Ensure healthy lives and promote well-being for all at all ages

As of April 2022, COVID-19 had infected more than 500 million people and killed more than 6.2 million worldwide. However, the latest estimates suggest the global “excess deaths” directly and indirectly attributable to COVID-19 could be as high as three times this number. The pandemic has severely disrupted essential health services, shortened life expectancy, and exacerbated inequities between countries and people in access to basic health services, threatening to undo years of progress in some health areas. Furthermore, immunization coverage dropped for the first time in ten years, and deaths from tuberculosis and malaria increased. 

Reproductive, maternal and child health

Based on data from 2015-2021, 84% of births worldwide were assisted by skilled health professionals, including medical doctors, nurses and midwives, an increase from 77% in 2008-2014. In sub-Saharan Africa, coverage is 20 percentage points lower. Available data does not reflect the impact of the COVID-19 pandemic on the disruption of services, which may reverse gains made over the past decades. 

The global under-5 mortality rate fell by 14% from 43 deaths per 1,000 live births in 2015 to 37 deaths in 2020, while the global neonatal mortality rate fell to 17 deaths per 1,000 live births in 2020 from 19 deaths in 2015, a 12% reduction. Even with that progress, 5 million children died before reaching their fifth birthday in 2020 alone—down from 5.9 million in 2015. Almost half of those deaths, 2.4 million, occurred in the first month of life. 

The proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern contraceptive methods had stagnated around 77% between 2015 and 2022. However, sub-Sharan Africa has seen the largest increase, by almost 5 percentage points. The ongoing COVID-19 pandemic may lead to a reversal of this trend because of supply-chain disruptions and decreased access to family planning services.

The adolescent birth rate has fallen worldwide from 56 births per 1,000 adolescents aged 15-19 years in 2000 to 45 in 2015 and 41 in 2020. The largest declines are occurring in Central and Southern Asia, from 70 births per 1,000 adolescent women in 2000 to 24 in 2020. Early adolescent childbearing, that occurs in the 10–14-year age group, is much more common in countries in sub-Saharan Africa and Latin America and the Caribbean than in other parts of the world.

Infectious diseases

An estimated 1.5 million new HIV infections and 680,000 deaths from AIDS-related causes occurred in 2020. The incidence of HIV infections globally declined by 39% between 2010 and 2020, far less than the 75% target agreed by the UN General Assembly in 2016. Measures to slow the spread of COVID-19 and the additional strain the new pandemic has placed on health systems have disrupted HIV services.

In 2020, an estimated 9.9 million people fell ill with tuberculosis (TB) worldwide. COVID-19 caused a rise in TB deaths for the first time in a decade, from 1.2 million in 2019 to 1.3 million in 2020 (excluding TB deaths in people with HIV). TB incidence is falling at about 2% per year, which is much slower than the 4–5% annual decline that was required to achieve the 2020 milestones of the End TB Strategy. Between 2018–2020, TB treatment reached 20 million people, only half of the global target. 

There were an estimated 241 million malaria cases and 627,000 malaria deaths worldwide in 2020. This represents about 14 million more cases in 2020 compared to 2019, and 69,000 more deaths. About two thirds of the additional deaths were linked to disruptions in the provision of malaria services during the pandemic. Africa was home to 95% of malaria cases and 96% of malaria deaths.

Despite significant disruptions to health services caused by COVID-19, the global number of people requiring treatment and care for neglected tropical diseases (NTDs) decreased from 2.19 billion in 2010 to 1.73 billion in 2020. Notably, in least developed countries (LDCs), 48% of the total population required NTDs treatment and care in 2020, down from 79% in 2010.

Non-communicable diseases, mental health and environmental risks

Globally, 74% of all deaths in 2019 were caused by noncommunicable diseases (NCDs). The probability of dying from any of the four main NCDs (cardiovascular disease, cancer, diabetes or chronic respiratory disease) between age 30 and 70 declined from 19.9% in 2010 to 17.8% in 2019. This rate of decline is insufficient to meet this SDG target.

Tobacco use rates have declined in 150 countries, contributing to the decline of the global average prevalence rate from 24.4% in 2015 to 22.3% in 2020. In fifteen countries, tobacco use rates are either steady or still going up.

Global suicide death rate declined by 29% from 13.0 deaths per 100,000 population in 2000 to 9.2 deaths in 2019. Although the available data do not show an increase in suicide rates during the first months of the COVID-19 crisis, the pandemic has had a severe impact on the mental health and wellbeing of people around the world. In 2020, there was an 25% increase in prevalence of anxiety and depression worldwide. 

Health Systems and Funding

Infant immunization coverage dropped to 83% in 2020 from 86% in 2019. The COVID-19 pandemic and associated disruptions have resulted in 22.7 million children missing out on vaccinations, 3.7 million more than in 2019 and the highest number since 2005. Moreover, 17.1 million children did not receive vaccines through the routine immunization programme, an increase from 13.6 million. Measles is a highly contagious disease and the current coverage levels of 70% with 2 doses are insufficient to prevent measles outbreaks illness, disability and deaths caused by complications associated with the disease. The human papillomavirus (HPV) vaccine, targeting 9-14 years old girls to prevent cervical cancer, was offered in 111 countries in 2020, but is still yet to reach the poorest countries.

Improvements in essential health services, as measured by the universal health coverage service index, increased from a global average of 45 out of 100 in 2000 to 67 in 2019, with the highest score in Europe and Northern America (81), and the lowest in sub-Saharan Africa (45). The pandemic is likely to halt the continuous progress made in service coverage expansion over the past 20 years as health systems face challenges to ensure the continuity of essential health services.

Even before the pandemic, the global proportion of the population with out-of-pocket health spending exceeding 10% of their household budget was on the rise, exceeding 13%. With the combined health and economic impacts of COVID-19, people are likely to face greater financial constraints to access care and, among those paying out-of-pocket for health, financial hardship is likely to further worsen, particularly among already disadvantaged populations.

Health and care workers remain at the fore front of the COVID-19 pandemic response. In the period between January 2020 and May 2021, the pandemic may have claimed the lives of 115,500 health and care workers, globally.

Data for 2014-2020 show that the density of nursing and midwifery personnel in Northern America remains the highest, over 152 per 10,000 population— close to 4 times the global average of 40 per 10,000 and over 15 times that of sub-Saharan Africa and 8 times that of Northern Africa and Southern Asia. Despite a steady increase in the density of medical doctors per 10,000 population globally, the disparities between regions remains high—from an estimated 40 medical doctors per 10,000 population in Europe, to only 2 in sub-Saharan Africa.

Source: Report of the Secretary-General, Progress towards Sustainable Development Goals- E/2022

Before the COVID-19 pandemic, progress had been made in many health areas, including improving the health of mothers and children, increasing immunization coverage and reducing the incidence of communicable diseases, albeit not fast enough to meet the Goal 3 targets by 2030. The disruption caused by the pandemic has now halted progress and even reversed some gains made. According to a recent survey, substantial disruptions persist more than a year into the pandemic, with about 90 per cent of countries and territories still reporting one or more disruptions to essential health services. Among the health services most extensively affected are those for mental, neurological and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; cancer screening; services for other non-communicable diseases, including hypertension and diabetes; family planning and contraception; urgent dental care; malnutrition; immunization; and malaria.

Reproductive, maternal and child health

According to data from the period 2014–2020, 83 per cent of births worldwide were assisted by skilled health professionals, including medical doctors, nurses and midwives, an increase from 71 per cent in the period from 2007 to 2013. The COVID-19 pandemic may reverse gains in skilled childbirth care coverage and disrupt maternity health services.

The world has made substantial progress towards the goal of ending preventable child deaths, with the global under-5 mortality rate decreasing from 76 to 38 deaths per 1,000 live births between 2000 and 2019. The global neonatal mortality rate fell from 30 deaths to 17 per 1,000 live births in the same period. Even with such progress, 5.2 million children died in 2019 before reaching their fifth birthday, with almost half of those deaths, 2.4 million, occurring in the first month of life. While the full impact of the pandemic on child survival is not yet known, significant disruption to the continued provision of life-saving interventions could stall or even reverse the progress made.

The proportion of women of reproductive age (15 to 49 years) who have their family planning needs met by modern contraceptive methods has remained steady at around 77 per cent between 2015 and 2021, reaching only 56 per cent in sub -Saharan Africa and 52 per cent in Oceania, excluding Australia and New Zealand. The ongoing pandemic may lead to reductions in these figures as a result of supply-chain disruptions and decreased access to family planning services, while the fertility intentions and family planning needs among women of reproductive age may also change.

The global adolescent birth rate has fallen from 56 births per 1,000 adolescent women 15 to 19 years of age in 2000 to 45 births per 1,000 adolescents in 2015 and 41 per 1,000 in 2020. The declines varied considerably across regions, with the largest decrease in Central and Southern Asia from 70 births per 1,000 adolescents in 2000 to 24 births per 1,000 in 2020.

Infectious diseases

While the rate of new HIV infections declined from 0.48 infections pe r 1,000 uninfected population among adults (15 to 49 years of age) to 0.37 per 1,000 between 2010 and 2019, it remained far higher than the global target for 2020. The largest decrease was in sub-Saharan Africa, the region with the highest numbers of people living with HIV. Major inequalities remain in access to HIV prevention, testing and treatment services across regions, countries, and sub-populations within countries. There is evidence to suggest that the COVID-19 pandemic has caused considerable disruption to HIV services, including testing, initiation of treatment, voluntary medical male circumcision and pre-exposure prophylaxis.

In 2019, an estimated 10 million people fell ill with tuberculosis, of whom 56 per cent were adult men, 32 per cent adult women, 12 per cent children and 8.2 per cent people living with HIV, making it the leading cause of death from a single infectious agent. Globally, the incidence of tuberculosis fell from 174 new and relapse cases per 100,000 population in 2000 to 130 cases per 100,000 in 2019, a 25 per cent decline over the period, with the tuberculosis mortality rate among HIV-negative people falling by 45 per cent in the same period. Although the disease burden is decreasing, large gaps in detection and treatment persist, and the current pace of progress is not fast enough to meet the target of ending tuberculosis by 2030. Drug - resistant tuberculosis is a continuing threat: in 2019, there were 465,000 new cases with resistance to rifampicin, the most effective first-line drug, and 78 per cent of those infected with tuberculosis had a multidrug-resistant strain. As a result of the COVID-19 pandemic, an estimated 1.4 million fewer people received necessary care for tuberculosis during 2020 compared with the previous year, a reduction in treatment levels of 21 per cent.

Between 2015 and 2019, the incidence of malaria plateaued at around 57 cases per 1,000 people at risk. The target of the World Health Organization for reductions in malaria case incidence in 2020 will be missed by 37 per cent. In 2019, there were a total of 229 million malaria cases worldwide, with the disease claiming some 409,000 lives. Gaps in funding and in access to life-saving tools are undermining global efforts to curb the disease, and the COVID-19 pandemic is expected to set the fight back even further.

The use of the hepatitis B vaccine in infants has reduced the incidence of new chronic hepatitis B infections considerably. The proportion of children under 5 years of age who became chronically infected fell from 4.7 per cent in the pre-vaccination era to 0.9 per cent in 2020. Worldwide, the 2020 target of 1 per cent seroprevalence in children under 5 years of age has been met. Additional efforts for increasing coverage are needed to achieve the Goal target of 0.1 per cent seroprevalence by 2030.

In 2019, 1.74 billion people were reported to have required mass or individual treatment and care for neglected tropical diseases, down from 2.19 billion in 2010 and 12 million fewer than the figure reported for 2018. The lower number of people requiring interventions is largely the result of having eliminated at least one neglected tropical disease in 42 countries and territories since 2010.

Non-communicable diseases, mental health and environmental risks

Globally, 74 per cent of all deaths in 2019 were caused by non-communicable diseases. The probability of dying from any of the four main non-communicable diseases (cardiovascular disease, cancer, diabetes or chronic respiratory disease) between 30 and 70 years of age decreased from 19.9 per cent in 2010 to 17.8 per cent in 2019. The rate of decline is insufficient to meet the Goal target. The COVID-19 pandemic has underscored the need for further attention to interventions in non-communicable diseases, as people with underlying non-communicable diseases are at higher risk of severe illness and death from the COVID-19 virus.

About 700,000 suicide deaths occurred in 2019. The global suicide death rate declined by 29 per cent, from 13 deaths per 100,000 population in 2000 to 9.2 deaths per 100,000 in 2019.

In 2019, global alcohol consumption was 5.8 litres of pure alcohol per person 15 years of age or older, a 5 per cent decrease from 6.1 litres in 2010.

The global rate of mortality from road traffic injuries fell by 8.3 per cent, from 18.1 deaths per 100,000 population in 2010 to 16.7 deaths per 100,000 in 2019. Nevertheless, 1.3 million people worldwide died in road traffic accidents in 2019, 75 per cent of whom were boys and men. Low-income countries and territories had lower rates of vehicle ownership than in high-income countries and territories, yet a death rate more than 3.5 times higher. Road traffic injuries were the leading cause of death among young people 15 to 29 years of age worldwide.

The global prevalence of tobacco uses among men declined from 50 per cent in 2000 to 38.6 per cent in 2018, and among women from 16.7 per cent in 2000 to 8.5 per cent in 2018. Even so, the number of people dying from a tobacco-related illness was estimated to be more than 8.1 million in 2017.

Unintentional poisonings were responsible for more than 84,000 deaths in 2019. Although the number of such deaths has steadily declined since 2000, mortality rates continue to be relatively high in low-income countries and territories, where they are more than twice the global average. One third of all deaths from unintentional poisonings occurred in sub-Saharan Africa.

Health Systems and Funding

Immunization is one of the world’s most successful and cost-effective health interventions. While vaccination coverage among infants increased from 72 per cent in 2000 to 85 per cent in 2015 before stalling until 2019, an estimated 19.7 million children did not receive essential vaccines during the first year of their life in 2019. In addition, global coverage levels for the pneumococcal conjugate vaccine, which has the potential to significantly reduce the incidence of pneumonia, have yet to reach 50 per cent. Measles is a highly contagious disease, and the 71 per cent coverage of the two-dose vaccine in 2019 was insufficient to prevent outbreaks of measles.

Improvements in essential health services, as measured by the universal health coverage service coverage index, increased from a global average of 45 out of 100 in the year 2000 to 66 in 2017. Low-income countries and territories experienced the greatest progress, driven mainly by interventions for infectious diseases. However, the pace of progress has slowed since 2010, and the poorest countries and territories and those affected by conflict are generally lagging furthest behind. The COVID-19 pandemic is derailing progress even further.

Before the pandemic, an estimated 927 million people, or 12.7 per cent of the global population, made out-of-pocket health-care payments amounting to more than 10 per cent of their household budgets, and for 209 million people, or 3 per cent, their share of health-care spending exceeded 25 per cent of their household budgets, posing an even greater threat to spending on other essential goods and services such as food and education.

ODA for basic health from all official donors has increased by 59 per cent in real terms since 2010, reaching $11 billion in 2019. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the Gavi Alliance and the United States of America accounted for more than half of that total, providing $2.4 billion, $1.9 billion and $1.8 billion, respectively. In 2019, $3.4 billion was spent on basic health care, $2.2 billion on infectious disease control, excluding HIV/AIDS, and $2.2 billion on malaria control.

Health workers are on the front line of the COVID-19 pandemic response. Countries and territories, especially those with a limited health workforce, are further constrained with regard to the delivery of essential health services. On the basis of data from the period 2013–2018, the density of nursing and midwifery personnel in Northern America is more than 150 per 10,000 population, which is more than 15 times that in sub-Saharan African and 8 times that in Northern Africa and Southern Asia. The density of medical doctors in Northern America, Oceania and Central Asia remains around 25 per 10,000 population, compared to 2 per 10,000 population in sub-Saharan African.

Source: Progress towards the Sustainable Development Goals - E/2021/58

Progress in many health areas continues, but the rate of improvement has slowed and will not be sufficient to meet most of the Goal 3 targets. The pandemic is devastating health systems globally and threatens health outcomes already achieved. Most countries, in particular poor ones, have insufficient health facilities, medical supplies and health-care workers to meet the surge in demand. Countries need comprehensive health strategies and increased spending on health systems to meet urgent needs and protect health workers, while a global coordinated effort is needed to support countries in need.

Reproductive, maternal, newborn and child health

Globally, an estimated 295,000 maternal deaths occurred in 2017, resulting in an overall maternal mortality ratio of 211 maternal deaths per 100,000 live births, a 4 per cent reduction compared with 2015 and a 38 per cent reduction compared with 2000. The majority of the deaths occurred in low- and lower-middle-income countries, and roughly 66 per cent of them occurred in sub-Saharan Africa. At the current pace of progress, the world will fall short of the target of the Goal.

Worldwide, 81 per cent of births were assisted by skilled health professionals in the period 2014–2019, up from 64 per cent in the period 2000–2005, with Central Asia, Eastern Asia, Western Asia, Northern America and Europe nearly achieving universal coverage.

The concerted effort of the global community continues to reduce preventable child deaths, from a mortality rate of 76 deaths per 1,000 live births in children under 5 years of age in 2000 to 42 in 2015 to 39 in 2018. Notwithstanding the progress, some 5.3 million children died before reaching 5 years of age in 2018 alone, and nearly half of those deaths, or 2.5 million, occurred in the first month of life.

Globally, the proportion of women of reproductive age (15 to 49 years) whose family planning needs were met by modern contraceptive methods increased only slightly, from 75.7 per cent in 2010 to around 77 per cent from 2015 to 2020, reaching only 56 per cent in sub-Saharan Africa and 52 per cent in Oceania (excluding Australia and New Zealand).

Worldwide, the adolescent birth rate fell steadily, from 45 births per 1,000 women 15 to 19 years of age in 2015 to 41 per 1,000 in 2020, with the highest rate, 101 per 1,000, in sub-Saharan Africa.

Infectious diseases

In 2018, there were an estimated 1.7 million new HIV infections, an incidence rate of 0.24 per 1,000 uninfected persons among the total population, almost unchanged from the level of 0.26 per 1,000 in 2015, putting the world off track in achieving the Sustainable Development Goal target. One in three of new HIV infections globally occurred among women 15 to 49 years of age in sub-Saharan Africa.

In 2018, an estimated 10 million persons fell ill with tuberculosis (89 per cent were adults, 63 per cent were men and 8.6 per cent were people living with HIV). The incidence of tuberculosis declined, from 141 new and relapse cases per 100,000 persons in 2015 to 132 in 2018. The tuberculosis mortality rate among HIV-negative people fell by 8.3 per cent in the same period. However, large gaps in detection and treatment persist, and the current pace of progress is not fast enough to meet the target of ending the epidemic by 2030. Drug-resistant tuberculosis is also a continuing threat.

After many years of impressive reductions in the global malaria burden, progress has stalled. Globally, malaria incidence (the number of cases per 1,000 persons) fell, from 81 in 2000 to 57 in 2014, and remained at a similar level throughout 2018. The world is not on a trajectory to achieve the Sustainable Development Goal target of ending malaria. 

The use of the hepatitis B vaccine in infants has reduced the incidence of new chronic hepatitis B virus infections considerably. The proportion of children under 5 years of age who became chronically infected fell, from 4.7 per cent in the pre-vaccine era to 0.9 per cent in 2018.

In 2018, 1.76 billion persons were reported to have required mass or individual treatment and care for neglected tropical diseases, down from 1.80 billion in 2015 and 2.19 billion in 2010. The 530 million persons requiring treatment and care in least developed countries represented 52 per cent of the population of those countries, down from 78 per cent in 2010. Progress has been driven largely by the fact that at least one neglected tropical disease has been eliminated in 40 countries.

Non-communicable diseases, mental health and environmental risks

The probability of dying from cardiovascular disease, cancer, diabetes or chronic respiratory disease at between 30 and 70 years of age decreased, from 19 per cent in 2010 to 18 per cent in 2016, a rate of decline that was insufficient to meet the Sustainable Development Goal target.

Based on 2016 data, nearly 800,000 persons died every year by suicide, and 79 per cent of global suicides occurred in low- and middle-income countries.

The number of persons dying of tobacco-related illnesses was estimated to be 8.1 million in 2017. The global prevalence of tobacco use among men was 38.6 per cent in 2018, compared with 8.5 per cent among women.

In 2016, indoor (household) and outdoor (ambient) air pollution caused some 7 million deaths worldwide. Inadequate water, sanitation and hygiene led to a total of 870,000 deaths in the same year.

Health systems and funding

Immunization is one of the world’s most successful and cost-effective health interventions. While vaccination coverage among infants increased, from 72 to 85 to 86 per cent in 2000, 2015 and 2018, respectively, an estimated 19.4 million children did not receive essential vaccines in their first year of life. In addition, global coverage levels of the pneumococcal conjugate vaccine, which has the potential to reduce pneumonia significantly, have yet to reach 50 per cent coverage. Measles is a highly contagious disease, and the 69 per cent coverage of the two-dose vaccine in 2018 was insufficient to prevent a measles outbreak.

In 2017, only around one third to half of the global population was covered by essential health services. If current trends continue, only 39 to 63 per cent of the global population will be covered by essential health services by 2030.

The proportion of the population spending more than 10 per cent of its household budget on out-of-pocket payment for health services increased continuously, from 9.4 to 12.7 per cent (927 million persons), between 2000 and 2015. At current rates, the proportion will reach 12.9 per cent, equal to 1 billion persons, in 2020. Nearly 90 million persons were pushed into extreme poverty owing to out-of-pocket medical expenses.

Official development assistance (ODA) for basic health from all donors increased by 41 per cent in real terms since 2010, reaching $10 billion in 2018. In 2018, about $1.7 billion was spent on malaria control, $0.8 billion on tuberculosis control and $1.9 billion on other infectious diseases, excluding HIV/AIDS.

Based on data from the period 2013–2018, globally, women make up more than 76 per cent of medical doctors and nursing personnel combined, but compose only slightly more than 40 per cent of medical doctors and nearly 90 per cent of nursing personnel.

In 2019, 166 countries reported the status of their capacity to implement the International Health Regulations with regard to preparedness for detecting, reporting and responding to health emergencies such as COVID-19. Analysis shows that steady progress has been made in nearly every core capacity of the Regulations, except in human resources, compared with 2018.

Source: Progress towards the Sustainable Development Goals, Report of the Secretary-General, https://undocs.org/en/E/2020/57

Major progress has been made in improving the health of millions of people, increasing life expectancy, reducing maternal and child mortality and fighting against leading communicable diseases. However, progress has stalled or is not happening fast enough with regard to addressing major diseases, such as malaria and tuberculosis, while at least half the global population does not have access to essential health services and many of those who do suffer undue financial hardship, potentially pushing them into extreme poverty. Concerted efforts are required to achieve universal health coverage and sustainable financing for health, to address the growing burden of non-communicable diseases, including mental health, and to tackle antimicrobial resistance and determinants of health such as air pollution and inadequate water and sanitation.

Reproductive, maternal, newborn and child health

• An estimated 303,000 women around the world died due to complications of pregnancy and childbirth in 2015. Almost all of these deaths occurred in low- and middle-income countries, and almost two thirds of those were in sub-Saharan Africa. These deaths are preventable with appropriate management and care. Globally in 2018, 81 per cent of births took place with the assistance of a skilled birth attendant, a significant improvement from 69 per cent in 2012. Coverage of skilled birth attendants in 2018 was only 59 per cent in sub-Saharan Africa.
• The under-5 mortality rate fell to 39 deaths per 1,000 live births in 2017, a 6.7 per cent reduction from 42 deaths in 2015, and an overall reduction of 49 per cent from 77 deaths per 1,000 live births in 2000. The total number of under-5 deaths dropped to 5.4 million in 2017 from 9.8 million in 2000. Still, most of these deaths were from preventable causes and almost half, or 2.5 million, occurred in the first month of life – the most crucial period for child survival. The global neonatal mortality rate has continued to decline after a long downward trend from 31 deaths per 1,000 live births in 2000 to 18 in 2017, a 41 per cent reduction.
• Immunization saves millions of lives and is widely recognized as one of the world’s most successful and cost-effective health interventions. Coverage of the required three doses of the vaccine that prevents diphtheria, tetanus and pertussis increased from 72 per cent in 2000 to 85 per cent in 2015 and has remained unchanged between 2015 and 2017. An estimated 19.9 million children did not receive the vaccines during the first year of life, putting them at serious risk of these potentially fatal diseases. The global coverage of pneumococcal conjugate vaccine, which has the potential to significantly reduce deaths in children under age of 5, has yet to reach 50 per cent. Two doses of the measles vaccine are required to prevent the disease and the illnesses, disabilities and deaths caused by complications associated with it. Coverage with the second dose of measles vaccine increased from 59 per cent in 2015 to 67 per cent in 2017, but that is still insufficient to prevent this highly contagious disease.
• Expanding access to modern contraceptive methods is essential to ensuring universal access to sexual and reproductive health-care services. Globally, the proportion of women of reproductive age (15 to 49 years old) who have their need for family planning satisfied with modern contraceptive methods has continued to increase slowly, from 74 per cent in 2000 to 76 per cent in 2019.
• Adolescent fertility declined from 56 births per 1,000 adolescent women in 2000 to 45 births in 2015 and 44 births in 2019. The level of adolescent fertility has remained high in sub-Saharan Africa, at 101 births per 1,000 adolescent women.

Infectious diseases

• Strong and steady domestic and international commitment and funding has fuelled an acceleration of evidence-informed HIV prevention, testing and treatment programmes. As a result, the incidence of HIV in sub-Saharan Africa (among adults aged 15 to 49) has declined by 37 per cent, from 3.39 infections per 1,000 uninfected people in 2010 to 2.49 in 2015 and 2.14 in 2017. However, the rate of global HIV incidence among adults aged 15 to 49 declined from 0.44 to 0.40 between 2015 and 2017 and overall by 22 per cent between 2010 and 2017, well short of the declines required to meet 2020 and 2030 targets.
• Tuberculosis remains a leading cause of ill health and death. In 2017, an estimated 10 million people fell ill with tuberculosis. The burden is falling globally: incidence of tuberculosis has continued to decline from 170 new and relapse cases per 100,000 people in 2000 to 140 in 2015, and 134 in 2017; and the tuberculosis mortality rate among HIV-negative people fell by 42 per cent between 2000 and 2017. However, large gaps in detection and treatment persist and the current pace of progress is not fast enough to meet the Sustainable Development Goal target, with drug-resistant tuberculosis remaining a continuing threat.
• After more than a decade of steady advances in fighting malaria, progress has stalled.  No significant gains were made in reducing the number of malaria cases worldwide in the period 2015–2017. Sub-Saharan Africa continues to carry the heaviest burden of disease, accounting for more than 90 per cent of the global malaria burden. Worryingly, there were an estimated 3.5 million more malaria cases in the 10 highest-burden African countries in 2017 compared with the previous year.
• In 2015, an estimated 325 million people worldwide were living with hepatitis B virus or hepatitis C virus infection. The widespread use of hepatitis B vaccine in infants has considerably reduced the incidence of new chronic HBV infections, as reflected by the decline in hepatitis B prevalence among children under 5 years of age, from 4.7 per cent in the pre-vaccine era to 0.8 per cent in 2017.
• In 2017, 1.58 billion people were reported as requiring mass or individual treatment and care for neglected tropical diseases, down from 1.63 billion in 2015 and 2.03 billion in 2010. Improved surveillance meant that further populations requiring interventions against such diseases were identified in 2017. The 522 million people requiring treatment and care in least developed countries represented 52 per cent of those countries’ populations, down from 584 million in 2015.

Non-communicable diseases, mental health and environmental risks

• The probability of dying from any of the four main non-communicable diseases – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – between the ages of 30 and 70 was 18 per cent in 2016. The risk remains markedly higher for men globally, at 21.6 per cent, compared with 15 per cent for women.
• Progress has been made in reducing the global suicide rate (from 12.9 per 100,000 in 2000 to 10.6 per 100,000 in 2016). However, suicide remains the second-highest cause of death among people aged 15 to 29 globally, with 79 per cent of suicides found in low- and middle-income countries in 2016.
• The prevalence of tobacco use declined from 27 per cent in 2000 to 20 per cent in 2016. Prevalence fell faster for women, from 11 per cent in 2000 to 6 per cent in 2016, compared with men: prevalence in men only fell from 43 per cent to 34 per cent. Despite the positive trends, the number of people dying from a tobacco-related illness was estimated to be more than 8.1 million in 2017.
• The number of road traffic deaths climbed from 1.31 million in 2013 to 1.35 million in 2016. Road traffic injury is the leading cause of death for children and young adults aged 5 to 29.
• Air pollution, both ambient and household, increases the risk of cardiovascular and respiratory disease and, in 2016, led to some 7 million deaths worldwide. Sub-Saharan Africa and most of Asia and Oceania (excluding Australia/New Zealand) have the highest mortality rates associated with air pollution, as a large proportion of the population still rely on polluting fuels and technologies for cooking.
• Inadequate and unsafe drinking water, sanitation and hygiene is linked to 60 per cent of the disease burden from diarrhoea, 100 per cent of the burden from infections with soil-transmitted helminths and 16 per cent of the burden from protein-energy malnutrition, leading to a total of 870,000 deaths in 2016 from the three conditions.

Health systems and funding

• Official development assistance (ODA) for basic health from all donors increased by 61 per cent in real terms since 2010 and reached $10.7 billion in 2017. In 2017, some $2.0 billion was spent on malaria control, $1.0 billion on tuberculosis control and $2.3 billion on other infectious diseases, excluding HIV/AIDS.
• Available data from 2013 to 2018 indicate that close to 40 per cent of all countries had fewer than 10 medical doctors per 10,000 people, and more than 55 per cent had fewer than 40 nursing and midwifery personnel per 10,000 people. All least developed countries had fewer than 10 medical doctors and fewer than 5 dentists and 5 pharmacists per 10,000 people, and 98 per cent had fewer than 40 nursing and midwifery personnel per 10,000 people.

Source: Report of the Secretary-General, Special edition: progress towards the Sustainable Development Goals

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

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.

Infectious diseases

• 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

• 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.

Source: Report of the Secretary-General, "Progress towards the Sustainable Development Goals", E/2016/75