Visualizing progress on 3 Millennium Development Goals (MDGs)

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

MDGsProgress toward the current Millennium Development Goals (MDGs) and establishing new goals after 2015 are a hot topic of discussion this week at the UN General Assembly in New York City.

In today’s post, we’ll use Global Burden of Disease Study 2010 (GBD 2010) data to explore how much progress countries have made in three key health MDGs, 4, 5 and 6, the first two focused on reducing child mortality and maternal mortality while the latter is on halting the spread of diseases such as HIV/AIDS and malaria.

MDG 6 is arguably the highest-profile goal and one that’s seen tremendous progress – halting or reversing the spread of HIV/AIDS, tuberculosis, and malaria. By 2010, antiretroviral therapy financed by country governments and donors had succeeded in reversing the rise in HIV/AIDS deaths at the global level.

Below is a figure showing donor funding (also known at IHME as development assistance for health, or DAH) for HIV/AIDs from IHME’s report Financing Global Health 2012: The End of the Golden Age?

Funding HIV AIDS

This next (somewhat sparse) graph shows global trends in HIV/AIDS deaths in years 1990, 1995, 2000, 2005, and 2010 (you can access the online data visualization tool here). Notice how much of the scale-up in donor funding for HIV/AIDS has coincided with declines in deaths from the pandemic.

Note: The lines surrounding each point in the figure represent the uncertainty intervals surrounding the estimate of HIV/AIDS deaths in a given year. Uncertainty intervals are a range of values that is likely to include the correct estimate of health loss for a given cause. Narrow uncertainty intervals indicate that evidence is strong, while wide uncertainty intervals show that evidence is weaker.
Note: The lines surrounding each point in the figure represent the uncertainty intervals surrounding the estimate of HIV/AIDS deaths in a given year. Uncertainty intervals are a range of values that is likely to include the correct estimate of health loss for a given cause. Narrow uncertainty intervals indicate that evidence is strong, while wide uncertainty intervals show that evidence is weaker.

To see trends in HIV/AIDS for specific countries level, you can use IHME’s online visualization tool called GBD Compare. At the same time that many countries have succeeded in halting HIV/AIDS mortality, 98 countries have seen increases in HIV/AIDS mortality, including China, Pakistan, the Philippines, and Sri Lanka, (full list can be viewed in Table 2 of a recently-published study).

For malaria, we see a similar pattern – global declines in malaria deaths have mirrored scale-ups in donor funding. Interventions for fighting malaria, including insecticide-treated bed nets and artemisinin combination therapy, financed by donors such as the US President’s Malaria Initiative and GFATM as well as ministries of health, have played a key role in reversing the spread of malaria.

Malaria Donor Funding GBD
IHME, UW

And below is a screen grab from our GBD Compare tool showing malaria deaths worldwide followed by donor funding for malaria.

MalariaDeathTrendsGBD

The goal of reducing child mortality, MDG 4, as of 2010, is specifically set at reducing by two-thirds, between 1990 and 2015, the under-five mortality rate. The developing countries that have achieved MDG 4 are China, Egypt, Hungary, Lebanon, Maldives, Macedonia, Peru, El Salvador, Serbia, and Turkmenistan.

Other developing countries such as Angola, Bangladesh, Brazil, Romania, Tunisia, and Vietnam, and many other nations reduced their under-5 mortality rates by more than 60% during this period. Below is a GBD Compare analysis of child mortality rate trends for Ethiopia and Senegal. You can download these and other data from the Institute for Health Metrics and Evaluation’s Global Health Data Exchange.

Child Mortality Ethiopia Senegal GBD

While the MDGs have helped saved millions of lives by mobilizing political will and funding to fight child and maternal mortality, HIV/AIDS, and malaria around the world, Global Burden of Disease Researcher Katrina Ortblad argues that future global health campaigns could be made even more effective by setting absolute instead of relative goals.

Ortblad, who has worked on the Global Burden of Disease Study for the past three years and just completed IHME’s Post-Bachelor Fellowship program, recently presented her ideas at IHME’s Global Health Metrics and Evaluation Conference.

“While countries have made impressive progress by striving to achieve the MDGs, we need more ambitious goals to define what are humane and equitable levels for childhood, maternal, HIV/AIDS, TB, and malaria mortality, and we need to measure how far countries are from achieving these levels,” said Ortblad.

To define these levels of mortality, Ortblad imagines a world where all countries achieve the percent declines in mortality seen in top-performing developing countries over the last decade.

Let’s take the example of maternal mortality. Here’s a figure showing decreases in the global maternal mortality ratio if every country continued achieving the same rates of decline they’ve seen over the last decade through 2030:

Maternal Mortality Ratio Graph 1

If countries sought to perform as well as Vietnam, a country that ranks in the top 5% for performance globally, however, progress in reducing maternal mortality would be significantly more impressive:

Maternal Mortality Ratio Graph 2

For other countries to achieve the same level of progress in reducing the maternal mortality ratio as Vietnam or other top-performing developing countries, we need to better understand what these countries are doing right and implement these approaches to achieve better health outcomes worldwide.

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