Dashboard map for 2022 SDG Index Goal #3 ratings. Data source: sdgindex.org
Maternal mortality rate (per 100,000 live births)
This indicator measures the estimated number of women between the ages of 15 and 49 dying from pregnancy-related causes whilst pregnant, or within 42 days of the pregnancy’s termination. The long-term aim is 3.4 deaths from these causes per 100,000 live births. Globally, the estimated maternal mortality ratio was 211 per 100,000 live births as of 2017, well above the long-term goal.
The maternal mortality rate is a proxy for the quality of a healthcare system. Complications due to pregnancy and childbirth can be common, but with proper care, healthcare professionals can handle difficulties, preventing the worst outcomes. Without proper healthcare available, it’s more difficult to prevent, diagnose and treat any complications arising due to pregnancy.
The same is true here for other indicators already mentioned which have a strong correlation between a red score and LDCs i.e., OECD countries will shoulder the responsibility on behalf of the LDCs in the form of giving 0.7% of gross income as foreign aid. This giving will afford an army of skilled birth attendants in rural areas, as well as affording medical techniques taken for granted in the developed world e.g., blood transfusions, asepsis and preventive prenatal care. A skilled health attendant can curtail these risks by caring for the mother during the pregnancy, childbirth, and postpartum period, including any postpartum bleeding or obstructed labours.
If aid flows to the LDCs and other aid recipient countries, the global maternal mortality rate can drop, achieving a measure which had a dedicated Millennium Development Goals (MDG #5 - Improve maternal health).
Summary: For OECD country readers, annually give 0.7% of your gross income as aid, aiming to reduce the global maternal mortality rate to 3.4 per 100,000 live births by 2030.
Neonatal mortality rate (per 1,000 live births)
This indicator measures the number of newborns per 1,000 live births who die within 28 days following birth, with a long-term aim of a neonatal mortality rate of 1.1 per 1,000 live births.
The absence of healthcare raises the risk factors for neonatal mortality. As with the prior indicator, such is the priority of infant mortality, it warranted its own Millennium Development Goal (MDG #4 - Reduce child mortality).
The correlation between extreme poverty and high birth rates also exacerbates neonatal mortality. As we reduce extreme poverty, birth rates will in turn reduce, as is the demographic trend observed worldwide. Therefore, we must encourage gender equality, women’s empowerment in the labour force, as well as educating girls.
The 2022 SDG Index map for this indicator is uniform with the prior indicator, again highlighting the link between mortality rates for both mothers and neonates. Again, there’s a strong correlation between LDCs and those countries with red scores.
Thus, the responsibility again lies with the OECD countries to finance improvements in healthcare in the LDCs. The 0.7% of gross income of OECD citizens will finance the outreach of a mass workforce of skilled community health workers, with resources on hand to meet the needs of rural areas.
Summary: For OECD country readers, annually give 0.7% of your gross income as aid, aiming to reduce the global neonatal mortality rate to less than 1.1 per 1,000 live births by 2030.
Mortality rate, under 5 per 1,000 deaths
The distinction between this indicator and the previous is age - this indicator measures the number of children under 5 per 1,000 who’ll die before reaching age 5. The long-term aim for this indicator is 2.6 deaths for children under 5 per 1,000, down from the 2019 rate of 37.7. As such, this measure of children under 5 also includes neonatal and infant mortality.
The leading causes are premature births and infections, especially pneumonia, diarrhoea and malaria. But the prevention measures are alike to the two prior indicators i.e., we need to finance public health needs. Most child deaths are preventable, and cheap to treat and prevent, yet the cost is irrelevant without the meagre funding forthcoming. We therefore need to fund vaccines, antibiotics, mosquito nets, fluid replacement, promotion of breastfeeding and handwashing, as well as improved sanitation and drinking water facilities.
A meagre 0.7% of your income will make you a literal hero, saving lives - without a cape, cowl or superpowers - just a bank account, a charity, and a device to make the donation. Rather than treating a diarrheal infection or making the trip to Africa, you pay someone to do it on your behalf, then get to go to bed knowing you’ve saved the lives of helpless children.
Summary: For OECD country readers, annually give 0.7% of your gross income as aid, aiming to reduce the global under-5 mortality rate to less than 2.6 per 1,000 live births by 2030.
Incidence of tuberculosis (per 100,000 population)
This indicator estimates the number of cases per 100,000 people with either new or relapsed cases of TB, inclusive of cases for those also living with HIV. The long-term goal is 0 cases of TB per 100,000, from a current global rate of 127 per 100,000 in 2020.
TB’s an infectious disease caused by a bacterium, Mycobacterium tuberculosis affecting the lungs. Symptoms include coughing bloody mucus, fever, and night sweats, though TB cases can be asymptomatic whilst contagious. The bacterium spreads by aerosol droplets micrometres wide.
Before the COVID-19 pandemic, TB was the highest cause of death from an infectious disease. A quarter of the global population may carry the disease in its latent form, with an annual rate of new infections of 1%. An estimated 10 million people have active cases worldwide, resulting in 1.5 million deaths, close to half occurring in Southeast Asia, and a quarter in Africa. TB is a disease of poverty, exacerbated by slum living, as well as malnutrition and poor sanitation conditions.
As suggested in the indicator’s definition, cases of TB often occur alongside HIV/AIDS. We’ll address HIV/AIDS in a later SDG #3 indicator, but taking preventive measures for HIV infection will affect the degree to which one may be at risk of TB.
In many countries, the diagnosis and testing of TB can be difficult, slow, or unavailable. Many poor countries, or poor parts of middle-income countries, are without affordable x-ray facilities, or affordable and accessible testing based on sputum cultures or other means.
A preventive measure is keeping from contact with known TB cases. You’ll be at greater risk if your immune system is low, a risk factor often caused by the generalities of poverty. Enter the responsibility of high-income readers to improve poverty in all its dimensions via aid.
Prevention is difficult, due to the poverty conditions TB thrives in, so treatment may be our best option. The vaccine for TB is the most widely used in the world, with an estimated 88% of all children vaccinated for TB, though the vaccine has less than complete efficacy.
TB can be treated with antibiotics, but resistance has become an issue with a growing prevalence of drug-resistant cases. TB carries with it many factors affecting successful prevention and treatment, sometimes with complexity on a scale addressed by public health efforts of national governments, or international agencies like the WHO.
For new cases of active TB, the patient should seek medical care where available, to undergo a regimen of antibiotic medications for up to six months. For recurrent cases of TB, a medical professional will need to find out which antibiotics in a treatment regimen are proving resistant. Testing may need to investigate whether the strain of TB in one’s system is multi-drug resistant, whereby the patient may need the other antibiotics in their regimen which are yet to prove resistant for a longer course up to 1-2 years.
If you’re finding it challenging to scrounge enough money to feed your family and yourself, having ready access to testing and treatment - if paid out of pocket, in contrast to government-funded - could be crippling to a household. You see how important it is for us to fund organisations like the WHO to carry out the work either households or national governments are unable to. Humanity has been battling TB since antiquity - a formidable foe. But we can manage TB at the population level if resourced and financed, as the rich countries did within their societies. The aid dollars we’ve been discussing from our rich country readers are going to go toward TB to aid public health efforts. The path to achieving the long-term aim of this indicator lies in the larger vantage of SDG #3 i.e., healthcare for all.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming to end TB by 2030.
For developing country readers:
vaccinate for TB, including your children
if symptomatic, seek diagnosis if available and affordable
if diagnosed, seek treatment, where available and affordable
New HIV infections (per 1,000 uninfected population)
The issue of HIV, alongside malaria, had its own Millennium Development Goal, MDG #6 (Combat HIV/AIDS, malaria, and other diseases). This indicator is aiming to eliminate new infections by 2030.
In the past decade, global deaths from AIDS have halved, yet can still kill a million people a year. In some countries, AIDS is the leading cause of death, resulting in a quarter of all deaths. The highest concentration of new HIV cases is in sub-Saharan Africa, below the equator. Several of the southernmost African countries are now middle-income countries e.g., South Africa, Namibia, and Botswana, yet each are very much in the grip of HIV/AIDS.
A cure is yet to be discovered, but the treatment or management of HIV/AIDS, when financed and resourced, is encouraging, via the use of antiretroviral drugs. These drugs are inexpensive to manufacture, but even their modest cost may be high for households living in extreme poverty. A national healthcare budget must cover the cost of these drugs, though when national governments are too poor to do so, we turn to the international donor community to step in.
For middle-income countries with high rates of new HIV infections, the message is the same as public health promotion efforts. We first need to acknowledge the infection known as AIDS is caused by a virus, therefore is a transmissible infection, spread via blood, semen, vaginal lubrication, and pre-ejaculate. The use of condoms, whether one’s sexual partner is a known carrier of the virus or unknown, is essential. A diagnosis of HIV/AIDS can be sought via a sample of either blood serum, saliva, or urine. If one suspects they may have had a sexual encounter with a carrier of the virus, it’s an opportunity to prevent further spread, and to receive management of the worst effects of AIDS if transmission has occurred. If you’re a carrier of the virus, and planning a family, transmission can occur to the baby via the course of pregnancy, childbirth, and the expression of breastmilk. If you suspect you may have been exposed to the virus, and are in a region where the following is available and affordable, you could use the treatment known as post-exposure prophylaxis, which could prevent exposure to the virus from turning into AIDS.
Though a vaccine is yet to be discovered for HIV/AIDS, with financing for medical research, a breakthrough may occur before 2030. Antiretroviral drugs are available for treatment for those who've received a diagnosis of HIV/AIDS.
For OECD readers, it’s time to mobilise your 0.7% of gross individual income. Some circumstances of poverty offer more of a fertile ground for the virus’ spread than in more affluent countries. Immune systems are already low for those living with malnutrition or absent healthcare, compounding the effects of a virus targeting the immune system. We’ve seen earlier how active infection by TB puts individuals living with HIV/AIDS at increased risk. Subpar sanitation conditions in medical settings could further place individuals at risk of transmission. Also, many sub-Saharan African countries may have cultural or religious attitudes hindering the use of condoms. As such, public health promotion efforts need funding to reach these communities to overcome stigmas and misperceptions.
Universal health care, per the aims of SDG #3, must be made available and affordable to all. Healthcare systems can then observe signs and symptoms, health promotion efforts can mitigate transmission via behavioural change, and we can champion the further financing of medical research.
This is an issue of financing. From the financing everything flows - from research, prevention, and treatment. We can end new cases of HIV/AIDS by 2030, but the key variable is the dollars.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming to end new cases of HIV by 2030.
For developing country readers:
use condoms
if you suspect you may have been exposed to HIV, get tested
if you receive a positive diagnosis, seek treatment with antiretroviral drugs, where affordable
Age-standardised death rate due to cardiovascular disease, cancer, diabetes, or chronic respiratory disease in adults aged 30-70 years (%)
Whereas TB and HIV are infectious diseases, involving the spread of a pathogen, the diseases for this indicator are all non-communicable diseases (NCDs), with altogether different risk factors.
Let’s profile the diseases to see what you can do to protect against dying from them before you turn 70, per the aim of this indicator.
Cardiovascular systems circulate blood throughout our bodies, transporting nutrients, hormones, and oxygen to and from cells, as well as aiding in our immune system, regulating our body temperature, and maintaining homeostasis.
Cardiovascular diseases are the leading cause of death in the world, by quite a margin, followed by cancer, then respiratory disease and diabetes, all of which we’ll soon address. Cardiovascular diseases manifest in many forms, from the restriction of blood supply in the arteries of the heart, caused by a build-up of plaque. This can hinder blood flow to the heart, which can result in a heart attack. Stroke is the hindrance of necessary blood flow to the brain, depriving the death of some brain cells.
Causes of cardiovascular disease include high blood pressure, which you can be alerted to by a sphygmomanometer, the inflatable cuff fitted to your arm by doctors and nurses. Smoking is a cause, as is lack of exercise, obesity, high cholesterol, poor diet, drinking too much alcohol, and diabetes.
How do you prevent cardiovascular disease? Abstain from smoking, eat healthily, drink alcohol in moderation or abstain altogether, and exercise. These are hackneyed commonplaces, seeming so obvious and simple, yet they so easily elude us, essential for healthy functioning. Depending on your doctor’s advice, you may need treatment to address high blood pressure.
The second-leading killer worldwide is cancer, the abnormal growth of cells into neighbouring tissues, which can then metastasise throughout the body. This contrasts with benign tumours, which leave neighbouring cells alone. The drivers of this disease are known as carcinogens, which include tobacco smoking, the cause of close to a quarter of all cancer deaths. Other major causes match with the risk factors for cardiovascular disease, including obesity, diet, sedentary lifestyles, alcohol abuse and radiation.
70% of all cancer deaths occur in low and middle-income countries. A third of the prevalence of cancer in these countries is due to hepatitis, the human papillomavirus, and a couple other bacterial and viral infections, including HIV. Less robust access to diagnosis and treatment in developing countries exacerbates this, where presenting to a medical professional in the late stages of cancer is a sad commonplace. Developed countries enjoy coverage of 90% comprehensive treatment of cancer, whereas low-income countries can only expect 15%.
Cancer screening, where recommended by public health authorities for your given age or sex, is important to adhere to. Our less affluent counterparts may be missing access to such regular screening, as is promoted in many developed countries. The success of screening is one of the reasons death rates from cancer have dropped in the developed world. Medical imaging technologies are expensive, but seek cancer screening if you have affordable access. Otherwise, the foreign aid spoken about throughout this book allows for the universal uptake of screening before 2030.
To limit your exposure to carcinogens, you can limit your alcohol intake, as alcohol is a Group 1 carcinogen, alongside processed and red meats. What risk factors can we mitigate in our personal lives as preventative measures? Early detection is important, where your healthcare system is capable, as is appropriate treatment and care.
Eat fruits, vegetables and whole grains, and exercise regularly.
Get vaccinated against human papillomavirus and hepatitis, if you have access in your country.
Limit overexposure to the Sun, or occupational radiation exposure.
Limit exposure to carcinogenic chemicals and agents common in some occupations, including outdoor and indoor pollution.
Seek preventive screening, where available in your country. This is of urgency for cervical Pap tests and mammography screenings for breast cancer.
The ethanol in alcoholic drinks metabolises into the carcinogen acetaldehyde. Consider what effects alcohol has, and whether it’s worth putting yourself and your loved ones at the tragic scene of your deathbed. If, in this example, and of tobacco smoking, you feel it’s beyond you to quit this addictive practice, chat to your GP - it’s what they’re there for.
Diabetes is a modern-day disease of our behaviours and poor choices. I’ve said enough elsewhere in these pages about the perils of processed food and refined sugar playing havoc with our insulin response. I recommend Dr Robert Lustig’s illuminating book Metabolical, if you’re curious for a deeper dive. We can characterise a healthy lifestyle by a healthy diet, high in fibre and whole grains, with sparing to zero consumption of refined sugars. Limiting ultra-processed carbohydrates and saturated fats is essential. These diet choices are healthy for people and the planet, as is regular exercise. It’s simple, but is why we underestimate the benefits of such healthful habits. If we eat well and exercise, we ought to keep our body weight in a healthy range, which otherwise would become another diabetes risk factor. As Lustig says, the simple mantra to curb metabolic diseases like diabetes is to “protect the liver and feed the gut”. The latter means to eat high-fibre foods, which feed the bacteria coexisting in our intestines’ walls, which digest the fibre before the rest of our body has the chance. Protecting the liver means avoiding processed foods and refined sugars, which put a strain on the functions of the liver, sometimes overwhelming it, leading to the accretion of fatty deposits. Drink alcohol in moderation, or abstain altogether, with your liver’s health in mind. Abstain from eating refined sugar, white carbohydrates, and saturated fats, and please abstain from eating foods containing all three - such concoctions together are like the nutritional equivalent of a speedball.
This indicator focuses on chronic forms of respiratory disease, rather than short-term occurrences, such as the common cold, flu, or COVID-19. Chronic forms include asthma, emphysema and chronic bronchitis. Smoking is a controllable risk factor, though less controllable is air pollution, plus exposure to occupational chemicals and dust. There’s yet a cure to many forms of chronic respiratory disease, but treatments can dilate airways to aid shortness of breath.
You can attempt to limit exposure to harmful particulate matter in the air around you, if you’re aware of it, by limiting the release of particulate matter, whether indoor, outdoor, of an occupational nature, or in a residential setting. Any dust or fine matter suspended in the air is putting you at risk. Dust may seem innocuous, as it’s all-pervading, but is often harmful. Our foreign aid from OECD readers will finance the adoption of cooking methods for those living in poverty, as many cooking methods used among the extreme poor are a cause of indoor pollution from the fumes of biomass, accompanied by poor ventilation. You already know smoking tobacco is harmful to health. You may be unable to control genetic factors, but you can control the degree to which you expose yourself to further risk of the above causes of chronic respiratory disease.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid.
For developing country readers:
mitigate the risk factors
if experiencing symptoms, seek diagnosis
if diagnosed, seek treatment, where affordable and available
Age-standardised death rate attributable to household air pollution and ambient air pollution (per 100,000 population)
We touched on the issue of air pollution as a cause of death in the prior indicator, in the context of it being a risk factor and a carcinogen. This indicator targets a mortality rate caused by air pollution of 0 per 100,000 population by 2030.
We see household air pollution in developing countries using biomass as cooking fuel in the form of wood, charcoal, dung, or crop residues left over in an agricultural field after the harvest. The exhaust gas from combusting these fuels contains particulate matter: microscopic particles suspended in the air, such as carbon monoxide, nitrogen dioxide, sulphur dioxide and a bunch of organic pollutants.
By contrast, ambient air pollution in the atmosphere has adverse consequences to human health, as well as the Earth’s climate when in the form of nitrous oxide, methane, carbon dioxide and chlorofluorocarbons. We know carbon dioxide is a driver of climate change, affecting the natural environment, destroying habitats, and hurting human health. Chlorofluorocarbons result in the depletion of the ozone. Many of the above chemical substances are also toxic to the organisms absorbing them. Ambient air pollution can cause acute respiratory tract infections, and is also a risk factor for cardiovascular disease, including stroke and lung cancer, in addition to evidence of its relationship between depression and prenatal development. We’ve known for a long time that air pollution in all its guises is damaging for human health. But the death toll has become startling, estimated to kill 7 million people a year, as well as costing the global economy $5 trillion, with an estimated 90% of the global population breathing dirty air.
The data we’re looking at combines deaths from ambient and indoor air pollution, but we can estimate the high death rate in sub-Saharan Africa is due to dirty cooking stoves. The global development community has been seeking to remedy this with the distribution of clean cooking stoves to the world’s poorest to prevent these needless deaths. Pneumonia is still the world’s biggest killer of children by infectious diseases, for which indoor air pollution is a risk factor.
The LDCs are short of the domestic resources to resolve this of their own accord, and will need help to reinforce their budgets. Aid workers can try to help ease the adoption of clean cooking and heating stoves in homes. What if you’re a reader from an LDC, or anyone living in a country scoring red or orange for this indicator, and are combusting solid biomass in your home? Please attempt to ensure there’s enough ventilation to keep combustion from polluting the surrounding environment of the living space. Some of the above-mentioned chemicals are microscopic, so even in the absence of smoke, there can be a danger - carbon monoxide being a good example of an invisible killer. We’re pinning our hopes to achieve the clean cooking stove issue via the international donor community paying for this on behalf of the extreme poor. Whatever the suite of solutions, we’ll return to this in Goal #7 (Affordable and Clean Energy).
What can we do about ambient air pollution? What we pollute in the immediate vicinity will be lurking in the nearby atmosphere - yet over time, we share the same air. In other chapters, we’ll look further at the effects of many of these air pollutants, and we’ll see throughout the coming indicators the degree to which we ought to be curbing carbon dioxide emissions. In the chapters for SDG #12 and 13, we’ll see how industry ought to curb its emissions of sulphur dioxide, nitrous oxide and carbon dioxide.
Some simple individual solutions include:
Eschew internal combustion vehicles, assisting in the phase-out of fossil fuel vehicles toward electric vehicles.
Prioritise more sustainable transport modes, including cycling.
Limit air travel until aviation fuel becomes less polluting.
Adopt a lifestyle more characterised by localism, reducing your need for transport.
Use electricity generated from clean, renewable energy, including heating.
For anyone running or managing an industrial operation, control devices should be of priority for the consideration of human health. If you live in a democracy and have a representative elected on your behalf, you can write to them to affirm your request for stringent air quality laws.
We know for the LDCs, our 0.7% foreign aid from OECD readers will help finance solutions to the main source of indoor air pollution.
The OECD countries are all on track for this indicator, and may in some cases have more stringent air quality laws. A health care system resourced and financed to treat diseases born of airborne pollutants is a vital factor in their success, despite playing their part as sources of air pollution in faraway countries.
Summary:
For all readers, be mindful of emissions contributing to ambient air pollution:
greenhouse gases
ozone
particulate matter (PM2.5)
sulphur dioxide
For OECD country readers, annually give 0.7% of your gross income as aid, aiming to end deaths from air pollution by 2030.
For developing country readers, use clean cooking fuels, where available and affordable.
Traffic deaths (per 100,000 population)
This indicator aims by 2030 for 3.2 deaths or less from traffic per 100,000 people.
To mitigate the risks of vehicle collisions, you can:
Drive free from the influence of intoxicating substances.
Remain focused from mobile phone distractions.
Follow the rules of the road, including observing speed limits.
Ensure while driving to have a clear distance ahead of the vehicle in front of you.
Be mindful of poor vision or a disability, if this may have progressed since you last underwent a driving test - pertinent for those of old age.
Be mindful of your disposition whilst driving, including if you find yourself irritable.
Consider what is, or is not, displayed in your side-view mirror.
Be careful in low visibility through the windshield in fog conditions.
As a driver in society, adopt a culture of safety, for yourself and others.
Wear seatbelts.
If riding a motorcycle, be mindful of the necessary safety precautions, including personal protective equipment.
What of the lack of universal health care in poor countries with high traffic fatality rates? Some of these deaths could have been prevented had enough medical care been available, keeping a road-related injury from being fatal. We’ve already seen how donor help goes a long way toward building up healthcare systems so medical access is universal, which could bring down traffic fatality rates.
You’re attempting to lower traffic fatalities which you as an individual reader have the power to control, but if you feel concerned about a certain stretch of road as it relates to safety, you may wish to alert this to the attention of the local road authority. They may very well remedy this upon your request if it poses a risk to road safety. If you work in the automotive industry at any level, be mindful of risks in the production or design process which could endanger drivers.
Driving a vehicle at a speed of 60km/h or more is a big responsibility for anybody getting behind the wheel. You must drive safely and accommodate your capacity for human error, as well as be aware of the fallibility of other drivers, pedestrians, cyclists, or motorcyclists.
Summary: Drive safe, heeding the above points, aiming to reduce national traffic deaths to less than 3.2 per 100,000 population by 2030.
Life expectancy at birth (years)
The fuller description of this indicator is the average years an infant can expect to live if exposed to age and sex-specific death rates in the country of their birth, aiming for a life expectancy of 83 by 2030. The global average is 73 as of 2022.
Most of the developed countries are on track for the 2022 SDG Index, with a glaring exception of the US, where life expectancy is falling. The priority countries are the LDCs, with low life expectancy in poor countries due to the demographic effects of high child mortality.
Let’s compare Angola and Afghanistan as examples to examine causes of death in countries both scoring red in the 2022 Index. Both have life expectancies at birth of 63 using 2019 data, both stagnating in their progress.
We see in Afghanistan a combination of deaths through communicable diseases, perinatal and non-communicable diseases, as well as collective violence due to war. The top six leading causes of death in Angola were all either communicable or perinatal.
Both countries have a need to address poverty - requiring enough nutrition, healthcare systems, and water and sanitation to meet their basic needs. Otherwise, infectious diseases and diseases of poverty will continue to remain rooted, and we can expect the life expectancy of these countries to continue to stagnate.
Nature has spared Afghanistan from the Petri dish of infectious diseases endemic to much of the tropical LDCs such as Angola. Still, Afghans have had to contend with what seems like an ongoing war, with one aggressor or another for decades to centuries. Such conditions make for less than fertile ground for a healthcare system to take root, or for an upward trajectory of life expectancy.
What can readers do vis-a-vis our LDC compatriots? The foreign aid we’re donating will lift them from poverty in all its dimensions, inclusive of financing health for all. What can readers do for poor countries in conflict, like Afghanistan or Yemen? If you believe your government is perpetuating such conflict for cynical ends, you can contact them to declaim against their tacit or overt support for such conflicts at the expense of the citizenry.
What about middle-income country readers? The quality and accessibility of healthcare where you live may be beyond your scope to control, though seeking medical attention where available may be within your control. The simplest route is a healthy life, characterised by a healthy diet, regular exercise, and limiting or eliminating harmful behaviours like alcohol abuse and smoking. Be a little more mindful of the leading causes of death in your country which you may be most vulnerable to in your circumstances. You can check what those top causes are on the WHO website. From there, you can discover what the risk factors are for those causes, ensuring you’re limiting any behaviours which may speed up their effect on your health and lifespan. It’s likely the leading causes of death in middle-income families will be non-communicable - if so, it’ll be worthwhile to revert to the earlier indicator relating to NCDs, and what you can do to mitigate their onset.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming for a global life expectancy at birth of 83 years by 2030.
For middle-income country readers:
healthy diet
regular exercise
be mindful of risk factors
Adolescent fertility rate (births per 1,000 females aged 15 to 19)
The 2022 map for this indicator shows a split result across the world, half the globe scoring green, the other red or orange. Close to the entirety of Latin America scores red or orange, as has sub-Saharan Africa, and about 10 countries across Asia.
In developing countries facing challenges on this indicator, teens falling pregnant may often have gotten married, seen as a good thing to the broader society and family. Yet many of these countries face issues with malnutrition and under-developed healthcare access - compounding any complications with the pregnancy, threatening maternal and infant mortality.
This issue is acute in sub-Saharan Africa, where we can expect a demographic explosion throughout this century. Elevated levels of extreme poverty will result in high birth rates due to anticipated high rates of child mortality by families. What is the solution to curbing such a demographic explosion? The region is already unable to support its existing population due to the depredations of extreme poverty, yet is expected to add up to a billion more souls to share in its already slim domestic resources.
Interweaving with Goal #5, the key is for teenage girls to remain longer in education, and to value them as staples of the labour market. We can encourage their value to society, so families see their greater worth by working or studying, rather than marrying young and starting a family. This is especially true between 13 and 19 years of age, when young women may yet feel they have the resources to care for themselves.
Cultural attitudes will differ wherever in the world one finds high rates of teenage pregnancy, and to shift these attitudes can be difficult. But we’re only looking to influence the sample size of one i.e., you. You need to reconcile any attitudes you may hold related to your society’s traditional practices and mores with those of the SDGs.
We need to emphasise educating girls, and lift them from poverty. We know by now our DAC readers will transfer foreign aid to reduce the conditions of poverty, which can also finance comprehensive sex education and access to birth control.
Core to this is keeping girls in education, a sentiment at the heart of Goal #4. The opportunity cost to the economy is a woman lost to the labour market as a wage earner for her family and self.
If you’re a reader in a middle-income country off-track, you may have better access to resources than a counterpart living in extreme poverty. The most valuable forms of prevention of teenage pregnancy are sex education and birth control. Be forthright with yourself within your conscience - there is a real-world imperative to bring teenage pregnancy rates down. We must decide which takes precedence: is it our pre-existing beliefs, or the principles of sustainable development, ensuring human health? There’s room to try to find compromise in a way allowing for your conscience to be at relative ease.
Global adolescent fertility rates are at present incompatible with public health. At the heart of any reservations about sex education and birth control is an overarching concern for the sanctity of human life - yet the greatest expression of this sentiment is to compromise on what we thought we valued in the sacrifice of what is healthiest.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming to reduce the global adolescent fertility rate to 2.5 births per 1,000 females aged 15-19.
For developing country readers, encourage women to wait until adulthood for marriage and childbirth, prioritising labour force participation and education.
Births attended by skilled health personnel (%)
This indicator reflects a crucial necessity of all the indicators thus far explored relating to maternal and infant health. The goal by 2030 is for all births to be attended by healthcare workers skilled in care during pregnancy, childbirth, and the postpartum period. This could include midwives, medical doctors, obstetricians or nurses. All can respond to any complications related to the pregnancy, offering prenatal care in a doctor’s clinic, hospital, or even a home.
As of 2018, skilled health personnel attend 80% of global births. Off-track in the 2022 SDG Index is most of the African continent, South Asia, and several Southeast Asian and Latin American countries. This indicator is very much consistent with Goal #3 to offer healthcare for all, as birth attendants are often the very first step in the beginning of a new life.
Those countries with major challenges remaining for this indicator need more robust healthcare. We could train a vast labour force in each of these lagging countries, and mobilise them to ensure all receive healthcare - the crucial factor is financing to build the network.
The key task for most readers will be to assist those living in extreme poverty in rural areas. Sometimes this means in middle-income countries with patches of dislocated, remote populations - like Bolivia, the Philippines, Morocco, or Guatemala - all scoring red for this indicator. In 2020, the split between births attended by skilled health personnel was 70% rural versus 90% urban. Our foreign aid must reach these isolated mothers. Further, the governments of these countries must prioritise their domestic resources to ensure they offer healthcare to all corners, inclusive of skilled birth attendants attending all births by 2030.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming for all births to be attended by skilled health personnel by 2030.
For developing country readers, if you’re an expecting reader, ensure a skilled health professional attends your birth, even if the skilled professional is in tandem with a traditional birth attendant.
Surviving infants who received 2 WHO-recommended vaccines (%)
The aim by 2030 is for all infants under 12 months of age to receive their first dose of the measles shot, as well as the third dose of the DPT vaccine, which combines diphtheria, pertussis (aka whooping cough) and tetanus.
The 2022 scores display most of the LDCs and countries in conflict facing challenges on this indicator, as well as any middle-income countries. The WHO estimates 20 million infants have insufficient access to vaccines.
In the instance of LDC countries off-track, we expect DAC readers will pick up the slack to finance this gap to reach 100% coverage by 2030. This includes costs for production, distribution, and administration of the vaccines to infants. We’re inviting a swath of the global population to fall through the cracks when a healthcare system could otherwise offer them coverage. Producing these specific vaccines is an affordable cost to developed world readers - but it is beyond reach for those living at or below subsistence. The developed world also needs to foot the remaining bill for the training or wages for those administering the vaccines.
If you're a parent or guardian in a middle-income country, and have affordable access to the measles and DPT vaccines, please immunise your child with these WHO-recommended vaccines. It may well be that your country’s national routine immunisation program for infants is sub-par. If so, you can contact a government representative to request a more robust national immunisation program, though you otherwise may need to seek out such immunisations out-of-pocket.
Summary:
For OECD country readers, annually give 0.7% of your gross income as aid, aiming for all surviving infants to receive the 2 WHO-recommended vaccines by 2030.
For middle-income countries off-track, vaccinate your infants younger than 12 months with the measles and DPT vaccines.
Universal health coverage (UHC) Index of service coverage
UHC cuts to the core of Goal #3 in its entirety, aiming for healthcare and well-being for all, with this indicator measuring this with the objective for UHC by 2030.
The indicator includes treatment of the following within the definition of UHC: reproductive, maternal, newborn and child health; infectious diseases and non-communicable diseases.
What can you do to ensure UHC in countries off-track? By now, readers might be able to answer themselves given the hint of the link between LDCs and low UHC. Nevertheless, LDC and lower-middle-income country governments need to mobilise as much of their domestic resources as possible to ensure UHC for their citizens. Although of greater emphasis, we know, is foreign aid. UHC requires money to train personnel, and develop the infrastructure of a health system accessible and affordable to all. Rather than DAC citizens financing the healthcare systems of the neediest countries in perpetuity, LDCs will gain a grasp on the bottom rung of the development ladder with aid, and can then climb up further rungs.
All these countries lagging on the indicator for meeting the aim of UHC by 2030 will have their heads above the poverty line to finance UHC, if high-income country readers meet aid commitments between now and 2030. Fostering the scale, skills, and quality of care necessary everywhere is a complicated, challenging task - but it’s fundamental to the precepts of wellbeing at the core of sustainable development. It requires significant effort, much expertise, a skilled workforce, and the financing to pump the lifeblood through all these much-needed possibilities. We first need to give priority to the most disadvantaged, who are the furthest from coverage.
Summary: For OECD country readers, annually give 0.7% of your gross income as aid, aiming for UHC by 2030.
Subjective well-being (average ladder score, worst 0-10 best)
This is one of my favourite indicators, drawing upon the World Happiness Report (WHR), published by the SDSN since 2012, and co-edited by SDG Index co-author Jeffrey Sachs. The WHR, rather than measuring the value of a country’s output by economic means such as GDP or GNI, instead measures the happiness of the citizenry i.e., GNH (gross national happiness). Bhutan pioneered the metric, including GNH in the country’s constitution in 2008.
Running an economy and society around the idea of happiness used to seem naive - now happiness is in the realm of measurable science, due to the work of the WHR, and the body of work it draws upon.
The WHR offers an index, akin to the SDG Index, based on ladder scores i.e., a measure of 0-10. Surveyors ask respondents how they perceive the well-being of their life, 10 being the highest score.
The long-term aim for this indicator is a score of subjective well-being of 7.6 out of 10. Compared to Finland, the #1 ranked country in the 2022 WHR with a score of 7.8, 7.6 makes for a lofty ambition. Below Finland, only Denmark and Iceland scored 7.6 or over in the 2021 data.
We can rank countries upon their sample size’s score for happiness. There’s a good parallel between the countries topping the WHR’s rankings and those of the SDG Index. The Nordic countries are luminaries in each, Finland taking the top prize for both in 2022. (Although my understanding is the Finns would object to this as ludicrous, and would be more content with the wooden spoon for the measure).
Below are the top 10 rankings of the 2022 WHR and 2022 SDG Index.
You can check your happiness by asking yourself the same question the Gallup World Poll employs for subjective well-being: How do you rate your life, 10 being the best, 0 the worst?
Whatever your score, rather than being static, can be improved upon. How do you make yourself happier? It seems an existential question, but you can keep six explanatory factors - measured by the WHR - in mind to cultivate:
GDP per capita
Social support
Healthy life expectancy
Freedom to make life choices
Generosity
Perceptions of corruption
I’ll use my home country of Australia to expand on how the six explanatory measures constitute a happiness score. Australia’s subjective well-being score is 7.1. This is akin to asking an average Australian, “What do you give your life out of 10?”, their response being approximately 7. Of this score of 7.1 out of 10, the below pie chart displays the explaining variables contributing toward this score, the white slice representing the gap between 7.1 and a perfect score of 10.
Data source: (Helliwell et al., 2022)
Life is more complicated than six explanatory variables, but if you want to make some headway toward boosting your self-reported measure of subjective wellbeing for your life, a place to start could well be:
attempting to increase your income
strengthening or broadening your social ties, including support of others
practise a healthy lifestyle to maximise your lifespan spent in health, free of disease or disability
donate monthly to charity, per the definition of the generosity measure
They may seem simple prescriptions, but try them first, then check in with your ladder score to see if it nudges the needle. Rather than expecting to go from 7 to 9 overnight, it’ll be more incremental and moderate, though progress worth maximising, nevertheless.
All of Africa and South Asia score red for this indicator, as do any LDCs outside those regions, as well as several Middle Eastern countries either in conflict, or bordering a country in conflict.
Afghanistan is the lowest ranking country in the 2022 WHR, a country in conflict at the time of data collection, scoring 2.4 out of 10. The WHR breaks down this score of 2.4 into the explaining variables illustrated in the below pie chart.
Data source: (Helliwell et al., 2022)
For the LDCs scoring red on this indicator, high-income country readers need to mobilise their foreign aid to boost, over time, the GDP per capita of the LDCs, to better the score of the strongest of the six explaining variables.
Two of the explaining measures further outside our control are the freedom and corruption measures - influential as they are due to the powerlessness one may feel. Like the GDP per capita explanation measure, if it’s too challenging for you to increase income due to external circumstances, this is a cause for poor well-being.
Incorporating all the topics already discussed relating to the Goal #3 indicators will contribute toward the healthy life expectancy explanatory variable. Better yet, if you have affordable access to a mental health professional, like a psychologist, put them to work. Go to your GP first to set off on this path if you think it might be suitable, which your subjective well-being score may well suggest. You may need medical attention for disorders of emotion, cognition, mood or personality. If you live in an LDC, it’s improbable you can afford a psychologist, if there are many in your country at all, but the purpose of SDG #3 is ‘Good Health and Well-being’, which means aiming for everyone to have such access by 2030.
Summary:
For all readers, maximise the explaining variables within your control, aiming for a subjective well-being score of 7.6 by 2030:
offer social support, defined as the ability to rely on someone in a time of need
give to a charity monthly
attempt to increase your income
visit a mental health professional, if affordable and accessible
For OECD country readers, annually give 0.7% of your gross income as aid.
Gap in life expectancy at birth among regions (years) *
This measures the difference in highest and lowest life expectancy between a country’s regions, aiming to narrow the gap to be non-existent by 2030 - ensuring we leave no one behind due to where they live in the country. For this indicator, the OECD countries scoring red are Canada, Colombia, Australia, Turkey and France.
In Canada, this means the gap between the life expectancies of the country’s provinces and territories. In Canada, the highest province or territory for life expectancy is Ontario, the lowest being the northernmost territory, Nunavut, comparable to the life expectancy of Tajikistan.
There’s only one hospital in Nunavut, with 35 beds for the population of 37,000, compared to 17,000 beds in Ontario. Whilst 11% of Ontarians smoke, the Nunavummiut rate is 65%. Between 2000-2007, the age-standardised suicide rate was 71 per 100,000 population, compared to 7 per 100,000 in Ontario, ten times higher. If Nunavut were an independent country, it would have the highest suicide rate in the world. The runner-up is another ethnic Inuit territory, Greenland, separated from Nunavut by the Baffin Bay and Davis Strait. Furthermore, a third of Nunavut Inuit attempt suicide.
The high suicide rates in Nunavut are due to a variety of mental afflictions characterised by a severe emotional reaction to an event, the catalyst of which can be by a variety of conditions, including abuse, neglect, unemployment, school dropout and relationship conflicts.
Inuit in the Canadian Arctic are also eating foods low in nutrient density compared to the amount of energy in foods i.e., the ultra-processed foods explored in the SDG #2 chapter. The Inuit are eating less traditional food, and little fresh fruit and vegetables, reflecting the food insecurity of communities only accessible by air. Furthermore, a third of Inuit children lived below the poverty line in the territory. The reasons for poor nutrition could range from behavioural reasons linked to a legacy of colonial trauma, as well as the general food insecurity reasons synonymous with isolation. Differentials in the life expectancies of indigenous people are common in colonial-settler countries, further evidenced by Australia’s red score for this metric. To remedy the above, the Government of Canada’s Nutrition North Canada works to make nutritious food more accessible and affordable.
Let’s use the same mechanism we have for OECD countries toward LDC countries, whereby the fortunate apportion their relative prosperity to the less fortunate among us i.e., directing the attention of Ontarians to the health outcomes in Nunavummiut.
Summary: For countries off-track, residents of regions with the highest life expectancy can donate to a charity focused on health operating in the region with the lowest low expectancy. The aim is to eliminate the gap in life expectancy at birth among the regions by 2030.
Gap in self-reported health status by income *
This indicator traces health inequalities within countries, on this occasion based on income. It considers those within a country who self-report their health to be ‘good’ or ‘very good’, comparing the poorest fifth to the richest fifth. The goal by 2030 is to close the gap between the upper and lower quintiles’ self-reporting of health. Only the Czech Republic and Baltics states have scored red in the 2022 SDG Index.
We’ll deal with income inequality with a much greater focus in Goal #10 (Reduced Inequalities), but social inclusion is central to all Goals, as well as the concept of sustainable development overall. The Czech Republic is an equal country according to income equality metrics, and its relative equality keeps its SDG Index score amongst the world’s highest. The three Baltic countries are a mix of income equality, though each is off-track to varying levels.
We’re looking at health equity in this indicator, and the social determinants of health. Health inequalities and diseases among the poor could be borne by those who are ageing, lack shelter, have poor sanitation, face social exclusion, or are unemployed, leading to higher levels of chronic conditions and death. Why does this occur? It could result from childhood development, education levels, the time someone spent in the labour force, as well as the type of employment, and healthcare available across their lifetime. Gender inequality, as well as ethnic and racial prejudices, can also be drivers of health inequity, or may arise between those living in metropolitan areas compared to isolated communities, as seen in the regional indicator before. Gaps can also occur due to the health policies of different governments, and social norms surrounding health behaviours.
The Czech Republic and the Baltics have public health insurance, which ought to capture the poor, but is resulting in the poor still self-reporting worse health. Identifiable to the above countries is the post-Soviet nature of each - all either former Soviet republics, or within the Eastern bloc.
To focus on Estonia, self-reporting on health seems consistent with other post-Soviet states, which could be a vestige of the legacy of the heavy industry of communism. Poor self-reporting of health also correlates with low education levels, and for men, living in rural areas. Russian citizenship forms a quarter of the Estonian population, who may import their poor health and NCD outcomes to the more developed Baltics. Research shows being of Russian nationality, as well as education levels of Russian women, have a negative effect on Estonian self-reported health. The research observed another correlation, of an individual's locus of control affecting self-reporting. This could be a by-product of coming of age under the rule of a one-party socialist state, atop actual poor health status. Another correlate was the emotional distress of transitioning from communism to a market economy, a dislocation experienced in all former Soviet and Eastern bloc countries to varying degrees.
To offer a contrast, Estonia and its neighbour across the Baltic Sea, Finland, share similar socioeconomic patterns of health, but self-reporting on health is much poorer in the former. Education may be the key determinant, accompanied by limitations on making healthy decisions, or a sense of the potential for social mobility.
Summary: For readers in countries off-track, and in your country's top income quintile, compensate for the lower income quintile by donating to charities operating within your country focused on health and/or poverty. The aim is to close the gap in self-reported health status by income by 2030.
Daily smokers (% of population aged 15 and over) *
Most OECD countries are close to on track for this indicator in the 2022 SDG Index. The aim by 2030 is for the percentage of people over age 15 smoking daily to be a tenth of the population.
Smoking is the leading preventable cause of death worldwide. The prevalence of tobacco use is higher for those experiencing mental disorder, alcoholism, physical dependence on drugs and homelessness.
If you can avoid using tobacco in adolescence, all the better. If you want to choose to achieve this indicator more than you want to smoke, first contact your GP. Nicotine is such an addictive substance, that you’ll need medical help. Unless you reckon your neural circuitry can outwit the chemistry of nicotine by going cold turkey, you have access to medication and nicotine replacement therapies. You might baulk at the idea of medication, but it means substituting one chemical you heretofore had welcomed into your body for another. Nicotine withdrawal will be an unwelcome experience for you, and those around you, with the attendant anxiety and depression it could induce. There are all manner of alternative ways of ceasing smoking which you might care to try alongside consultations with your GP e.g., acupuncture, hypnosis, herbal medicine, smokeless tobacco, aversion therapy, or even vaccines.
Summary: Quit smoking, aiming for 10.1% or less of the national population aged 15 and over to be daily smokers by 2030.