The Municipal Sustainable Development Health Index (MSDHI) to monitor the 2030 agenda in Brazil: a methodological...

The Municipal Sustainable Development Health Index (MSDHI) was developed to monitor achieving health-related targets outlined in the 2030 Agenda. This study aims to support effective, comprehensive, and context-sensitive policy formulation at the local level by developing a local index that accounts for regional health inequalities. The study addresses critical gaps in existing health equity assessments at the municipal level, where disparities exist in health outcomes due to regional inequalities.

This article presents a methodological framework for calculating the index, based on secondary administrative data from various public information systems in Brazil. The MSDHI was estimated for all 5,570 Brazilian municipalities for the period from 2018 to 2022. Its construction followed a systematic eight-step procedure, ensuring consistency and reliability of the results. The municipal index combines multiple health-related indicators: values equal to 1 indicate the best national results, whereas values close to 0 indicate a greater distance from the best outcomes. The same interpretation applies to the thematic indexes: (1) Reproductive and maternal health, (2) Newborn and child health, (3) Infectious diseases, (4) non-communicable diseases, (5) Injuries and violence, (6) Environmental risks, and (7) Universal health coverage and health systems. The results of the MSDHI and its thematic indexes were classified in three tiers: Tier 1 (0 to 0.40) - insufficient; Tier 2 (0.41 to 0.69) - moderated; and Tier 3 (0.70 to 1.00) - adequate.

The construct evaluation indicated positive correlations with life expectancy, HDI-M, IDB, and GDP, and a negative correlation with mortality rate. However, the magnitude of the correlations was low, suggesting that the MSDHI may be capturing additional dimensions beyond those reflected in the selected indicators. An applicability assessment was performed for the municipalities of the State of Minas Gerais, Brazil, indicating that the municipal index and the thematic indexes can identify sustainable health scenarios and highlight areas of inequality.

The MSDHI is a valuable tool for local governments and policymakers to effectively implement the 2030 Agenda. Future studies should focus on developing an annual index and integrating the MSDHI into policy prioritization methods.