WORLD HEALTH STATISTICS
MONITORING HEALTH FOR THE
SDGs
S U S T A I N A B L E DEVELOPMENT GOALS
WORLD HEALTH STATISTICS
MONITORING HEALTH FOR THE
SDGs S U S T A I N A B L E DEVELOPMENT GOALS
WHO Library Cataloguing-in-Publication Data World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 1.Health Status Indicators. 2.Global Health. 3.Health Priorities. 4.Mortality. 5.Universal Coverage. 6.Life Expectancy. 7.Statistics. I.World Health ISBN 978 92 4 156526 4
(NLM classification: WA 900.1)
E-ISBN 978 92 4 069569 6 (PDF) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email:
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CONTENTS Executive summary. . Abbreviations. Introduction. .
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1. The 2030 Agenda – a new impetus for health monitoring..
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2. Implications of the SDGs for health monitoring – a challenge and an opportunity for all countries. 2.1 2.2 2.3 2.4 2.5 2.6 2.7
Scope – an agenda for all countries.. . . . . . . . . . . . . . . . . . . . . . . Contents – all major health areas are included. . . . . . . . . . . . . . . Equity – the need for disaggregated data. . . . . . . . . . . . . . . . . . . Multisectoral data – health-related risk factors and determinants. Country monitoring – data gaps and capacity. . . . . . . . . . . . . . . . Regional and global monitoring – mechanisms and estimates. . . . Review – using data for improved implementation. . . . . . . . . . . .
3. Monitoring the health goal – indicators of overall progress. . 3.1 3.2 3.3 3.4
5.1 5.2 5.3 5.4 5.5 5.6
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Sex – major differences between men and women for many indicators. . . . . . . . . . . . Age – data should cover the full life course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Socioeconomic status – major disadvantages for the poorest and the least educated. . Place of residence – focus on geographical differences within countries. . . . . . . . . . . . Migrants and minorities – requiring special efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . Data gaps – disaggregation is a crucial data challenge.. . . . . . . . . . . . . . . . . . . . . . . .
6. SDG health and health-related targets. 6.1 6.2 6.3 6.4
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UHC coverage index of essential health services – a new summary measure. . Inequalities in coverage – towards an integrated assessment.. . . . . . . . . . . . . Financial protection – measuring the impact of out-of-pocket payments. . . . . Data gaps – regular UHC monitoring is possible. . . . . . . . . . . . . . . . . . . . . . .
5. Equity – leave no one behind. .
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Life expectancy – major gains but still large differences. . . . . . . . . . . . . . . . . . . Healthy life expectancy – gaining healthy life years. . . . . . . . . . . . . . . . . . . . . . Premature mortality – focusing on deaths among those under 70 years of age. . Data gaps – most deaths not registered. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Universal health coverage – at the centre of the health goal. 4.1 4.2 4.3 4.4
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Health targets – 13 targets and 26 proposed indicators. . . . . . . . . . . . Health-related targets in other goals – many targets linked to health. . Situation in 2016 – a sketch based on global data. . . . . . . . . . . . . . . . Reproductive, maternal, newborn and child health. . . . . . . . . . . . . Infectious diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noncommunicable diseases and mental health. . . . . . . . . . . . . . . Injuries and violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health systems.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Data gaps – need for strong country health information systems. . . . .
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Annex A: Summaries of the SDG health and health-related targets. .
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Explanatory notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.1 Maternal mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.1 Births attended by skilled health personnel. . . . . . . . . . . . . . . . . . . . Target 3.2 Child mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.3 HIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.3 Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.3 Malaria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.3 Hepatitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.3 Neglected tropical diseases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.4 Noncommunicable diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.4 Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.5 Substance abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.6 Road traffic injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.7 Sexual and reproductive health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.9 Mortality due to air pollution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.9 Mortality due to unsafe water, unsafe sanitation and lack of hygiene.. Target 3.9 Mortality due to unintentional poisoning. . . . . . . . . . . . . . . . . . . . . . Target 3.a Tobacco use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.b Essential medicines and vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.c Health workforce. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 3.d National and global health risks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 2.2 Child stunting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 2.2 Child wasting and overweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 6.1 Drinking-water. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 6.2 Sanitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 7.1 Clean household energy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 11.6 Ambient air pollution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 13.1 Natural disaster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 16.1 Homicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target 16.1 Conflicts.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Annex B: Tables of health statistics by country, WHO region and globally. . Explanatory notes. .
Annex C: WHO regional groupings..
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EXECUTIVE SUMMARY
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he 17 Sustainable Development Goals (SDGs) of the 2030 Agenda integrate all three dimensions of sustainable development (economic, social and environmental) recognizing that eradicating poverty and inequality, creating inclusive economic growth and preserving the planet are inextricably linked. Health is centrally positioned within the 2030 Agenda, with one comprehensive goal (SDG 3) and its 13 targets covering all major health priorities, and links to targets in many of the other goals.
The 2030 Agenda has major implications for health monitoring. Monitoring will need to reflect the fact that the SDGs are relevant for all countries. In order to accommodate a much broader range of health and health-related issues, country, regional and global monitoring systems will have to adapt. This will mean, at the very least, undertaking health data collection, analysis and communication in an integrated manner. The SDG focus on leaving no one behind means that much greater attention will have to be given to disaggregated data. Health monitoring will have to look beyond the health sector and consider economic, social and environmental indicators, as well as intersectoral actions. The 2030 Agenda also puts strong emphasis on country follow-up and review processes as the basis for accountability. Strengthening country health information systems should therefore be a priority. This report brings together the most recent data on the proposed health and selected health-related SDG indicators – to assess the current situation and describe crucial data gaps. In the current absence of official goal-level indicators, summary measures of health such as (healthy) life expectancy are used to provide a general assessment of the situation. As universal health coverage (UHC) is a central concern, statistics are presented on a service-coverage index and on measures of financial protection using the WHO/World Bank UHC monitoring framework. In relation to equity, special attention is given to describing the statistical situation disaggregated by key demographic, geographic and socioeconomic characteristics. Because the 2030 Agenda emphasizes the interlinked nature of all the various goals, this report also includes indicators of selected health determinants and risk factors in relation to other SDG targets. More work is required to fully integrate monitoring the health dimension in other goals. Available data show that in spite of the major progress during the Millennium Development Goal (MDG) era, major challenges remain in terms of reducing maternal and child mortality, improving nutrition, and achieving further progress in the battle against infectious diseases such as HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and hepatitis. The situation analysis also provides evidence of the importance of addressing noncommunicable diseases and their risk factors such as tobacco use, mental health problems, road traffic injuries, and environmental health issues. Data on water and sanitation and air quality show that much more needs to be done to reduce risks to health. Weak health systems are a major obstacle in many countries, resulting in major deficiencies in UHC for even the most basic health services and inadequate preparedness for health emergencies. This report shows that for most SDG health and health-related targets it is possible to provide an overview of the global situation and trends using a limited number of indicators. It, however, also shows that there are major data gaps for many indicators. For instance, several health and health-related indicators require regular, quality data on mortality by age, sex and cause of death, which are still lacking in most countries. The demand for comparable disaggregated statistics is particularly challenging for almost all indicators. These deficiencies will require major investments in strengthening country health information and statistical systems.
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ABBREVIATIONS ABR AFR AIDS AMR ART CRD CRVS CVD DHS EML EMR EPPM EUR FCTC GDP GHO GSHRH HAT HBV HCV HepBOT HIV HLE HLPF HRH IAEG-SDGs ICD IGME IHR ITN LMIC MDG MICS MMEIG MMR NCD NHA NHWA NTD ODA
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adolescent birth rate WHO African Region acquired immunodeficiency syndrome WHO Region of the Americas antiretroviral therapy chronic respiratory disease civil registration and vital statistics cardiovascular disease Demographic and Health Survey essential medicines list WHO Eastern Mediterranean Region ending preventable maternal mortality WHO European Region Framework Convention on Tobacco Control gross domestic product Global Health Observatory Global strategy on human resources for health human African trypanosomiasis hepatitis B virus hepatitis C virus HBV vaccine birth dose administered in a timely way human immunodeficiency virus healthy life expectancy High-Level Political Forum human resources for health Interagency and Expert Group on SDG Indicators International Classification of Diseases Inter-agency Group for Child Mortality Estimation (United Nations) International Health Regulations insecticide-treated net low- and middle-income countries Millennium Development Goal Multiple Indicator Cluster Survey Maternal Mortality Estimation Inter-agency Group (United Nations) maternal mortality ratio noncommunicable disease national health account national health workforce accounts neglected tropical disease official development assistance
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OECD OOP PM PPP R&D SDG SEAR STH TB THE UHC UN UNAIDS UNDESA UNESCO UNICEF UNODS WASH WHA WPR YLD
Organisation for Economic Co-operation and Development out-of-pocket particulate matter purchasing power parity research and development Sustainable Development Goal WHO South-East Asia Region soil-transmitted helminthiases tuberculosis total health expenditure universal health coverage United Nations Joint United Nations Programme on HIV/AIDS United Nations Department of Economic and Social Affairs United Nations Educational, Scientific and Cultural Organization United Nations Children’s Fund United Nations Office on Drugs and Crime water, sanitation and hygiene World Health Assembly WHO Western Pacific Region years of healthy life lost due to disability
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INTRODUCTION
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he World Health Statistics series is WHO’s annual compilation of health statistics for its 194 Member States. World Health Statistics 2016 focuses on the proposed health and health-related Sustainable Development Goals (SDGs) and associated targets. It represents an initial effort to bring together available data on SDG health and health-related indicators. In the current absence of official goal-level indicators, summary measures of health such as (healthy) life expectancy are used to provide a general assessment of the situation.
The series is produced by the WHO Department of Information, Evidence and Research, of the Health Systems and Innovation Cluster, in collaboration with all relevant technical departments of WHO. As in previous years, World Health Statistics 2016 has been compiled primarily using publications and databases produced and maintained by WHO or United Nations groups of which WHO is a member, such as the UN Inter-agency Group for Child Mortality Estimation (IGME). A number of statistics have been derived from data produced and maintained by other international organizations, such as the United Nations Department of Economic and Social Affairs (UNDESA) and its Population Division. Unless otherwise stated, all estimates have been cleared following consultation with Member States and are published here as official WHO figures. Where necessary the estimates provided have been derived from multiple sources, depending on each indicator and on the availability and quality of data. In many countries, statistical and health information systems are weak and the underlying empirical data may not be available or may be of poor quality. Every effort has been made to ensure the best use of country-reported data – adjusted where necessary to deal with missing values, to correct for known biases, and to maximize the comparability of the statistics across countries and over time. In addition, statistical modelling and other techniques have been used to fill data gaps. However, these best estimates have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. Because of the weakness of the underlying empirical data in many countries, a number of the indicators presented here are associated with significant uncertainty. It is WHO policy to ensure statistical transparency and to make available to users the methods of estimation and the margins of uncertainty for relevant indicators. However, to ensure readability while covering such a comprehensive range of health topics, printed versions of the World Health Statistics series do not include the margins of uncertainty which are instead made available through online WHO databases such as the Global Health Observatory (GHO).1 While every effort has been made to maximize the comparability of the statistics across countries and over time, users are advised that country data may differ in terms of the definitions, data-collection methods, population coverage and estimation methods used. More information on indicator metadata is available through the Global Health Observatory.
1 The Global Health Observatory (GHO) is WHO’s portal providing access to data and analyses for monitoring the global health situation. See: http://www.who.int/gho/en/, accessed 16 April 2016.
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