuberculosis and HIV. In fact, the authors believe these goals are unlikely to be reached within the timeframe. They say: "A substantial change in the current trajectory of HIV and tuberculosis incidence will be needed - likely requiring major technological leaps coupled with universal delivery - to meet this target."

At this stage, less than 20 percent of countries have reached the 2030 goal to eliminate stunting and wasting in children under 5, and only around 25 percent have managed to achieve the target of substantially reducing exposure to household air pollution.

Additionally, less than one fifth of countries have reached target regarding universal access to affordable, safe water and sanitation.

Expectation vs. observation

To compare each country's actual performance against their expected performance, the researchers created the so-called Socio Demographic Index (SDI). The SDI takes into account factors such as income per capita, education levels, and total fertility rates to create an overall picture of a country's development status.

The SDI can then be used to measure a country's performance against countries with which it should be relatively matched.

This measure threw out some unexpected results; Timor-Leste, Tajikistan, Columbia, Taiwan, and Iceland all performed better than might have been expected. Among other factors, Timor-Leste's boost was partially due to improved access to health services for the poor. Also, Iceland's strong tobacco control policies may have contributed to their relative success.

Of course, other countries SDIs demonstrated a worse than expected overall performance. Libya and Syria were two of five surprisingly low scores. War was no doubt a substantial part of this negative performance.

According to Prof. Lim, "Our study is a starting point for further investigation on how and why countries are underperforming or performing well compared to the average. 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."

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