The title you have defined for today's seminar could well have been
selected from an advocacy handbook of the World Health Organization: Breaking the Poverty
Cycle: Investing in Early Childhood.
The discussions we have just had encapsulate a message that I am committed to bringing
to the political decision-makers in our effort to bring health to the centre of the global
development agenda: investing in health matters. Investing in health is a well documented
strategy for lifting populations out of poverty. Investing in early childhood is
cost-effective and a sound example of preventive public health policies.
The fact that we address these issues at the Seminar of the Inter-American Development
Bank is encouraging - but not surprising. IDB has been a frontrunner in showing why health
matters and why Member States should devote time and energy to getting their health
policies right. It has done so working closely with PAHO - the health component of the
Inter American System to which IDB also belongs - but at the same time the Regional Office
of WHO for the Americas.
I am here today to lend all my support to this collaboration, and to send a clear
message that WHO will work actively to reach out to the international financial
institutions in our quest for better health and better lives for billions.
This afternoon I wish to share with you some broad guidelines for WHO's work on
child health, and to reflect on how this work can fit into a broader cooperation with the
development banks. We have different roles. But we cannot live in different worlds. We
need to pull together the efforts of all the actors engaged in development.
Today we have a reliable overview of the global burden of disease. The figures from
1995 hold few surprises. The leading causes of mortality or disability show the
traditional three on top: respiratory infections, diarrhoea, and birth-related conditions.
What about the leading risk factors? First, there is malnutrition. Then follow poor water
The same three killers would have been on top had we done this study back in 1965 or
even earlier. But even if the top causes of child mortality remain the same, the levels
for most of them have dropped significantly.
Still, it is in child mortality where social inequalities have become most visible.
Most of the unfinished health agenda at the doorstep of the 21st century is
explained by the persistence of childhood illness. Illness against which we have tools.
Yet the application of those tools to all has failed because of social inequality and
inequitable health systems. So vast improvements in child health have not been shared by
all. This is why we still see persistence of causes of deaths which should no longer
occupy the top ranks.
But overall, child mortality rates and life expectancies have greatly improved. More
children survive the first five years of their lives than ever before.
What it means is that we have more children to take care of. The improvements in
science and public health which allow so many more children to survive their first years,
have handed us a new responsibility: Having secured children their survival, we must
ensure that they can have a healthy and stimulating childhood. This will prepare them for
challenges later in life and enable them to make contributions to the social and economic
development of their countries and communities.
Investing in early childhood means investing in poverty prevention. We have known for a
long time that poverty breeds ill health. What some have long suspected but which only
recently has become evident is that it works both ways. Ill health perpetuates poverty.
This is the root of the poverty cycle. And as the speakers before me have already
emphasised, the way to break the poverty cycle is to focus on children.
I feel we are making some headway.
We have strong and cost-effective tools to improve the lives of the youngest children.
Integrated approaches to children's needs that recognize the importance of early
childhood care for survival, growth and development have changed the way we look at
strategies for helping children living in poverty.
Let me focus on where WHO can contribute.
We are all aware that we need to pay attention to cognitive stimulation and
psycho-social factors in child development. But the underlying foundation for normal
mental development is the absence of serious disease. A child weakened by repeated attacks
of diarrhoea or malaria will not benefit.
Preventing or arresting the repeated assaults of illness on a young child are therefore
an integral and fundamental part also of ensuring a child's psycho-social
Nutrition is a key factor. The effects of nutrition not only on growth and physical
development, but also on cognitive and social development are well documented. A
malnourished child is not only more vulnerable to disease. Cognitive development will be
in peril, especially during the first three years of life. Stunted physical growth is
closely linked to reduced mental development.
Our intervention, of course, needs to start long before birth. Between 5% and 15% of
the global burden of disease is associated with failures to address reproductive health
needs. Many of these problems stem from adolescents becoming parents far too early.
Just imagine the costs, to the individual and to society, of the 600 000 women dying
every year due to maternal causes, and the 7.6 million perinatal deaths. Failing to ensure
that young people have the knowledge, skills and services they need to help them make
healthy choices in their sexual and reproductive lives costs us dear.
Investment in reproductive health is an investment in future health and development.
The world made real pledges at Cairo 5 years ago. But sufficient resources have not been
put forward. We need a renewed focus on the reproductive agenda - and WHO will actively
play its part.
Reproductive health, nutrition and strategies to combat common early childhood diseases
must take a central place in any programme for children. Other development activities can
spring from this. Health, nutrition, cognitive and social stimulation, as well as
education are complementary issues which lend themselves to cooperation across
A child's day is not compartmentalized into health, nutrition, education and the
like, and we should not impose our professional compartments on their lives. It is our job
to ensure that health and education, nutrition and social activities blend into one
protective and nourishing environment for the child.
One of WHO's contributions to early childhood care and development is the strategy
for Integrated Management of Childhood Illness. It is a product of lessons learnt during
the fight against childhood diseases. We found that many separate strategies to combat
single diseases in children often missed opportunities, resulted in redundant efforts and
sometimes gave mothers confusing or too narrow advice.
IMCI is important because it focuses on the youngest children - from birth to five
years - who traditionally have been the most difficult to reach. It is also important
because it uses existing infrastructures as a starting point: local health workers are
given training and support to assist children and parents.
A child brought to a clinic with diarrhoea will be treated for his complaint; at the
same time he will be checked for acute respiratory infections and other diseases and
receive a nutritional assessment. The child will be vaccinated, the mother will be told
about breastfeeding and other aspects of nutrition, and the importance of impregnated bed
nets in malaria-prone areas. All this in one integrated consultation.
As part of the IMCI strategy, these efforts to improve health workers' practices
are complemented by improvements in the health infrastructure, and by focused efforts to
change key family and community practices.
IMCI is a new strategy - too new for us to present definite and large-scale data on its
success. But on the ground, the change is already noticeable. Uganda is one of the 58
countries worldwide which have so far adopted the IMCI strategy.
One baffled mother coming out of a health station in a small Ugandan village recently
asked suspiciously whether there had been a major pay rise among nurses, since the health
workers now actually talked to her at length and showed unusual concern for her child.
In Brazil - which is one of 19 countries in Latin America and the Caribbean that have
adopted IMCI - early data from a research study suggest that nutritional counseling of
mothers in poor rural areas by health workers trained in IMCI has pretty much eliminated
the drop in weight which had been normal for babies in the transition period from
mother's milk to ordinary household food.
The strategy also emphasizes that no opportunity to immunize a child should be missed.
Childhood immunization is an area in which the achievements have been considerable. The
proportion of the world's children who are vaccinated has risen from less than 5% in
the 1970s to around 80% today. But maintaining coverage at these levels is an ongoing
task, and extending this basic service to all children is an unmet challenge. There is
still a long time-lag between the introduction of new vaccines into the rich world and
their availability to the world's less privileged children. Creative financing
mechanisms are part of the solution to these outstanding issues.
The key is team-work across disciplines and agencies. That leads me to the second
reason why this gathering today makes me optimistic.
A few years ago, a seminar such as this would typically have been organized by UNICEF,
by WHO or by one of the many child-oriented organizations that exist. This time, however,
it is organized by a bank.
I have always believed that you cannot make real changes in society unless the economic
dimension of the issue is fully understood. Once we understood the economic implications
of environmental degradation we were able to transform the Environment from being a cause
for the convinced to becoming an issue for real societal attention by major players. The
same goes for health.
The way to results is through partnerships. Often the best partnerships are those that
are forged between unorthodox entities. When people with vastly different backgrounds come
together with a shared purpose, creativity is released and expertise is used in innovative
and constructive ways.
For the World Health Organization this provides real inspiration. We have now
strengthened our intellectual capacity to prove how economic good sense can underpin sound
health policies. We intend to collect, analyze and spread the evidence that investing in
health is one major avenue towards poverty alleviation. We have established close
cooperation with the World Bank and the International Monetary Fund as well as with the
regional development banks.
As I said at the outset, the Inter-American Development Bank is no stranger to such
thinking. IDB has taken a lead in social-sector project lending, with its first so-called
"soft-sector" loans stretching back to the 1980s. Other regional development
banks are now following this path. Over the past decade, the World Bank has also
drastically expanded such lending.
The recent and ongoing economic crisis in Asia and several countries in Latin America
has brought home the need to protect and strengthen social sector activities and ensure
low-cost and universal health and education systems for all. "Trickle-down" does
not work on its own. Although this fact may be obscured during good economic times, it
becomes glaringly apparent during recession and crisis. Nowhere is the need for
intervention greater than in ensuring that children get the childhood they have a right
to. And, as several speakers this afternoon have shown, the economic benefits from
investing in early childhood are impressive.
But interventions need to be cost-effective. It need not cost a lot to make substantial
improvements in children's conditions. But poorly designed programmes can easily
become failures, wasting meagre public resources and making it harder to convince
decision-makers next time around that child-focused programmes are of value.
When Prime Ministers and Finance Ministers are told that early childhood development is
also their business - that wise investments yield real results - then they will listen in
a different way. They will consider changing their traditional priorities. When they see
that sound, cost-effective strategies exist, and that they are backed by world-renowned
expertise, then there is real hope that they will actually allot money for them.
This seminar has shown that we have the expertise, we have a growing number of
cost-effective strategies and - through the IDB - we have a willing and competent
financier: in short, we have what it takes to improve conditions for the children of the
Americas and the rest of the world.
This seminar is proof of the willingness to forge new partnerships. It makes me
confident that we will succeed in fulfilling the promises and duties towards our children
and in breaking the poverty cycle.