from to

Box 1.1
Life expectancy improvements during the MDG era
Overall trends in life expectancy at birth provide one partial, but important, summary
of the health improvements since 1990 (Figure 1.2). Life expectancy increased at a
faster rate in most regions from 2000 onwards and, overall, there was a global increase
of 6.8 years in life expectancy from 1990 to 2015, with even larger increases of 9.3
years in the African Region and the South-East Asia Region. This corresponds to an
average increase in global life expectancy at birth of 2.7 years per decade, which is
faster than the increases in today’s high-income countries over the past century. 45
The gap between African life expectancy and European life expectancy has narrowed
by four years in the MDG period.
Figure 1.2
Trends in average life expectancy at birth, by WHO region and globally,
1990–2015 46
Life expectancy at birth (years)
AFR AMR SEAR EUR EMR WPR Global
80
75
70
65
60
55
50
45
1990 1995 2000 2005 2010 2015
All major causes of deaths contributed to these huge gains. For instance, WHO
calculations indicate that compared to the numbers of deaths in 2012 that would have
been expected if death rates in 2000 had applied, there were 42% fewer maternal
and child deaths, 36% fewer deaths due to HIV, TB and malaria and around 7% fewer
due to other causes, including the main NCDs and injuries.
mortality due to HIV, malaria, TB or child mortality or NCD
deaths between ages 30 and 70 – depending on their
relevant priorities. A 40% reduction in premature mortality
by 2030 would be achievable by: averting two thirds of
maternal and child deaths; two thirds of HIV, TB and malaria
deaths; one third of premature deaths from NCDs; and one
third of deaths from other causes (other communicable
diseases, undernutrition and injuries). These challenging
subtargets would halve under-50 deaths, avert one third
of the (mainly NCD) deaths at ages 50–69, and so prevent
40% of under-70 deaths. Such a reduction would result in
a global increase in life expectancy of five years, assuming
mortality rates at age 70 and over also decline, as projected
by WHO. Concerted action to reduce NCD deaths before
age 70 is likely to also reduce NCD death rates for people
age 70 and over.
satisfaction: a reflective assessment on a person’s life or
some specific aspect of it; (ii) affective or hedonic: a person’s
feelings or emotional states, typically measured with
reference to a particular point in time; and (iii) eudemonic:
a sense of meaning and purpose in life, autonomy and
self-realization. 51 It may, however, be too early to adopt an
indicator as part of the SDG monitoring.
Monitoring equity
Equity is at the heart of the SDGs, which are founded on
the concept of “leaving no one behind”. The overall health
SDG calls for healthy lives for all at all ages, positioning
equity as a core, cross-cutting theme, while SDG 10 calls
for the reduction of inequality within and among countries,
and Target 3.8 calls for the establishment of UHC, founded
on the principle of equal access to health without risk of
financial hardship. A movement towards equity in health
depends, at least in part, on strong health and health
financing information systems that collect disaggregated
data about all health areas and health expenditures. This
fact is recognized in Target 17.8, which calls for efforts to
build capacity to enable data disaggregation by a number
of stratifying factors, including income, gender, age, race,
ethnicity, etc. Disaggregated data enable policy-makers
to identify vulnerable populations and direct resources
accordingly.
MDGs were focused on national progress and on specific
populations, notably mothers and children and people
affected by HIV, TB and malaria. In contrast, the health
SDGs address health and well-being at all ages, including
in newborns and children, adolescents, adult women and
men, and older persons. Not only is the goal to be monitored
much broader, but it is also extended over time, and will thus
require a comprehensive, life course approach. Needless to
say, such an approach will also be relevant in monitoring
progress towards UHC.
The “promote well-being” component of the overall health
SDG also presents an interesting monitoring challenge, as
does health Target 3.5, which refers to “promote mental
health and well-being”. While health and self-reported
well-being are intricately related (health status is a critical
determinant of subjective well-being, for example) they
are not synonymous. 47,48,49,50 Measurement of self-reported
well-being shares many of problems encountered in the
measurement of non-fatal health outcomes. The field of
measuring subjective well-being is rapidly expanding and
distinguishes different aspects including: (i) evaluative life
FROM MDGs TO SDGs: GENERAL INTRODUCTION
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