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Child health: a global perspective

The Millenium Development Goals

The state of child health globally

Broader determinants of child health

Making progress

The Millennium Development Goals

In 2000, 189 countries adopted the United Nations Millennium Declaration, which committed the international community to a set of goals aimed at improving the access of every individual to fundamental human rights. The fourth Millennium Development Goal (MDG4) aimed to reduce the mortality of children under the age of 5 years by 2/3rd between 1990 and 2015.

The state of child health

In the 1960's, there were an estimated 20 million child deaths. This number reduced sharply, and was halved by the 1990's. In 2006, the estimated annual number of child deaths was 9.7 million. The rate and magnitude of these global improvements in child survival are not uniform throughout the world, and many countries have made either no progress (in terms of improvements in child mortality) or insufficient progress in realizing MDG4. In fact, by 2003, the only region outside the developed world (defined by standard WHO designations) that was on track to achieve MDG4 was Latin America and the Caribbean. Such inequities in progress exist both between and within countries.

For more information, see:

Progress for Children - a world fit for children statistical review, 2007

Useful links:

• UNICEF The State of the World's Children 2009
• Ahmad O, Lopez A, Inoue M, The decline in Mortality: a reappraisal, Bulletin of the World Health Organization, 2000, 78: 11751191
• Countdown to 2015: tracking progress in maternal, newborn and child survival
• Child and Adolescent Health and Development: Progress Report 2006-2007
• WHO/UNICEF Regional Child Survival Strategy: Accelerated and Sustained Action Towards MDG4

Where are children dying?

In 2000, 41% of all child deaths occurred in Sub-Saharan Africa and another 34% in South East Asia. The inequity of global child health is reflected in the fact that 50% of all deaths in children under 5 years old each year occur in only 6 countries. Ninety percent of all deaths occur in 42 countries.

For more information, see:

Black R, Morris S, Bryce J, Where and why are 10 million children dying every year? Lancet 2003, 361: 2226-34

Why are children dying?

Between 2000 and 2003, 75% of the 10.7 annual deaths in children less than 5 years were caused by only 6 conditions: pneumonia, diarrhoea, malaria, neonatal infection, preterm delivery and birth asphyxia. With the exception of malaria, the burden of these conditions were similar across all the regions of the developing world. The major killers of children continue to be diseases that are preventable or treatable. Significant headway in child survival can be made (and is made) when these few high-burden conditions are targeted through simple interventions, such as oral rehydration, improvements in pneumonia prevention and case-management and neonatal care.

For more information, see:

Bryce J, Boschi-Pinto C, Shibuya K, Black R et al, WHO estimates of the causes of death in children, Lancet 2005, 365: 1147-52

Broader determinants of child health

Improving child health requires a broader and more integrated approach than just reducing the burden of childhood disease.  Major determinants of the disparities in child mortality between and within countries are poverty and maternal illiteracy.  The Millennium Development Goals are interdependent; achievements in one goal require progress in the others.  Without adequate sanitation, diarrhoeal diseases will continue to be prevalent.  Without improvements in maternal health and education, neonatal mortality will remain high.  Abused or exploited children or those who live in absolute poverty suffer, even in the absence of physical disease.  Some of the broader issues affecting child health globally include:

• Poverty
• Maternal illiteracy
• Child abuse
• Unclean drinking water
• Inadequate sanitation
• Indoor smoke
• Passive smoking
• Environmental pollution
• Child injuries
• Child labour and trafficking

For more information, see:

Gordon B, Mackay R, Rehfuess E, Inheriting the World: atlas of children's health and environment

Making progress

In 2003, the Lancet published a series of articles, collectively known as the 'Child Survival Series'. These aimed at advocating for the importance of child health in the global agenda. Some of the main findings highlighted that interventions to achieve MDG4 are already present, but their global coverage is currently below 50%.  Appropriate implementation of 23 of these basic interventions can avert an estimated 5.5 million annual child deaths.

For more information, see:

Jones G, Steketee R, Black R, Bhutta Z, Morris S et al, How many child deaths can we prevent this year?, Lancet 2003; 362: 65-71

How much additional resources are required to achieve universal coverage of the above-mentioned 23 interventions and to avert an estimated 5.5 million deaths?  Bryce et al, in 2003, estimated the cost at $5.1 billion each year. This is $887 per life saved.  While this amount may be affordable by the global community, in many instances, delivery of such widespread interventions requires a level of health system development and human resources that are not currently present in areas where child mortality is high. This highlights the importance of health-system and human resource development.  It also highlights the importance of implementation research and research aimed at building local capacity in developing countries.

For more information, see:

Bryce J, Black R, Walker N, Bhutta Z et al, Can we afford to save the lives of 6 million children each year? Lancet 2005; 365: 2193-2200

For an informative lecture and information sheet on the current state of global child health:

Another Inconvenient Truth? [PDF 1.64 MB] a lecture by Trevor Duke

International Health Resources (PDF 139 KB) includes a summary of the above lecture