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- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 2. |
- Reitsma, Marissa B., et al.
(författare)
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Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015 : a systematic analysis from the Global Burden of Disease Study 2015
- 2017
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 389:10082, s. 1885-1906
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Tidskriftsartikel (refereegranskat)abstract
- Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
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| 5. |
- Gromark, Sten, 1951, et al.
(författare)
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Integrative Ways of Residing Health and Quality of Residence. A Concerted Trans-Disciplinary Research Effort - AIDAH ‘14-‘18. Architectural Inventions for Dwelling, Ageing and Healthcare
- 2014
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Ingår i: International Conference ARCH 14 on Research on Health Care Architecture, Helsinki Aalto University 19-21 Nov 2014.
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Konferensbidrag (refereegranskat)abstract
- The original AIDAH environment intends to generate cross-disciplinary research and implementation projects for a sustainable built environment that confront three major challenges. (1) Increasingly diverse demands on the housing market call for flexibility and adaptability in resilient ways. (2) An ageing society requires new residential models that combine dignity and appropriate care but also provide good working environments for personnel. (3) Profound changes in technical conditions for caring and medical treatment necessitate rethinking traditional healthcare situations, developing new situations ranging from complex care in residence to intensive care units in hospital and patient hotels. Sustainability issues at stake in patterns of residential behaviour must be considered to have paramount importance in any strategy for a resilient urban future. The involved teams provide different and complementary perspectives focusing on the common notion of quality of residence considered in architectural, spatial and experiential properties of built environments for housing and healthcare contexts. The applied conceptual and theoretical framework focuses on architectural and caring innovations for reconfigured spatial situations that enhance sustainable caring, and improve health, welfare, and living quality. Our research effort will focus on identifying and characterizing strategies directed towards the integration of different ways of residing. The scientific integration in conceptual and methodological terms between architecture qualitative research, sociology of residence, and caring sciences is intended to bridge gaps and initiate cross disciplinary approaches. Objectives include identifying and articulating new resilient qualities in designs supporting care processes and healing environments, thereby providing new operational knowledge developed in close collaboration with diverse stakeholders. International exchanges will provide further strategic evidence-based design support for decision makers in planning, building and healthcare services. The cross-disciplinary teams of researchers from architectural design, social and caring sciences are based at the Centre for Healthcare Architecture and the CIB W069 Residential Studies, both hosted by Chalmers.
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| 6. |
- Mangold, Marcel, 1982-
(författare)
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Securing the working democracy : Inventive arrangements to guarantee circulation and the emergence of democracy policy
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the 1990s, Swedish democracy's ability to remain strong and renew itself became increasingly questioned in government commission reports and social-scientific writings. The perceptions of the financial crisis in 1992–1994, new identities, immigration and changes in participation in civic associations and organizations were listed as challenges to democracy. Together, they helped constitute an understanding of an emerging gap between the population and existing representative democratic forms. In response, the 1990s and the first decade of the 2000s saw the emergence of several discourses, political initiatives and scientific contributions that articulated and responded to the need to secure a “working democracy”. By analyzing theoretically the arrangements of elements in policy and in attempts to shape the population's habits, dispositions and behavior, this thesis illuminates the role of aesthetics in the knowledge and power effects of these efforts. Methodologically, the thesis draws on Michel Foucault's genealogical approach in four empirical chapters. In doing so, the thesis displays why, when and how the efforts to secure a working democracy emerged, and analyzes the politics inherent to them. The chapters consist, first, of a study of the birth and changes in “democracy policy” as a distinct political domain; second, a mapping of the emergence of the discourse and dispositif of “valuefoundation”; third, a mapping of the discourse on exclusion and the discourse on and apparatus to combat “violence-promoting extremism”, and, finally, a mapping of inventive approaches in survey research that articulated how to secure a working democracy. This mapping exposes a vision of democratic dis-involvement and how to contain it infused by risk-management, benchmarking and a monitoring of changes in the population. Taken together, the chapters demonstrate the emergence of a complex network of power relations and knowledge used to achieve congruence between the population and governmental aims. This, the thesis underscores, marginalizes the role of dissent and interruptions in democratic life, to instead equate democracy with a system of congruence, smooth interactions and overall alignment to demands on circulation.
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| 7. |
- Sundqvist, Pernilla, 1979-
(författare)
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Teknik i förskolan är inte något nytt, men idag är vi mera medvetna om vad vi kallar teknik : Personalens beskrivningar av teknik som innehållsområde i förskolan
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study investigates what preschool staff include in the technology subject in preschool education, what content they view as relevant and how the teaching of this content can be organized. This is motivated by the fact that technology as subject have not been clearly defined, leaving the teachers insecure and unconfident about what to teach and how to teach it. In addition, preschool do not have a tradition of addressing teaching and learning the way they are now obliged to do according to the curriculum and many studies have shown subject teaching to be a challenge in preschool. Thus, the preschool staff’s challenge is twofold regarding the teaching of technology.The aim is addressed by a mixed methods design, starting with questionnaires and followed by interviews with preschool staff (daycare attendants and preschool teachers). The questionnaire was completed by 102 preschool staff members and interviews were held with seven of these participants.A key results is that technology in preschool involves building and creating. Emphasized is that children should be offered much and varied materials and that it should be available in the environment and inspire creative activities. Another key result is that every-day use of artifacts is viewed as part of technology education. Children should learn to handle artifacts by using them, e.g. pulling up the zipper to close the jacket or cut with scissors. These are activities preschool have always engaged children in, which the staff now name technology. However, there are variations in the result and there are preschool staff members who express a more conscious teaching where children are able to learn about things like the purpose of technology, what parts an object consist of and how these parts are connected, and about technological systems, e.g. how the water get from the lake to the tap and how it is purified on the way. But there are also examples where technology activities are used as a means for working towards the striving goals of other areas, such as math, science and social behavior.Implications are that preschool staff need to develop their teaching in order to work in accordance with the curriculum. A relevant first step is to strengthen their content competence in technology, but also, they need tools for how to teach subject matter like technology in a practice characterized by children’s own choice and influence.
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