Since 2000, impressive advancements have been made on many health fronts. However, to meet the Sustainable Development Goals health targets by 2030, progress must be accelerated, in particular in regions with the highest burden of disease.
Reproductive, maternal, newborn and child health
- In 2015, the global maternal mortality ratio stood at 216 maternal deaths per 100,000 live births. Achieving the target of less than 70 maternal deaths by 2030 requires an annual rate of reduction of at least 7.5 per cent, more than double the annual rate of progress achieved from 2000 to 2015. Most maternal deaths can be prevented. In 2016, 78 per cent of live births worldwide benefited from skilled care during delivery, compared to 61 per cent in 2000. In sub-Saharan Africa, however, the rate in 2016 was only 53 per cent of live births.
- The mortality rate for children under 5 years of age globally was 43 deaths per 1,000 live births in 2015. That rate represents a 44 per cent reduction since 2000. Mortality among children under 5 years of age remains high in sub-Saharan Africa, with a rate of 84 deaths per 1,000 live births in 2015.
- Children are most vulnerable in the first 28 days of life (the neonatal period). In 2015, the global neonatal mortality rate was 19 deaths per 1,000 live births, a decrease from 31 deaths per 1,000 live births in 2000. Neonatal mortality is highest in Central and Southern Asia and in sub-Saharan Africa, at 29 deaths per 1,000 live births in each of those regions in 2015.
- Preventing unintended pregnancies and reducing adolescent childbearing through universal access to sexual and reproductive health care is crucial to the health and well-being of women, children and adolescents. In 2017, 78 per cent of women of reproductive age (15 to 49 years of age) worldwide who were married or in union had their need for family planning satisfied with modern methods, up from 75 per cent in 2000. Progress has been substantial in the least developed countries, with a rise of 18 percentage points from 2000 to 2017.
- Globally, the adolescent birth rate among females aged 15 to 19 declined by 21 per cent from 2000 to 2015; in Northern America and Southern Asia, it dropped by more than 50 per cent. However, the adolescent birth rate remains high in two thirds of all countries, with more than 20 births per 1,000 adolescent girls in 2015.
- Major advances have been made in combating infectious diseases. Globally in 2015, there were 0.3 new HIV (human immunodeficiency virus) infections per 1,000 uninfected people; among children under 15 years of age, there were 0.08 new HIV infections. That data represents a decline of 45 per cent and 71 per cent, respectively, since 2000. The incidence of HIV infection remained highest in sub-Saharan Africa, with 1.5 new infections per 1,000 uninfected people in 2015.
- In 2015, 10.4 million new cases of tuberculosis were reported worldwide, which represents 142 new cases per 100,000 people, or a decline of 17 per cent since 2000. The global malaria incidence rate in 2015 was 94 per 1,000 people at risk, a 41 per cent decrease since 2000. In 2015, 1.6 billion people required mass or individual treatment and care for neglected tropical diseases, a 21 per cent decline from 2010.
- Around 1.34 million deaths were attributed to hepatitis in 2015, including 0.9 million deaths owing to hepatitis B. Hepatitis B can be prevented through vaccinations; global coverage of vaccinations for that disease among children 1 year of age increased from 29 per cent in 2000 to 84 per cent in 2015.
- A major risk factor for infectious diseases and mortality is the lack of safe water, sanitation and hygiene (WASH) services, which disproportionately affects sub-Saharan Africa and Central/Southern Asia. Death rates owing to the lack of WASH services in those two regions were 46 and 23 per 100,000 people, respectively, compared to 12 per 100,000 people globally in 2012.
Non-communicable diseases and mental health
- Premature deaths (before 70 years of age) owing to cardiovascular disease, cancer, chronic respiratory disease or diabetes totalled about 13 million in 2015, accounting for 43 per cent of all premature deaths globally. From 2000 to 2015, the risk of dying between 30 and 70 years of age from one of those four causes decreased from 23 per cent to 19 per cent, falling short of the rate required to meet the 2030 target of a one-third reduction.
- Such mental disorders as depression can lead to suicide. Nearly 800,000 suicides occurred worldwide in 2015, with men about twice as likely to commit suicide as women.
- Tobacco and alcohol use contributes to the burden of non-communicable diseases. The World Health Organization (WHO) Framework Convention on Tobacco Control has been ratified by 180 parties, which represent 90 per cent of the global population. Still, more than 1.1 billion people, mostly men, consumed tobacco in 2015. The prevalence of smoking among those individuals 15 years of age and older dropped from 23 per cent in 2007 to 21 per cent in 2013. In 2016, the average consumption of pure alcohol was 6.4 litres per year per person among those individuals 15 years of age or older.
- Indoor and ambient air pollution is the greatest environmental health risk. Globally in 2012, household air pollution from cooking with unclean fuels or inefficient technologies led to an estimated 4.3 million deaths, while ambient air pollution from traffic, industrial sources, waste burning or residential fuel combustion resulted in an estimated 3 million deaths.
Other health risks
- In 2013, about 1.25 million people died from road traffic injuries, the leading cause of death among males between 15 and 29 years of age. Road traffic deaths have increased by about 13 per cent globally since 2000.
- Worldwide in 2015, an estimated 108,000 people died as a result of unintentional poisoning. That figure represents 1.5 deaths per 100,000 people, a 33 per cent decrease since 2000.
Health systems and funding
- In 2015, total official flows for medical research and basic health from all donor countries and multilateral organizations amounted to $9.7 billion, an increase in real terms of 30 per cent since 2010. Of that amount, the member countries of the Development Assistance Committee of OECD contributed $4.3 billion.
- Available data from 2005 to 2015 indicate that over 40 per cent of all countries have less than one physician per 1,000 people, and around half have fewer than three nurses or midwives per 1,000 people. Almost all least developed countries have less than one physician and fewer than three nurses or midwives per 1,000 people.
Source: Report of the Secretary-General, "Progress towards the Sustainable Development Goals", E/2017/66
Many more people today are living healthier lives than in the past decade. Nevertheless, people are still suffering needlessly from preventable diseases, and too many are dying prematurely. Overcoming disease and ill health will require concerted and sustained efforts, focusing on population groups and regions that have been neglected.
Reproductive, maternal, newborn and child health
- The maternal mortality ratio has declined by 37 per cent since 2000. Nevertheless, in 2015, 303,000 women around the world died due to complications during pregnancy or childbirth. Over the period 2012–2017, almost 80 per cent of live births worldwide occurred with the assistance of skilled health personnel, up from 62 per cent in 2000–2005.
- Globally, from 2000 to 2016, the under-5 mortality rate dropped by 47 per cent, and the neonatal mortality rate fell by 39 per cent. Over the same period, the total number of under-5 deaths dropped from 9.9 million to 5.6 million.
- Even in the region facing the greatest health challenges, progress has been impressive. Since 2000, the maternal mortality ratio in sub-Saharan Africa has been reduced by 35 per cent, and the under-5 mortality rate has dropped by 50 per cent.
- In 2018, the global adolescent birth rate is 44 births per 1,000 women aged 15 to 19, compared to 56 in 2000. The highest rate (101) is found in sub-Saharan Africa.
Infectious diseases and non-communicable diseases
- Globally, the incidence of HIV declined from 0.40 to 0.26 per 1,000 uninfected people between 2005 and 2016. For women of reproductive age in sub-Saharan Africa, however, the rate is much higher, at 2.58 per 1,000 uninfected people.
- In 2016, 216 million cases of malaria were reported versus 210 million cases in 2013. There were 140 new cases of tuberculosis per 100,000 people in 2016 compared to 173 cases per 100,000 in 2000. Hepatitis B prevalence declined among children under 5— from 4.7 per cent in the pre-vaccine era to 1.3 per cent in 2015.
- In 2016, 1.5 billion people were reported to require mass or individual treatment and care for neglected tropical diseases, down from 1.6 billion in 2015 and 2 billion in 2010.
- Unsafe drinking water, unsafe sanitation and lack of hygiene continue to be major contributors to global mortality, resulting in about 870,000 deaths in 2016. These deaths were mainly caused by diarrhoeal diseases, but also from malnutrition and intestinal nematode infections.
- Globally, 32 million people died in 2016 due to cardiovascular disease, cancer, diabetes or chronic respiratory disease. The probability of dying from these causes was about 18 per cent in 2016 for people between 30 and 70 years of age.
- In 2016, household and outdoor air pollution led to some 7 million deaths worldwide.
Health systems and funding
- Globally, almost 12 per cent of the world’s population (over 800 million people) spent at least one tenth of their household budgets to pay for health services in 2010, up from 9.7 per cent in 2000.
- Official development assistance (ODA) for basic health from all donors increased by 41 per cent in real terms since 2010, reaching $9.4 billion in 2016.
- Available data from 2005 to 2016 indicate that close to 45 per cent of all countries and 90 per cent of least developed countries (LDCs) have less than one physician per 1,000 people, and over 60 per cent have fewer than three nurses or midwives per 1,000 people.
Source: Report of the Secretary-General, The Sustainable Development Goals Report 2018
- Goal 3 seeks to ensure health and well-being for all, at every stage of life. The Goal addresses all major health priorities, including reproductive, maternal and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines. It also calls for more research and development, increased health financing, and strengthened capacity of all countries in health risk reduction and management.
- Between 2000 and 2015, the global maternal mortality ratio, or number of maternal deaths per 100,000 live births, declined by 37 per cent, to an estimated ratio of 216 per 100,000 live births in 2015. Almost all maternal deaths occur in low-resource settings and can be prevented. Globally, 3 out of 4 births were assisted by skilled health-care personnel in 2015. Under-five mortality rates fell rapidly from 2000 to 2015, declining by 44 per cent globally. Nevertheless, an estimated 5.9 million children under the age of 5 died in 2015, with a global under-five mortality rate of 43 per 1,000 live births. The neonatal mortality rate, that is, the likelihood of dying in the first 28 days of life, declined from 31 deaths per 1,000 live births in 2000 to 19 deaths per 1,000 live births in 2015. Over that period, progress in the rate of child survival among children aged 1 to 59 months outpaced advances in reducing neonatal mortality; as a result, neonatal deaths now represent a larger share (45 per cent) of all under-five deaths.
- Preventing unintended pregnancy and reducing adolescent childbearing through universal access to sexual and reproductive health-care services are critical to further advances in the health of women, children and adolescents. Worldwide, in 2015, approximately 3 in 4 women of reproductive age (15 to 49 years of age) who were married or in union satisfied their need for family planning by using modern contraceptive methods; in sub-Saharan Africa and Oceania, however, the share was less than half. Childbearing in adolescence has steadily declined in almost all regions, but wide disparities persist: in 2015, the birth rate among adolescent girls aged 15 to 19 ranged from 7 births per 1,000 girls in Eastern Asia to 102 births per 1,000 girls in sub-Saharan Africa.
- The incidence of major infectious diseases, including HIV, tuberculosis and malaria, has declined globally since 2000. Globally in 2015, the number of new HIV infections among all people was 0.3 new infections per 1,000 uninfected people; 2.1 million people became newly infected that year. The incidence of HIV was highest in sub-Saharan Africa, with 1.5 new cases per 1,000 uninfected people. In 2014, 9.6 million new cases of tuberculosis (133 cases per 100,000 people) were reported worldwide, with 58 per cent of them in South-Eastern Asia and the Western Pacific. Almost half the world’s population is at risk of malaria and, in 2015, the incidence rate was 91 new cases per 1,000 people at risk, an estimated total of 214 million cases. Sub-Saharan Africa accounted for 89 per cent of all malaria cases worldwide, with an incidence rate of 235 cases per 1,000 people at risk. In 2014, at least 1.7 billion people, in 185 countries, required treatment for at least one neglected tropical disease.
- According to estimates from 2012, around 38 million deaths per year, accounting for 68 per cent of all deaths worldwide, were attributable to non communicable diseases. Of all deaths among persons under the age of 70, commonly referred to as premature deaths, an estimated 52 per cent were as a result of non-communicable diseases. Over three quarters of premature deaths were caused by cardiovascular disease, cancer, diabetes and chronic respiratory disease. Globally, premature mortality from those four main categories of non communicable disease declined by 15 per cent between 2000 and 2012. Reducing tobacco use will be critical for meeting the proposed target of reducing premature mortality from non-communicable diseases by one third. In 2015, over 1.1 billion people consumed tobacco, with far more male (945 million) than female (180 million) smokers.
- Unhealthy environmental conditions increase the risk of both non communicable and infectious diseases, which is reflected in the strong integrated nature of the Goals. In 2012, an estimated 889,000 people died from infectious diseases caused largely by faecal contamination of water and soil and by inadequate hand-washing facilities and practices resulting from poor or non-existent sanitation services. In 2012, household and ambient air pollution resulted in some 6.5 million deaths.
- Substance use and substance-use disorders have also created a significant public health burden. Worldwide, average alcohol consumption in 2015 was estimated at 6.3l of pure alcohol per person among those aged 15 or older, with wide variations across countries. Alcohol consumption was highest in the developed regions (10.4l per person) and lowest in Northern Africa (0.5l per person). In 2013, only about 1 in 6 people worldwide suffering from drug-use disorders received treatment. Approximately 1 in 18 people with drug-use disorders received treatment in Africa that year, compared with 1 in 5 in Western and Central Europe.
- Mental disorders occur in all regions and cultures. The most common are anxiety and depression, which, not infrequently, can lead to suicide. In 2012, an estimated 800,000 people worldwide committed suicide, and 86 per cent of them were under the age of 70. Globally, suicide is the second leading cause of death among those between the ages of 15 and 29.
- Around 1.25 million people died from road traffic injuries in 2013. Halving the number of global deaths and injuries from road traffic accidents by 2020 is an ambitious goal given the dramatic increase in the number of vehicles, which nearly doubled between 2000 and 2013.
- Total official flows from all providers for medical research and basic health sectors were $8.9 billion in 2014. Within this total, official development assistance (ODA) from DAC donors was $4.5 billion in 2014, an increase of 20 per cent in real terms since 2010, with the United Kingdom of Great Britain and Northern Ireland and the United States of America accounting for $2.6 billion of that total. In 2014, $1 billion was spent on malaria control and $1.2 billion was spent on other infectious diseases, excluding AIDS.