Press Release WHO/59
10 August 1998
PAEDIATRICIANS ENLISTED IN FIGHT AGAINST CHILDHOOD KILLERS
In her first major policy address since taking office last 21 July, Dr Gro Harlem Brundtland, Director-General of the World Health Organization (WHO), has enlisted paediatricians worldwide in the fight to reduce the deaths of children under age five. While five conditions alone - acute respiratory infection, diarrhoea, measles, malaria and malnutrition - kill about 70% of the 11 million children who die annually worldwide before reaching their fifth birthday, other diseases, and causes of death associated with the rapid expansion of cities, are increasingly afflicting children. Paediatricians, she said, have a special role to play in developing health systems and healthcare so as to nurture and protect humanity's future.
"Paediatricians are more than just doctors prescribing treatments. You are the people we turn to and trust for advice on the healthy growth and development of our children. This trust makes you a very special kind of community leader. You are a powerful voice for children who have very little voice in far too many countries," she said in addressing the XXII International Congress of Paediatrics in Amsterdam, the Netherlands, on 10 August. Enlisting paediatricians is Dr Brundtland's first high-profile effort to implement a new culture of "reaching out" to sectors of society which so far have not been approached by WHO in its efforts to achieve physical and mental well-being for all the world's people.
"We should have a winning case you as paediatricians and we as the World Health Organization inviting partners to join in advocacy for the rights and needs of the child in giving better and more compelling advice to governments on how to structure their health systems in a way that takes care of children properly .it is our combined and concerted efforts that can make a difference."
Investing in health will bring tangible returns in terms of, for example, a more productive workforce and more attentive pupils, she declared. Yet while the major causes of death worldwide are shifting from communicable diseases to non-communicable diseases and injury, for children there is little prospect of a similar change occurring in the next 20 years unless there is a major increase in attention to child health problems. The diseases of underdevelopment, the persistence of infectious diseases and malnutrition and unsafe motherhood and the lack of care will continue to be the major killers of children.
"Children are vulnerable. More than half of deaths due to acute respiratory infections and up to 90 per cent of deaths from diarrhoea, malaria and measles occur among children under the age of five. Underpinning all of this is the vicious cycle of poverty and ill health. Poverty leads to ill health and ill health breeds poverty," said Dr Brundtland.
The poor are five times more likely to die before the age of five and, in some African countries, one child in five still dies before reaching age five, while 75 per 1 000 live-born children die before reaching one month of age. In the developing world, one-sixth of all children are born underweight, and, globally, malnutrition underlies more than 50% of all childhood deaths.
Dr Brundtland emphasized the special role of breastfeeding in preventing both malnutrition and susceptibility to contracting infectious diseases, and called on her listeners to remain vigilantly on guard against aggressive marketing of breast-milk substitutes that undermine breastfeeding. In cases where the mother could be HIV positive, "correct, balanced and cautious advice" had to be given to mothers. It is critically important to avoid scaring mothers away from breastfeeding. Otherwise, decades of work to improve breastfeeding practices could be lost, Dr Brundtland insisted, and children would be the ones to suffer.
Vaccines were also a critical element in the battle to beat childhood diseases. Polio eradication was within sight and exciting vaccine developments in other areas are on the horizon, Dr Brundtland said. But donors would have to go that extra mile with WHO to finally rid the world of polio, while new partnerships, such as those between WHO and industry, will be needed to find means of making existing and new vaccines available to all children.
The IMCI Strategy
Beyond vaccines there is care and cure. Families must have access to effective case management and preventive measures, Dr Brundtland argued. Consequently WHO, in conjunction with UNICEF, had developed a strategy which could overcome many of these problems and lead to a major reduction in the number of children who die each year. The Integrated Management of Childhood Illness (IMCI) provides simple but effective case management and preventive measures which families can take in the home. It ensures effective combined treatment of the five major childhood illnesses, it speeds referral of seriously ill children and it empowers parents to care for their sick children at home, wherever possible.
The afternoon of 11 August is being consecrated by the International Congress of Paediatrics to a presentation of IMCI and the means by which it can improve the prospects for a child's survival even in the most remote of African villages.
Integrated approaches to disease management have inspired Dr Brundtland's initiative called "Roll Back Malaria". Every day, 3 000 children die from the disease and there are an estimated 500 million cases of the disease annually around the world. To combat this disease, once thought to be on the decline, WHO will build a coalition with WHO Member States, the World Bank, UNICEF, the United Nations Development Programme and other UN agencies to strengthen local health systems and the healthcare they can provide.
She then touched on other risk factors which would increasingly become killers of today's children. Foremost of these are HIV/AIDS and tobacco. More than 1 million children under 15 are living with HIV, while more than 2 million have already died of AIDS. Thousands and thousands of children have been orphaned by AIDS and many of them have already died as a consequence.
Highlighting the other major initiative she has launched since taking office "No Tobacco" - Dr Brundtland said, "Most adult smokers started smoking before the age of 18. The industry knows it and acts accordingly in their marketing strategies. If tobacco-related diseases are to be curbed, children should grow up in a world where homes, schools and working places are tobacco-free."
Today, 3.5 million people die from tobacco every year, while that number is likely to grow to close to 10 million in 2020, making tobacco the single largest global burden of disease. It is estimated that up to 250 million of today's children will die of smoking-related diseases if current trends continue.
Additional health concerns were caused by urbanization, Dr Brundtland said. By 2000, nearly half of the world's population would be living in cities, where factors such as overcrowding, air pollution, violence and road accidents were dangers to health. As cities increased in size, particularly in developing countries, water and sanitation systems would come under increasing strain, putting the health of all inhabitants at risk. The changing environment also means a greater threat to children from indoor air pollution, which could kill more than 1 million children per year, while the changes in lifestyle brings about increased stress and higher incidence of psychosocial problems.
"The health of the world should be judged by the health of its most vulnerable populations. That means children, and especially children of the developing world The destitute poor have for too long been kept at arm's length by good wishes and promissory notes," Dr Brundtland recalled in closing.
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