2 research outputs found
Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015
Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe
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The effects of child welfare reform on levels of child abandonment and deinstitutionalization in Romania, 1987-2000
textHigh rates of child institutionalization are a legacy of Romania’s socialist regime. After
the fall of the dictator in December 1989, Romania was found to have one of the highest
rates of child institutionalization among postsocialist countries in the region. During the
postsocialist decade (1990-2000), widespread poverty and ineffective child welfare
policies have caused high levels of child institutionalization to remain persistently high.
Romania is one of the ten postsocialist countries in Eastern Central Europe that has
submitted its application for membership in the European Union. Among the necessary
political and socioeconomic reforms that Romania has taken in its transition to a
democratic society, a major criterion for EU accession is to improve the problem of child
institutionalization. Since 1990 the Romanian government has implemented several
major child welfare reform measures aimed at improving this problem. However, in
addition to being hampered by economic constraints, empirical data on the dynamics of
child institutionalization have not been readily available for policymakers to formulate
effective child welfare policies. The objective of this study is to collect and analyze
empirical data for the purpose of examining the effects of Romania’s child welfare
reform legislation on levels of child abandonment and deinstitutionalization. While the
results may provide new information for stakeholders, another important objective is to
provide a model for compiling and analyzing data from local institutions in order to
inform national policy.
The study draws on event history data collected on 21,089 children ages 0 to 3 years who
lived in state-run orphan institutions between 1987 and 2000. These data comprise about
one third of all institutionalized infants over this period and they represent trends in ten of
forty counties outside of Bucharest. These data are the first to make known at a national
level the direction and magnitude of child institutionalization and deinstitutionalization
throughout the transition period. Moreover, this individual level data is sensitive to the
effects of national legislation. Demographic approaches are used to estimate the effects
of legislation on levels of child abandonment and on levels of deinstitutionalization.
A major finding is that while transition period reforms have had a significant impact
overall on deinstitutionalization, there has been a relatively small impact on reducing
levels of child abandonment.Sociolog