Don't let them die

With renewed attention and a boost in funding, millions of children could be saved

April 09, 2009|By David Kohn

From the 1960s to the 1980s, child mortality dropped drastically in the world's poorest regions. Vaccination, sanitation, health education and improved medical care saved millions of children. Most experts expected this success to continue automatically.

It hasn't.

Over the past two decades, child mortality has flat-lined; in some places, it's risen. Take Chad. There, a child has an astounding 1-in-5 chance of dying before age 5. That hasn't changed in two decades. In the U.S., an infant's risk of dying is less than 1 in 100.

"The world started a revolution in child health but didn't finish it," says Johns Hopkins University researcher Jennifer Bryce, a leading child health expert.

What happened? The answer is simple: lack of focus, lack of money. The groups that can make a difference - governments, health organizations, donors and the media - turned their attention elsewhere.

The scope of the problem is enormous. Every year, more than 9 million children under age 5 die around the world, mostly in sub-Saharan Africa and South Asia. Tragically, most of these deaths are caused by problems and diseases that are easily prevented or treated.

Diarrhea kills 1.6 million children a year, pneumonia and malaria more than 2 million. Measles - an ailment vanquished in the West by an inexpensive, effective vaccine - kills another 240,000. More than 800,000 newborns die of suffocation during birth; these deaths could be avoided with a $10 resuscitation bag.

In other words, researchers and doctors have the techniques and medicines to save millions of these kids. Ms. Bryce and her colleagues calculate that spending $5 billion a year could cut global child mortality by more than half. This plan would use proven, low-cost measures such as routine vaccinations and insecticide-treated bed nets.

This is a large sum, but not unimaginable in the context of the hundreds and hundreds of billions our government and others have been rapidly pumping into the faltering world economy. No doubt, the financial crisis deserves urgent attention, but so, too, do 9 million children dying every year.

"Five billion dollars seems very small compared with the money we're throwing around now," says Johns Hopkins University epidemiologist Robert Black, who has worked for decades on child health in Africa and Asia.

What impedes progress most is inertia - the vague sense, even among those who should know better, that it's normal for so many children in poor countries to die. "Child mortality is not a question of technical and medical knowledge," says Maurice Middleberg, vice president of the Global Health Council. "It's a question of political will."

Unlike ailments such as HIV and autism, child mortality hasn't captured the attention of celebrities, the media and the public. Diarrhea and many other child killers don't sell as well as some other diseases.

The result: Global funding for child health remains far below that of diseases such as HIV. In 2006, governments gave about $3.5 billion to the developing world for child and maternal health. This represents only 3 percent of all aid.

The U.S. hasn't done enough either. For fiscal 2008, the budget for child and maternal health was $476 million - about half the $900 million that child health advocates say is needed.

Sometimes this money doesn't save as many children as it could. Donors devote hundreds of millions of dollars to give expensive, cutting-edge medicines to children with AIDS. These children deserve care, but HIV represents 2 percent of all child mortality. Pneumonia, which receives far less money, accounts for almost a fifth of all child mortality.

The first step toward a solution is to spread the word that so many children are dying. Just as with HIV, public understanding will put pressure on governments and donors to get moving.

Luckily, we already know a great deal about what moves to make. We simply need the determination - and the money that follows.

David Kohn, a former reporter for The Baltimore Sun, spent 2007 as a Nieman/Gates fellow studying global health. His e-mail is

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