Background The sustainable development goals (SDGs) have generated momentum for global health, aligning efforts from governments and international organisations toward a set of goals that are expected to reflect improvements in life conditions across the globe. Mexico has huge social inequalities that can affect access to quality care and health outcomes. The objective of this study is to analyse inequalities among Mexico’s 32 states on the health-related SDG indicators (HRSDGIs) from 1990 to 2017.
Methods These analyses rely on the estimation of HRSDGIs as part of the Global Burden of Disease study 2017. We estimated the concentration index for 40+3 HRSDGI stratified by Socio-demographic Index and marginalisation index, and then for indicators where inequalities were identified, we ran decomposition analyses using structural variables such as gross domestic product per capita, poverty and health expenditure.
Findings Mexico has made progress on most HRSDGIs, but current trends in improvement do not appear to fast enough to meet 2030 targets. Out of 43 HRSDGIs, we identified evidence of inequality between Mexico’s states for 30 indicators; of those, 23 HRSDGIs were unequal distributed affecting states with lower development and seven affecting states with higher development. The decomposition analysis indicates that social determinants of health are major drivers of HRSDGI inequalities in Mexico.
Interpretation Modifying current trends for HRSDGIs will require subnational-level and national-level policy action, of which should be informed by the latest available data and monitoring on the health-related SDGs. The SDGs’ overarching objective of leaving no-one behind should be prioritised not only for individuals but also for communities and other subnational levels.
- health policy
- public health
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Handling editor Eduardo Gómez
Contributors JPG, MA-B, SG-S, CZ-T, CAD-C, MCG-R and RL conceived the study. JPG designed and implemented the inequalities analysis. MA-B and CAD-C implemented the trend analysis. JPG, MA-B, SG-S, CZ-T, CAD-C, MCG-R, NF and RL drafted the manuscript. All authors discussed the results and contributed to the final manuscript.
Funding This study was funded by Bill and Melinda Gates Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. Data used for these analyses are available at the Institute for Health Metrics and Evaluation GBD Project website https://vizhub.healthdata.org/gbd-compare/
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