Authors

Nancy Fullman
Jamal Yearwood
Solomon M. Abay
Cristiana Abbafati
Foad Abd-Allah
Jemal Abdela
Ahmed Abdelalim
Zegeye Abebe
Teshome Abuka Abebo
Victor Aboyans
Haftom Niguse Abraha
Daisy M. X. Abreu
Laith J. Abu-Raddad
Akilew Awoke Adane
Rufus Adesoji Adedoyin
Olatunji Adetokunboh
Tara Ballav Adhikari
Mohsen Afarideh
Ashkan Afshin
Gina Agarwal
Dominic Agius
Anurag Agrawal
Sutapa Agrawal
Aliasghar Ahmad Kiadaliri
Miloud Taki Eddine Aichour
Mohammed Akibu
Rufus Olusola Akinyemi
Tomi F. Akinyemiju
Nadia Akseer
Faris Hasan Al Lami
Fares Alahdab
Ziyad Al-Aly
Khurshid Alam
Tahiya Alam
Deena Alasfoor
Mohammed I. Albittar
Kefyalew Addis Alene
Ayman Al-Eyadhy
Syed Danish Ali
Mehran Alijanzadeh
Syed M. Aljunid
Ala'a Alkerwi
François Alla
Peter Allebeck
Christine Allen
Mahmoud A. Alomari
Rajaa Al-Raddadi
Ubai Alsharif
Khalid A. Altirkawi
Nelson Alvis-Guzman
Azmeraw T. Amare
Kebede Amenu
Walid Ammar
Yaw Ampem Amoako
Nahla Anber
Catalina Liliana Andrei
Sofia Androudi
Carl Abelardo T. Antonio
Valdelaine E. M. Araújo
Olatunde Aremu
Johan Ärnlöv
Al Artaman
Krishna Kumar Aryal
Hamid Asayesh
Ephrem Tsegay Asfaw
Solomon Weldegebreal Asgedom
Rana Jawad Asghar
Mengistu Mitiku Ashebir
Netsanet Abera Asseffa
Tesfay Mehari Atey
Sachin R. Atre
Madhu S. Atteraya
Leticia Avila-Burgos
Euripide Frinel G. Arthur Avokpaho
Ashish Awasthi
Beatriz Paulina Ayala Quintanilla
Animut Alebel Ayalew
Henok Tadesse Ayele
Rakesh Ayer
Tambe Betrand Ayuk
Peter Azzopardi
Natasha Azzopardi-Muscat
Tesleem Kayode Babalola
Hamid Badali
Alaa Badawi
Maciej Banach
Amitava Banerjee
Amrit Banstola
Ryan M. Barber
Miguel A. Barboza
Suzanne L. Barker-Collo
Till Bärnighausen
Simon Barquera
Lope H. Barrero
Quique Bassat
Sanjay Basu
Bernhard T. Baune
Shahrzad Bazargan-Hejazi
Neeraj Bedi
Ettore Beghi
Masoud Behzadifar
Meysam Behzadifar
Bayu Begashaw Bekele
Abate Bekele Belachew
Saba Abraham Belay
Yihalem Abebe Belay
Michelle L. Bell
Aminu K. Bello
Derrick A. Bennett
James R. Bennett
Isabela M. Bensenor
Derbew Fikadu Berhe
Eduardo Bernabé
Robert Steven Bernstein
Mircea Beuran
Ashish Bhalla
Paurvi Bhatt
Soumyadeep Bhaumik
Zulfiqar A. Bhutta
Belete Biadgo
Ali Bijani
Boris Bikbov
Charles Birungi
Stan Biryukov
Hailemichael Bizuneh
Ian W. Bolliger
Kaylin Bolt
Ibrahim R. Bou-Orm
Kayvan Bozorgmehr
Oliver Jerome Brady
Alexandra Brazinova
Nicholas J. K. Breitborde
Hermann Brenner
Gabrielle Britton
Traolach S. Brugha
Zahid A. Butt
Lucero Cahuana-Hurtado
Ismael Ricardo Campos-Nonato
Julio Cesar Campuzano
Josip Car
Mate Car
Rosario Cárdenas
Juan Jesus Carrero
Felix Carvalho
Carlos A. Castañeda-Orjuela
Jacqueline Castillo Rivas
Ferrán Catalá-López
Kelly Cercy
Julian Chalek
Hsing-Yi Chang
Jung-Chen Chang
Aparajita Chattopadhyay
Pankaj Chaturvedi
Peggy Pei-Chia Chiang
Vesper Hichilombwe Chisumpa
Jee-Young J. Choi
Hanne Christensen
Devasahayam Jesudas Christopher
Sheng-Chia Chung
Liliana G. Ciobanu
Massimo Cirillo
Danny Colombara
Sara Conti
Cyrus Cooper
Leslie Cornaby
Paolo Angelo Cortesi
Monica Cortinovis
Alexandre Costa Pereira
Ewerton Cousin
Michael H. Criqui
Elizabeth A. Cromwell
Christopher Stephen Crowe
John A. Crump
Alemneh Kabeta Daba
Berihun Assefa Dachew
Abel Fekadu Dadi
Lalit Dandona
Rakhi Dandona
Paul I. Dargan
Ahmad Daryani
Maryam Daryani
Jai Das
Siddharth Kumar Das
José das Neves
Nicole Davis Weaver
Kairat Davletov
Barbora de Courten
Diego De Leo
Jan-Walter De Neve
Robert P. Dellavalle
Gebre Demoz
Kebede Deribe
Don C. Des Jarlais
Subhojit Dey
Samath D. Dharmaratne
Meghnath Dhimal
Shirin Djalalinia
David Teye Doku
Kate Dolan
E. Ray Dorsey
Kadine Priscila Bender dos Santos
Kerrie E. Doyle
Tim R. Driscoll
Manisha Dubey
Eleonora Dubljanin
Bruce Bartholow Duncan
Michelle Echko
Dumessa Edessa
David Edvardsson
Joshua R. Ehrlich
Erika Eldrenkamp
Ziad El-Khatib
Matthias Endres
Aman Yesuf Endries
Babak Eshrati
Sharareh Eskandarieh
Alireza Esteghamati
Mahdi Fakhar
Tamer Farag
Mahbobeh Faramarzi
Emerito Jose Aquino Faraon
André Faro
Farshad Farzadfar
Adesegun Fatusi
Mir Sohail Fazeli
Valery L. Feigin
Andrea B. Feigl
Netsanet Fentahun
Seyed-Mohammad Fereshtehnejad
Eduarda Fernandes
João C. Fernandes
Daniel Obadare Fijabi
Irina Filip
Florian Fischer
Christina Fitzmaurice
Abraham D. Flaxman
Luisa Sorio Flor
Nataliya Foigt
Kyle J. Foreman
Joseph J. Frostad
Thomas Fürst
Neal D. Futran
Emmanuela Gakidou
Silvano Gallus
Ketevan Gambashidze
Amiran Gamkrelidze
Morsaleh Ganji
Abadi Kahsu Gebre
Tsegaye Tewelde Gebrehiwot
Amanuel Tesfay Gebremedhin
Yalemzewod Assefa Gelaw
Johanna M. Geleijnse
Demeke Geremew
Peter W. Gething
Reza Ghadimi
Khalil Ghasemi Falavarjani
Maryam Ghasemi-Kasman
Paramjit Singh Gill
Ababi Zergaw Giref
Maurice Giroud
Melkamu Dedefo Gishu
Giorgia Giussani
William W. Godwin
Srinivas Goli
Hector Gomez-Dantes
Philimon N. Gona
Amador Goodridge
Sameer Vali Gopalani
Yevgeniy Goryakin
Alessandra Carvalho Goulart
Ayman Grada
Max Griswold
Giuseppe Grosso
Harish Chander Gugnani
Yuming Guo
Rahul Gupta
Rajeev Gupta
Tanush Gupta
Tarun Gupta
Vipin Gupta
Juanita A. Haagsma
Vladimir Hachinski
Nima Hafezi-Nejad
Gessessew Bugssa Hailu
Randah Ribhi Hamadeh
Samer Hamidi
Graeme J. Hankey
Hilda L. Harb
Heather C. Harewood
Sivadasanpillai Harikrishnan
Josep Maria Haro
Hamid Yimam Hassen
Rasmus Havmoeller
Caitlin Hawley
Simon I. Hay
Jiawei He
Stephen J. C. Hearps
Mohamed I. Hegazy
Behzad Heibati
Mohsen Heidari
Delia Hendrie
Nathaniel J. Henry
Victor Hugo Herrera Ballesteros
Claudiu Herteliu
Desalegn Tsegaw Hibstu
Molla Kahssay Hiluf
Hans W. Hoek
Enayatollah Homaie Rad
Nobuyuki Horita
H. Dean Hosgood
Mostafa Hosseini
Seyed Reza Hosseini
Mihaela Hostiuc
Sorin Hostiuc
Damian G. Hoy
Mohamed Hsairi
Aung Soe Htet
Guoqing Hu
John J. Huang
Kim Moesgaard Iburg
Fachmi Idris
Ehimario Uche Igumbor
Chad Ikeda
Bogdan Vasile Ileanu
Olayinka S. Ilesanmi
Kaire Innos
Seyed Sina Naghibi Irvani
Caleb M. S. Irvine
Farhad Islami
Troy A. Jacobs
Kathryn H. Jacobsen
Nader Jahanmehr
Rajesh Jain
Sudhir Kumar Jain
Mihajlo M. Jakovljevic
Moti Tolera Jalu
Amr A. Jamal
Mehdi Javanbakht
Achala Upendra Jayatilleke
Panniyammakal Jeemon
Ravi Prakash Jha
Vivekanand Jha
Jacek Józwiak
Oommen John
Sarah Charlotte Johnson
Jost B. Jonas
Vasna Joshua
Mikk Jürisson
Zubair Kabir
Rajendra Kadel
Amaha Kahsay
Rizwan Kalani
Chittaranjan Kar
Marina Karanikolos
André Karch
Corine Kakizi Karema
Seyed M. Karimi
Amir Kasaeian
Dessalegn Haile Kassa
Getachew Mullu Kassa
Tesfaye Dessale Kassa
Nicholas J. Kassebaum
Srinivasa Vittal Katikireddi
Anil Kaul
Norito Kawakami
Konstantin Kazanjan
Seifu Kebede
Peter Njenga Keiyoro
Grant Rodgers Kemp
Andre Pascal Kengne
Maia Kereselidze
Ezra Belay Ketema
Yousef Saleh Khader
Morteza Abdullatif Khafaie
Alireza Khajavi
Ibrahim A. Khalil
Ejaz Ahmad Khan
Gulfaraz Khan
Md Nuruzzaman Khan
Muhammad Ali Khan
Mukti Nath Khanal
Young-Ho Khang
Mona M. Khater
Abdullah Tawfih Abdullah Khoja
Ardeshir Khosravi
Jagdish Khubchandani
Getiye Dejenu Kibret
Daniel Ngari Kiirithio
Daniel Kim
Yun Jin Kim
Ruth W. Kimokoti
Yohannes Kinfu
Sanjay Kinra
Adnan Kisa
Niranjan Kissoon
Sonali Kochhar
Yoshihiro Kokubo
Jacek A. Kopec
Soewarta Kosen
Parvaiz A. Koul
Ai Koyanagi
Michael Kravchenko
Kewal Krishan
Kristopher J. Krohn
Barthelemy Kuate Defo
G. Anil Kumar
Pushpendra Kumar
Michael Kutz
Igor Kuzin
Hmwe H. Kyu
Deepesh Pravinkumar Lad
Alessandra Lafranconi
Dharmesh Kumar Lal
Ratilal Lalloo
Hilton Lam
Qing Lan
Justin J. Lang
Van C. Lansingh
Sonia Lansky
Anders Larsson
Arman Latifi
Jeffrey Victor Lazarus
Janet L. Leasher
Paul H. Lee
Yirga Legesse
James Leigh
Cheru Tesema Leshargie
Samson Leta
Janni Leung
Ricky Leung
Miriam Levi
Yongmei Li
Juan Liang
Misgan Legesse Liben
Lee-Ling Lim
Stephen S. Lim
Margaret Lind
Shai Linn
Stefan Listl
Patrick Y. Liu
Shiwei Liu
Rakesh Lodha
Alan D. Lopez
Scott A. Lorch
Stefan Lorkowski
Paulo A. Lotufo
Timothy C. D. Lucas
Raimundas Lunevicius
Grégoire Lurton
Ronan A. Lyons
Fadi Maalouf
Erlyn Rachelle
King Macarayan
Mark T. Mackay
Emilie R. Maddison
Fabiana Madotto
Hassan Magdy Abd El Razek
Mohammed Magdy Abd El Razek
Marek Majdan
Reza Majdzadeh
Azeem Majeed
Reza Malekzadeh
Rajesh Malhotra
Deborah Carvalho Malta
Abdullah A. Mamun
Helena Manguerra
Treh Manhertz
Mohammad Ali Mansournia
Lorenzo G. Mantovani
Tsegahun Manyazewal
Chabila C. Mapoma
Christopher Margono
Jose Martinez-Raga
Sheila Cristina Ouriques Martins
Francisco Rogerlândio Martins-Melo
Ira Martopullo
Winfried März
Benjamin Ballard Massenburg
Manu Raj Mathur
Pallab K. Maulik
Mohsen Mazidi
Colm McAlinden
John J. McGrath
Martin McKee
Suresh Mehata
Ravi Mehrotra
Kala M. Mehta
Varshil Mehta
Toni Meier
Fabiola Mejia-Rodriguez
Kidanu Gebremariam Meles
Mulugeta Melku
Peter Memiah
Ziad A. Memish
Walter Mendoza
Degu Abate Mengiste
Desalegn Tadese Mengistu
Bereket Gebremichael Menota
George A. Mensah
Atte Meretoja
Tuomo J. Meretoja
Haftay Berhane Mezgebe
Tomasz Miazgowski
Renata Micha
Robert Milam
Anoushka Millear
Ted R. Miller
G. K. Mini
Shawn Minnig
Andreea Mirica
Erkin M. Mirrakhimov
Awoke Misganaw
Philip B. Mitchell
Fitsum Weldegebreal Mlashu
Babak Moazen
Karzan Abdulmuhsin Mohammad
Roghayeh Mohammadibakhsh
Ebrahim Mohammed
Mohammed A. Mohammed
Shafiu Mohammed
Ali H. Mokdad
Glen Liddell D. Mola
Mariam Molokhia
Fatemeh Momeniha
Lorenzo Monasta
Julio Cesar Montañez Hernandez
Mahmood Moosazadeh
Maziar Moradi-Lakeh
Paula Moraga
Lidia Morawska
Ilais Moreno Velasquez
Rintaro Mori
Shane D. Morrison
Mark Moses
Seyyed Meysam Mousavi
Ulrich O. Mueller
Manoj Murhekar
Gudlavalleti Venkata Satyanarayana Murthy
Srinivas Murthy
Jonah Musa
Kamarul Imran Musa
Ghulam Mustafa
Saravanan Muthupandian
Chie Nagata
Gabriele Nagel
Mohsen Naghavi
Aliya Naheed
Gurudatta A. Naik
Nitish Naik
Farid Najafi
Luigi Naldi
Vinay Nangia
Jobert Richie Njingang Nansseu
K. M. Venkat Narayan
Bruno Ramos Nascimento
Ionut Negoi
Ruxandra Irina Negoi
Charles R. Newton
Josephine Wanjiku Ngunjiri
Grant Nguyen
Long Nguyen
Trang Huyen Nguyen
Emma Nichols
Dina Nur Anggraini Ningrum
Ellen Nolte
Vuong Minh Nong
Ole F. Norheim
Bo Norrving
Jean Jacques N. Noubiap
Alypio Nyandwi
Carla Makhlouf Obermeyer
Richard Ofori-Asenso
Felix Akpojene Ogbo
In-Hwan Oh
Olanrewaju Oladimeji
Andrew Toyin Olagunju
Tinuke Oluwasefunmi Olagunju
Pedro R. Olivares
Patricia Pereira Vasconcelos de Oliveira
Helen E. Olsen
Bolajoko Olubukunola Olusanya
Jacob Olusegun Olusanya
Kanyin Ong
John Nelson Opio
Eyal Oren
Doris V. Ortega-Altamirano
Alberto Ortiz
Raziye Ozdemir
Mahesh Pa
Amanda W. Pain
Marcos Roberto Tovani Palone
Adrian Pana
Songhomitra Panda-Jonas
Jeyaraj D. Pandian
Eun-Kee Park
Hadi Parsian
Tejas Patel
Sanghamitra Pati
Snehal T. Patil
Ajay Patle
George C. Patton
Vishnupriya Rao Paturi
Deepak Paudel
Marcel de Moares Pedroso
Sandra P. Pedroza
David M. Pereira
Norberto Perico
Hannah Peterson
Max Petzold
Niloofar Peykari
Michael Robert Phillips
Frédéric B. Piel
David M. Pigott
Julian David Pillay
Michael A. Piradov
Suzanne Polinder
Constance D. Pond
Maarten J. Postma
Farshad Pourmalek
Swayam Prakash
V. Prakash
Narayan Prasad
Noela Marie Prasad
Caroline Purcell
Mostafa Qorbani
Hedley Knewjen Quintana
Amir Radfar
Anwar Rafay
Alireza Rafiei
Kazem Rahimi
Afarin Rahimi-Movaghar
Vafa Rahimi-Movaghar
Mahfuzar Rahman
Muhammad Aziz Rahman
Sajjad Ur Rahman
Rajesh Kumar Rai
Sree Bhushan Raju
Usha Ram
Saleem M. Rana
Zane Rankin
Davide Rasella
David Laith Rawaf
Salman Rawaf
Sarah E. Ray
Christian Aspacia Razo-García
Priscilla Reddy
Robert C. Reiner
Cesar Reis
Marissa B. Reitsma
Giuseppe Remuzzi
Andre M. N. Renzaho
Serge Resnikoff
Satar Rezaei
Mohammad Sadegh Rezai
Antonio L. Ribeiro
Maria Jesus Rios Blancas
Juan A. Rivera
Leonardo Roever
Luca Ronfani
Gholamreza Roshandel
Ali Rostami
Gregory A. Roth
Dietrich Rothenbacher
Ambuj Roy
Nobhojit Roy
George Mugambage Ruhago
Yogesh Damodar Sabde
Perminder S. Sachdev
Nafis Sadat
Mahdi Safdarian
Saeid Safiri
Rajesh Sagar
Amirhossein Sahebkar
Mohammad Ali Sahraian
Haniye Sadat Sajadi
Joseph Salama
Payman Salamati
Raphael de Freitas Saldanha
Hamideh Salimzadeh
Joshua A. Salomon
Abdallah M. Samy
Juan Ramon Sanabria
Parag K. Sancheti
Maria Dolores Sanchez-Niño
Damian Santomauro
Itamar S. Santos
Milena M. Santric Milicevic
Abdur Razzaque Sarker
Nizal Sarrafzadegan
Benn Sartorius
Maheswar Satpathy
Miloje Savic
Monika Sawhney
Sonia Saxena
Mete I. Saylan
Elke Schaeffner
Josef Schmidhuber
Maria Inês Schmidt
Ione J. C. Schneider
Austin E. Schumacher
Aletta E. Schutte
David C. Schwebel
Falk Schwendicke
Mario Sekerija
Sadaf G. Sepanlou
Edson E. Servan-Mori
Azadeh Shafieesabet
Masood Ali Shaikh
Marina Shakh-Nazarova
Mehran Shams-Beyranvand
Heidar Sharafi
Mahdi Sharif-Alhoseini
Sheikh Mohammed Shariful Islam
Meenakshi Sharma
Rajesh Sharma
Jun She
Aziz Sheikh
Mebrahtu Teweldemedhin Shfare
Peilin Shi
Chloe Shields
Mika Shigematsu
Yukito Shinohara
Rahman Shiri
Reza Shirkoohi
Ivy Shiue
Mark G. Shrime
Sharvari Rahul Shukla
Soraya Siabani
Inga Dora Sigfusdottir
Donald H. Silberberg
Diego Augusto Santos Silva
João Pedro Silva
Dayane Gabriele Alves Silveira
Jasvinder A. Singh
Lavanya Singh
Narinder Pal Singh
Virendra Singh
Dhirendra Narain Sinha
Abiy Hiruye Sinke
Mekonnen Sisay
Vegard Skirbekk
Karen Sliwa, Australian Catholic University
Alison Smith
Adauto Martins Soares Filho
Badr H. A. Sobaih
Melek Somai
Samir Soneji
Moslem Soofi
Reed J. D. Sorensen
Joan B. Soriano
Ireneous N. Soyiri
Luciano A. Sposato
Chandrashekhar T. Sreeramareddy
Vinay Srinivasan
Jeffrey D. Stanaway
Vasiliki Stathopoulou
Nicholas Steel
Dan J. Stein
Mark Andrew Stokes
Lela Sturua
Muawiyyah Babale Sufiyan
Rizwan Abdulkader Suliankatchi
Bruno F. Sunguya
Patrick J. Sur
Bryan L. Sykes
P. N. Sylaja
Cassandra E. I. Szoeke
Rafael Tabarés-Seisdedos
Santosh Kumar Tadakamadla
Andualem Henok Tadesse
Getachew Redae Taffere
Nikhil Tandon
Amare Tariku Tariku
Nuno Taveira
Arash Tehrani-Banihashemi
Girma Temam Shifa
Mohamad-Hani Temsah
Abdullah Sulieman Terkawi
Azeb Gebresilassie Tesema
Dawit Jember Tesfaye
Belay Tessema
J. S. Thakur
Nihal Thomas
Matthew J. Thompson
Taavi Tillmann
Quyen G. To
Ruoyan Tobe-Gai
Marcello Tonelli
Roman Topor-Madry
Fotis Topouzis
Anna Torre
Miguel Tortajada
Bach Xuan Tran
Khanh Bao Tran
Avnish Tripathi
Srikanth Prasad Tripathy
Christopher Troeger
Thomas Truelsen
Derrick Tsoi
Lorainne Tudor Car
Kald Beshir Tuem
Stefanos Tyrovolas
Uche S. Uchendu
Kingsley Nnanna Ukwaja
Irfan Ullah
Rachel Updike
Olalekan A. Uthman
Benjamin S. Chudi Uzochukwu
Pascual Rubén Valdez
Job F. M. van Boven
Santosh Varughese
Tommi Vasankari
Narayanaswamy Venketasubramanian
Francesco S. Violante
Sergey K. Vladimirov
Vasiliy Victorovich Vlassov
Stein Emil Vollset
Theo Vos
Fasil Wagnew
Yasir Waheed
Mitchell T. Wallin
Judd L. Walson
Yafeng Wang
Yuan-Pang Wang
Molla Mesele Wassie
Marcia R. Weaver
Elisabete Weiderpass
Robert G. Weintraub
Jordan Weiss
Kidu Gidey Weldegwergs
Andrea Werdecker
T. Eoin West
Ronny Westerman
Richard G. White
Harvey A. Whiteford
Justyna Widecka
Andrea Sylvia Winkler
Charles Shey Wiysonge
Charles D. A. Wolfe
Yohanes Ayele Wondimkun
Abdulhalik Workicho
Grant M. A. Wyper
Denis Xavier
Gelin Xu
Lijing L. Yan
Yuichiro Yano
Mehdi Yaseri
Nigus Bililign Yimer
Peng Yin
Paul Yip
Biruck Desalegn Yirsaw
Naohiro Yonemoto
Gerald Yonga
Seok-Jun Yoon
Marcel Yotebieng
Mustafa Z. Younis
Chuanhua Yu
Vesna Zadnik
Zoubida Zaidi
Maysaa El Sayed Zaki
Sojib Bin Zaman
Mohammad Zamani
Zerihun Menlkalew Zenebe
Maigeng Zhou
Jun Zhu
Stephanie R. M. Zimsen
Ben Zipkin
Sanjay Zodpey
Liesl Joanna Zuhlke
Christopher J. L. Murray
Rafael Lozano

Publication Date

2018

Abstract

Summary Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

School/Institute

Mary MacKillop Institute for Health Research

Document Type

Journal Article

Access Rights

ERA Access

Access may be restricted.

Share

COinS