Drivers of inequality in Millennium Development Goal progress: a statistical analysis

Area of Science:

• Global Health
• Public Health Policy
• Epidemiology

Background:

• Many low- and middle-income countries (LMICs) are not meeting public health targets set by the Millennium Development Goals (MDGs).
• Factors influencing progress include economic development, public health funding, and health system infrastructure.
• The concurrent epidemics of HIV/AIDS and noncommunicable diseases (NCDs) may hinder household capacity to address child mortality and increase infectious disease risks.

Purpose of the Study:

• To evaluate the association between economic development, public health funding, health system infrastructure, and progress towards health MDGs.
• To examine the impact of joint HIV/AIDS and NCD epidemics on achieving health MDGs.
• To determine the relative influence of disease burdens versus economic factors on MDG attainment.

Main Methods:

• Calculated country-specific distances from MDG targets for HIV/AIDS, tuberculosis, and child mortality (1990-present).
• Analyzed associations with GDP per capita, health spending (as % of GDP and real spending), HIV/AIDS burden, and NCD burden.
• Adjusted for initial disease burdens and analyzed rates of change in MDG progress versus expected rates.

Main Results:

• Economic development, health priority, spending, and infrastructure explained less than one-fifth of the differences in MDG progress.
• HIV/AIDS and NCD burdens explained over half of the inequalities in child mortality progress (R² infant mortality = 0.57, R² under-5 mortality = 0.54).
• HIV/AIDS and NCD burdens were the strongest correlates of unequal progress towards tuberculosis goals (R² = 0.57), with NCDs showing an independent effect.

Conclusions:

• Unequal progress in health MDGs in LMICs is significantly related to population burdens of HIV/AIDS and NCDs.
• Lower burdens of HIV/AIDS and NCDs were associated with greater MDG progress than GDP gains.
• Development programs should consider the interrelationships between NCDs, child mortality, and infectious diseases in poor households.