For years, we’ve heard people question whether investments in the fight against global poverty have an impact. Clearly, we believe they do.
We are launching this report this year and will publish it every year until 2030 because we want to accelerate progress in the fight against poverty by helping to diagnose urgent problems, identify promising solutions, measure and interpret key results, and spread best practices.
As it happens, this report comes out at a time when there is more doubt than usual about the world’s commitment to development. In our own country, Congress is currently considering how to deal with the big cuts to foreign aid proposed in the president’s budget. A similar mood of retrenchment has taken hold in other donor countries. Meanwhile, most developing countries need to do more to prioritize the welfare of their poorest citizens.
In 2015, the member states of the United Nations adopted the Sustainable Development Goals (SDGs), which together paint a picture of what we all want the world to look like in 2030. However, if we don’t reaffirm the commitment that has led to so much progress over the past generation, that world will remain out of reach. Leaders everywhere need to take action now to put us on the path we set for ourselves just two years ago.
This report tracks 18 data points included in the SDGs that we believe are fundamental to people’s health and well-being. To complement the data, we’re also telling the stories behind the numbers—about the leaders, innovations, and policies that have made the difference in countries where progress has been most significant.
The decisions we collectively make in the next couple of years are going to have a big impact on the shape these curves take. Of course, it’s not really about the shape of the curves. It’s about what the curves signify: whether or not millions or even billions of people will conquer disease, lift themselves out of extreme poverty, and reach their full potential.
– Bill & Melinda Gates
If I had to pick just one data point to focus on, it would be the number of children who die every year before reaching the age of 5.
There’s so much packed into that number. Child mortality is a proxy for overall well-being; it’s also a leading indicator of progress (or the lack of it). And when you talk to mothers who have experienced the death of a child, you understand what that number means in human terms. What is more fundamental than keeping children alive so they can thrive and build the future?
If you were trying to invent the most efficient way to devastate communities and put children in danger, you would invent maternal mortality.
Luckily, solutions already exist. To deliver those solutions to all women, the most important priority is persuading them to give birth in health facilities, where they can get obstetric care.
Perhaps the best way to describe the importance of family planning is this: achieving the family planning goal makes it more likely that we’ll achieve virtually every other Sustainable Development Goal.
Poverty. Maternal mortality. Child mortality. Education. Gender equity. They all get better when women can plan their pregnancies so they are physically and economically ready when they have a child.
When the AIDS epidemic was totally out of control, people said attending funerals was a routine experience, like cooking breakfast or commuting to work.
Starting in the early 2000s, the world made a huge investment to address the crisis. In the history of global health, there had never been an increase of that magnitude in getting products and services to people who need them.
Poverty is not just the lack of money. It’s also the lack of access to basic financial services that help the poor use what money they have to improve their lives.
So the development community has been trying to promote financial inclusion—that is, to connect almost 2 billion people who live completely outside the formal financial system to bank accounts and services like credit and insurance.
Stunting is one of the most powerful, but most complex, measures in global health.
Stunted children are defined as children who are short for their age by a specified amount. But it’s not actually a child’s height we’re concerned about; rather, stunting is a proxy for something much more important.
To hit the target, many countries must accelerate their rate of growth and share growth more equally. Ultimately, the goal is to “end poverty in all its forms,” which is more ambitious than simply guaranteeing a wage on which people can subsist.
It means, as our foundation’s mission statement says, that all people can lead a healthy, productive life.
Stunted children will be less healthy and productive for the rest of their lives, and countries with high rates of stunting will be less prosperous.
Addressing stunting is not straightforward, because the condition is influenced by so many different factors, but experts have been compiling evidence about what works–and combining basic health and nutrition interventions reduces stunting significantly.
We will publish this report every year until 2030, because we want to inspire leaders by showing what is possible and arm them with evidence and insights about how they might be more effective.
In this report, we have selected 18 out of the 232 SDG indicators. Below are the sources for the chart data. Where the Institute for Health Metrics and Evaluation has a measurement definition that needs further explanation, we have included additional details below. The 2030 global targets included on the charts illustrate the progress the world is aiming to achieve. Some SDG indicators have a quantifiable global target (e.g., maternal mortality), some have a quantifiable country target (e.g., child and neonatal mortality), which we have extrapolated to a global level, and for others we have used the WHO proposed 2030 targets (e.g., for HIV, malaria, and TB).
Homi Kharas, the Brookings Institution, personal correspondence, July 2017.
Global data for the "Current projection" scenario is based on the following sources:
2005 and 2008: International Monetary Fund, Financial Access Survey. http://data.imf.org/FAS
2011 and 2014: World Bank, Global Financial Inclusion (Global Findex) Database. http://datatopics.worldbank.org/financialinclusion/
2015 and beyond: Manyika, J., Lund, S., Singer, M., White, O., and Berry, C., “Digital finance for all: Powering inclusive growth in emerging economies," McKinsey Global Institute, September, 2016. http://www.mckinsey.com/global-themes/employment-and-growth/how-digital-finance-could-boost-growth-in-emerging-economies
Field, E., Pande, R., Rigol, N., Schaner, S., and Moore, C. T., “On Her Account: Can Strengthening Women’s Financial Control Boost Female Labor Supply?” November 15, 2016. http://scholar.harvard.edu/files/rpande/files/on_her_account.can_strengthening_womens_financial_control_boost_female_labor_supply.pdf
Jack, W., and Suri, T., “The long-run poverty and gender impacts of mobile money,” Science, December 9, 2016. http://science.sciencemag.org/content/354/6317/1288
Estimates are from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Methodologies for scenarios: “If we progress” scenarios are derived from setting the rates of change to the 85th percentile of historical median annual rates of change across countries. “If we regress” scenarios are derived from setting rates of change to the 15th percentile of historical median annual rates of change across countries. Current projections are based on past trends.
For further information on IHME data, please visit http://healthdata.org/globalgoals, and read the forthcoming article by Global Burden of Disease (GBD) 2016 SDG collaborators in the September 2017 volume of Lancet, “Measuring progress and projecting attainment based on past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. The Lancet. 2017 Sept.
Further details on IHME’s definitions for the following indicators:
NEGLECTED TROPICAL DISEASES
IHME measures the sum of the prevalence of 15 NTDs per 100,000, currently measured in the Global Burden of Disease study: Human African trypanosomiasis, Chagas disease, cystic echinococcosis, cysticercosis, dengue, food-borne trematodiases, Guinea worm, intestinal nematode infections, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis, and trachoma.
UNIVERSAL HEALTH COVERAGE
Defined by a UHC index of the coverage of nine tracer interventions and risk-standardized death rates from 32 causes amenable to personal healthcare. Tracer interventions include: vaccination coverage (coverage of three doses of DPT, measles vaccine, and three doses of the oral polio vaccine or inactivated polio vaccine); met need for modern contraception; ANC coverage; SBA coverage; in- facility delivery rates; and coverage of antiretroviral therapy among people living with HIV. The 32 causes amenable to personal healthcare include tuberculosis, diarrheal diseases, lower respiratory infections, upper respiratory infections, diphtheria, whooping cough, tetanus, measles, maternal disorders, neonatal disorders, colon and rectal cancer, non-melanoma cancer, breast cancer, cervical cancer, uterine cancer, testicular cancer, Hodgkin’s lymphoma, leukemia, rheumatic heart disease, ischaemic heart disease, cerebrovascular disease, hypertensive heart disease, peptic ulcer disease, appendicitis, hernia, gallbladder and biliary diseases, epilepsy, diabetes, chronic kidney disease, congenital heart anomalies, and adverse effects of medical treatment.
IHME then scaled 41 inputs on a scale of 0 to 100, with 0 reflecting the worst levels observed between 1990 to 2016 and 100 reflecting the best observed. They took the arithmetic mean of these 41 scaled indicators to capture a wide range of essential health services pertaining to reproductive, maternal, newborn, and child health; infectious diseases; noncommunicable diseases; and service capacity and access.
IHME's measurement included the following vaccines: DPT (three doses), measles (one dose), BCG, polio vaccine (three doses), hepatitis B (three doses), Haemophilus influenzae type b (Hib, three doses), pneumococcal conjugate vaccine (PCV, three doses), and rotavirus vaccine (two or three doses). IHME used the geometric mean of coverage of these eight vaccines, based on their inclusion in a country's national vaccine schedule.
IHME measured households with piped sanitation (with a sewer connection); households with improved sanitation without a sewer connection (pit latrine, ventilated improved latrine, pit latrine with slab, composting toilet); and households without improved sanitation (flush toilet that is not piped to sewer or septic tank, pit latrine without a slab or open pit, bucket, hanging toilet or hanging latrine, shared facilities, no facilities), as defined by the Joint Monitoring Program.