Study shows impact of the pandemic on health indicators in 185 countries

The economic impacts caused by the COVID-19 pandemic are likely to slow down the pace of implementation of the Sustainable Development Goals (SDGs) that make up the 2030 Agenda. This is the finding of a study by Fiocruz Minas, which investigated the evolution of 43 health-related indicators in 185 countries and made a projection of their performance for the period between 2021 and 2030, based on economic growth forecasts before and after the pandemic. The analysis showed that the countries with the lowest incomes could see a 16% drop in all indicators assessed, a much more significant decline than the 3% estimated for high-income countries, leading to worsening inequalities.

"Countries with stronger economies recover more quickly and are able to restructure in less time. The poorest countries, on the other hand, have had a much greater disorganization of their economic base, with a much longer reorganization process. This has an impact on the pace at which each country moves towards fulfilling the SDGs," explains researcher Rômulo Paes, from the Health and Social Protection Policies group, who coordinated the study.

To assess the evolution of health indicators, the researchers used an econometric model that included three indicators related to the economic aspects of the countries: GDP per capita (GDPpc), which represents the average production and wealth of a country distributed to each inhabitant and is based on projections by the International Monetary Fund (IMF); the Gini coefficient, which measures income distribution and is calculated by the World Bank; and each country's health investments, according to data from the World Health Organization (WHO). The analyses were carried out considering two scenarios: the countries' economic projections made in January 2020, i.e. before the pandemic; and those updated in October 2021, already taking into account the pandemic situation.

Following World Bank criteria, the researchers divided the countries into four groups: low-income countries, whose GDPpc is 1045.00 dollars; lower-middle-income countries, with GDPpc ranging from 1046.00 to 4095.00 dollars; upper-middle-income countries, with GDPpc between 4096.00 and 12.695 dollars; and high-income countries, with GDPpc above 12,696 dollars.

Results

When comparing the two projections for the decade, the study reveals a drop of 42% on average in economic growth in low-income countries and 28% in lower-middle-income countries. For high-income countries, the drop is 7%, and 15% for upper-middle-income countries. These indexes reverberate in most health indicators and show that the economic impacts of the pandemic are even more challenging for the poorest countries.

Indicators related to infectious diseases are among the most negatively impacted, with the pace of implementation expected to slow down in all four groups of countries. However, in low-income countries, the expected slowdown is 33.8% on average, compared to an average of 6.4% in high-income countries. The worst performers also include injuries and violence, maternal and reproductive health, health system coverage, neonatal and child health.

Low-income countries lead the regression in most indicators, with more negative impacts than expected for injuries and violence, maternal and reproductive health. Lower-middle-income countries, in addition to suffering an average 30% drop in indicators related to infectious diseases, tend to have a slowdown of around 10% in the pace of implementation of indicators related to maternal, child and neonatal health, as well as health systems and coverage. For upper-middle-income countries, non-communicable diseases, injuries and violence are the main areas of concern. Among high-income countries, in addition to setbacks in indicators related to infectious diseases, there is also less progress in environmental risks and maternal and reproductive health, but with much lower rates of deceleration than in low-income countries.

Also according to the study's projections, inequality, as measured by the Gini coefficient, had a significant influence on 15 indicators, especially the indexes of children with delayed growth, child vaccination coverage, malaria incidence, number of people infected with neglected tropical diseases, mortality from chronic non-communicable diseases, smoking prevalence, homicides and direct health spending. The greater the inequality, the worse the performance on these indicators.

Investments in health have influenced the indicators health systems and coverage, child malnutrition, immunization, mortality rates due to natural disasters, mortality rates attributed to pollution and exposure to unsafe water, sanitation and hygiene services. The impact is directly proportional, since the performance of the indicators is better in countries with greater investment in health.

The results of the study offer valuable reflections for international public health policy and show that international cooperation and targeted support to strengthen health systems in low-income countries are key to ensuring equitable progress towards a healthier future for all. "This study is a wake-up call as to what the main health challenges are and which aspects need more attention," says Paes.

Entitled  Post-Covid-19 health inequalities: Estimates of the potential loss in the evolution of the health-related SDGs indicators, the study was published (7/25) in the journal Plos One.