Setting post-2015 health goals: an empirical assessment based on the GBD 2010 results

Abstract

BackgroundSetting ambitious targets to address health problems has proven to be an effective motivator for change. We used the results of the Global Burden of Disease Study (GBD) 2010 to explore what would be technically feasible but ambitious and motivating goals for Millennium Development Goals 4, 5, and 6. MethodsWe outlined desirable target attributes and used these to guide our analysis. Annualised percentile declines for the maternal mortality ratio (MMR) as well as HIV/AIDS, tuberculosis, malaria, under-5 mortality, and adult mortality rates from 2000 to 2010 were analysed for 187 countries. Using the 90th, 95th, and 99th percentile declines as well as highest decline observed in a developing country, rates of change from 2015 to 2030 were calculated. These same percentile declines were also used to project country-specific indicator estimates for 2030 that, when aggregated to the global level, informed absolute indicator targets. FindingsWe applied consistent criteria across each indicator; the most ambitious indicator targets were generated with the 99th percentile declines. Using these declines, rates of change from 2015 to 2030 were 85·0% for MMR, 88·3% for HIV/AIDS, 71·6% for tuberculosis, 95·7% for malaria, 80·7% for under-5 mortality, and 74·7% for adult mortality. In comparison, rates of change for these indicators using the less ambitious 90th percentile declines were 62·0%, 58·9%, 52·7%, 86·9%, 58·2%, and 32·8%, respectively. The absolute targets generated from the most ambitious percent declines were 15·8 (95% CI 13·0–18·6), 1·2 (1·1–1·3), 0·3 (0·3–0·4), and 3·3 (2·5–3·7) deaths per 100 000, and 4·1 (4·0–4·3) and 96·6 (93·9–99·5) deaths per 1000 for these indicators. InterpretationSetting absolute targets for all countries shifts the focus of health goals away from high-burden countries and towards countries that need the most help in achieving the targets. Absolute targets are equity promoting and can easily be applied at subnational levels. New resources and strategies, however, need to be developed in order to accelerate progress in countries furthest from the targets. FundingBill & Melinda Gates Foundation.