Medics call for action on child health crisis

Deprivation, not disease, is killing world's children, warn reports.
27 June 2003

TOM CLARKE

More money is needed to pay for vaccinations. © WHO

The health of the world's children is in an "abysmal state", say medical experts in a series of reports, the first of which is published today. Only cash and coordinated effort can end the crisis, they warn.

Each year, 10.8 million under-fives die. More than 60% of these infants are killed by preventable illnesses such as diarrhoea and pneumonia, the reports reveal¹-⁵.

"We could save 6 million children every year by doing what we know how to do," says Jennifer Bryce, a child health specialist at the World Health Organization (WHO) in Geneva, Switzerland - namely, tackling malnutrition and sanitation, and giving basic treatment for respiratory diseases and diarrhoea.

Bryce coordinated the effort, which presents the first comprehensive analysis of child survival data for two decades. The reports highlight a worsening trend in child health. Worldwide child mortality fell by about 2.5% each year between 1960 and 1990. This slowed to 1.1% between 1990 and 2001. "Focus has drifted away from child survival," says child health epidemiologist Saul Morris of the London School of Hygiene and Tropical Medicine.

Donations to child health care are also down. At $1.9 billion, this year's US overseas health aid budget is larger than ever, but funds earmarked for child survival are just $326 million, their lowest since 1995.

All this despite the United Nations' resolution in 2000 that made a 60% reduction in child mortality by 2015 one of its eight Millennium Development Goals.

The international community must find $7.5 billion a year, the analysis concludes. This money will pay for vaccinations against diseases such as measles and diphtheria, treating diarrhoea pneumonia and malaria, raising barriers to and HIV and improving nutrition.

A new strategy is needed, too, argue the reports. Global public-health money is almost always allocated to a specific disease or problem -tuberculosis or improved sanitation, for example. This compartmentalization can mean that resources are not maximized to benefit children, often those at greatest risk.

Recent initiatives, such as The Global Fund to Fight AIDS, Tuberculosis & Malaria, are well-intentioned, says Bryce. But they may be distracting attention and resources needed to improve the health of children as a whole.

She hopes that the WHO, which comes under new leadership in July, and the United Nations' children's fund UNICEF, will take the lead in finding the money and the strategy to improve child survival.

Epidemiologist Steve Luby of the US Centers for Disease Control and Prevention in Altlanta, Georgia, agrees. "If political rhetoric is going to mean anything you have to take concrete steps," he says. "This work shows they are achievable and also which steps you must take."

1. Black, R. E., Morris, S. S. & Bryce, J. Where and why are 10 million children dying each year?. The Lancet, 361, 2226 - 2234, (2003). |Homepage|
2. Jones, G. et al. How many child deaths can we prevent this year?. The Lancet,361,, in the press, (2003). |Homepage|
3. Bryce, J. et al. Reducing child mortality: can public health deliver?. The Lancet,361,, in the press, (2003). |Homepage|
4. Victora, C. G. et al. Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet,361,, in the press, (2003).|Homepage|
5. The Bellagio Study Group on child survivalKnowledge into action for child survival. The Lancet,361,, in the press, (2003).|Homepage|