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Inequality has transformed surviving childhood into a global postcode lottery

Flavia Bustreo, Assistant Director-General - Family, Women's and Children's Health

Commentary
3 June 2015

You may already know the grim statistics: every day, 17 000 children under the age of 5 die; nearly half of them are newborn babies.

Flavia Bustreo, Assistant Director-General - Family, Women's and Children's Health.

Almost all these deaths – which occur in just a handful of countries – could be prevented. The inequalities between countries are stark. A child born in Angola is 84 times more likely to die before the age of 5 than a child born in Luxembourg.

Contrary to what you might think, this is not just an issue in poor countries. It applies to poor communities everywhere, including those in some of the richest countries.

Every child’s life is precious. But right now, a child’s chance of survival is determined almost entirely by luck: where he or she is born, the income and education level of the parents, and other social and environmental factors that have a direct impact on health.

"It is inexcusable that so many children die because they miss out on basic, cost-effective health services."

Flavia Bustreo, Assistant Director-General, Family, Women's and Children's Health

This means that despite the progress achieved, we have failed to reach the ones who need it the most – the poorest, the most disadvantaged, the most vulnerable. It is inexcusable that so many children die because they miss out on basic, cost-effective health services.

So what do we need to fill this equity gap?

1. A skilled health workforce

Many newborn deaths can be prevented by having a trained birth attendant nearby, someone with knowledge of simple, life-saving methods such as kangaroo mother care and exclusive breastfeeding, the latter of which is the single most effective intervention in high mortality settings. Skilled health workers are critical for providing care during childbirth and in the crucial week that follows, when more than 40% of child deaths occur.

2. Bringing care close to home

A key strategy in reaching the “unreachable” in remote areas is to make care more readily available by training local community members to give basic healthcare and treat common childhood illnesses. Antibiotics would prevent most child deaths from pneumonia and other infections. But access to these medicines remains difficult in the places where child death rates are highest. Removing legal barriers that prevent health workers from administering antibiotics for pneumonia would also save children’s lives.

3. Political commitment

Most important is political will and providing universal coverage to vulnerable populations. Countries such as India and Brazil, with strong economic disparities, are tackling inequalities and have set up special programmes to ensure free essential care to pregnant women, babies and young children. The results have been remarkable. Brazil’s infant mortality rate dropped from 47.1 deaths for every 1000 live births in 1990 to 20 in 2007. And in India over the same period, under-5 child mortality dropped 54.4% – from 118 to 52 deaths for every 1000 live births.

I was recently in New York, where the UN Secretary-General Ban Ki-moon convened world leaders to commit to a strategy for women’s, children’s and adolescents’ health. Ban brings strong global leadership to this approach, which looks to save lives through a focus on equity and human rights, and will serve as a platform for implementing the sustainable development goals, which will be adopted at the UN general assembly in New York in September.

As we move beyond the era of the millennium development goals, we, the global community, must seize the opportunity to work together. The gaps created by inequality must be bridged, and the conditions created for a healthy, sustainable future for every infant, child and person, regardless of where they live. We need action at the highest level, with commitments and resources to back it up.

Let’s not forget that action does not only rely on political commitment or the availability of medical knowhow. It must be founded on a recognition that our newborns and young children are not mere recipients of care, but are “rights holders” of their own, with legal entitlements to survival and the highest possible standards of health and care. Both in law and in practice. For all children. Without discrimination.


This article was first published in Guardian Global development on 28 May 2015.