Inequity in Child Health as a Global Issue
From the Department of Community Paediatrics, Newcastle General Hospital, Newcastle Upon Tyne, United Kingdom
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ABSTRACT |
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The Issue. Poverty, violence, lack of education, abuse and exploitation, and refugee status are among the primary determinants of the health of children worldwide. There are 1.3 billion people living on less than US $1 per day. Half the world’s population, 3 billion people, live on less than US $1.30 per day. Of the 4.4 billion people who live in developing countries, 60% lack access to sanitation, 33% lack clean water, 20% have no health care, and 20% do not have enough dietary energy and protein.1 The world’s 225 richest people have a combined wealth equivalent to the annual income of the poorest 2.5 billion people, nearly half of the world’s population.1 This article describes a number of the social, political, and environmental factors impacting children in the developing (southern hemisphere) world and how these are affected by actions taken in the developed (northern hemisphere) world.
Key Words: global child health • poverty • child health in developing countries • malnutrition • world debt • war and child health
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PROBLEMS AFFECTING CHILDREN GLOBALLY |
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It is within our power to reduce dramatically many of the health problems in the world that result from poverty, if there is the political will to do so. The money is available but is not used to benefit children. Table 1 shows comparisons between spending priorities, contrasting what is spent on health with personal consumer spending. Table 2 presents the primary causes of morbidity and mortality in children worldwide. Poverty is a key factor in the causation of all of these conditions. There is huge potential for wealthy countries to improve the health of children throughout the world from these mostly preventable conditions. The UN Convention on the Rights of the Child is a central tool in this endeavor.
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WORLD DEBT AND ITS IMPACT ON HEALTH |
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The debt incurred in past years by developing countries, which now accrues large interest charges, is a primary contributor to poverty in the southern hemisphere and has led to these countries’ seeking loans from the World Bank and the International Monetary Fund to repay them. "Structural adjustment" is the name given to the policies imposed by these organizations as prerequisites for receiving their monetary support.
The debt owed by developing countries is approximately US $2 trillion.2 Most of the national income in many very poor countries goes toward the repayment of these debts. This problem particularly affects sub-Saharan Africa. Although it is actually a smaller proportion of worldwide debt than it has been in the past, sub-Saharan Africa remains a focus of the World Bank because its debts represent a greater economic burden than in other regions. Latin American debt also is very significant, although it seems to be decreasing. The largest current increase in debt is in East Asia, where debts have risen 10-fold over the past several decades.
In international terms, debt reduction is perhaps the most important strategy to reduce poverty and improve child health. Debt affects health because of the structural adjustment policies of the World Bank and the International Monetary Fund. As a condition of the loans made to countries that are unable to repay their debts, structural adjustment policies require governments to privatize facilities, liberalize trade, decrease government spending on public services, and reduce food subsidies. These policies have disproportionately affected the education and health budgets of developing countries and consequently have led to major decreases in investments in schools and health care facilities. Another sequel is the introduction of user charges for needed services and the removal of food subsidies, which are often the only way countries can provide food at acceptable cost to populations with low income. Structural adjustment policies have a particularly severe effect on the poor in developing countries, particularly on children.3
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WAR AND CHILD HEALTH |
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War has a disastrous impact on children. Two million children have been killed in wars over the past 10 years.4 Disablement, displacement, and the orphaning of children have had a profound impact on the global health of children.4 A half million children died after the introduction of sanctions in Iraq. Data are now available that indicate the very adverse and direct effects of these sanctions on the health of Iraqi children.5,6
Children continue to be recruited as soldiers, particularly in developing countries. The use of child soldiers is widespread in conflicts throughout Africa. There are many other countries where child soldiers are a major part of the conflict. Both the United States and the United Kingdom recruit underage children into their armed forces as soldiers, showing that it is not just in developing countries that children act as soldiers.
Arms sales by the northern hemisphere continue to perpetuate war in the southern hemisphere. The members of the UN Security Council are the countries that are most involved in these arms sales.4 The United Kingdom and the United States are among the biggest arms salesmen; as such, we bear a responsibility for many of the wars in developing countries. Land mines are a particular concern as unsuspecting children often are the victims. Our Royal College of Paediatrics and Child Health supports the Land Mines Treaty, but support by the United States is less than it might be. The United States is among the few countries in the world that has not ratified this treaty.
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NUTRITION |
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Poor nutrition is the main cause of death during childhood in developing countries; it is implicated in more than half of all child deaths. One in 3 children in Africa is underweight. The United Nations Children’s Fund has analyzed the causes of protein-energy malnutrition, which are shown in Table 3.
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There is no reason that malnutrition could not be eradicated in many developing countries. However, large tracts of the agricultural land in the southern hemisphere are used by the northern hemisphere for growing exotic foods and vegetables and for production of meat to be eaten in more well-off countries. An additional issue is the marketing of unsuitable and expensive foods, in particular infant formula. Pediatricians worldwide have a close (some say too close) relationship with infant formula manufacturers, and this may inhibit their ability to speak critically about the role of these corporations in promoting bottle-feeding in poor countries. Infant formula manufacturers continue to evade the World Health Organization International Code of Marketing of Breast-milk Substitutes,8 and there is a need for pediatricians to assist in monitoring these violations.
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CLIMATE CHANGE |
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Climate change will have a marked effect on the health of children. More unstable weather patterns, rising water levels in coastal areas, the increase in vector-borne diseases, and the increase in desertification all will result in environmental changes that will impact children more than any other group in society.9
Many practices in the northern hemisphere contribute to global warming, in particular fossil fuel consumption. In the United Kingdom, we become worried as soon as we perceive a potential threat to our fuel supplies. Even if this lasts only for several days, people become frantic. We must learn to be less dependent on fossil fuels. This requires investing in public transportation and reducing our addiction to car travel, as well as developing renewable energy sources such as solar, tidal, and wind power. Fuel companies lobby against global agreements on carbon dioxide reduction targets, and there is insufficient research into sustainable energy.
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CONCLUSIONS |
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Children worldwide are threatened by poverty, violence, disease, and exploitation. Many of these threats are related to problems that are created in and by the northern hemisphere and to policies that we continue to practice. A focus on the rights of children is among the tools that pediatricians can use to improve the health and well-being of children in all countries. The Royal College of Paediatrics and Child Health and the American Academy of Pediatrics should begin to work with pediatricians and pediatric societies worldwide to pursue a children’s rights strategy to improve the global health of children.
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FOOTNOTES |
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Received for publication Mar 14, 2003; Accepted Mar 14, 2003.
Address correspondence to Thomas Tonniges, MD, FAAP, American Academy of Pediatrics, Department of Community Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: ttonniges{at}aap.org
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REFERENCES |
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SUGGESTED READING |
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Global health curriculum. Medact web site. Available at: http://www.medact.org. Accessed December 26, 2002Spencer NJ.
Poverty and Child Health. Abingdon, England: Radcliffe Press; 2000Tippale I, ed.
War or Health: A Reader. London, England: Zed Books; 2002Werner D, Bower B.
Helping Health Workers Learn: A Book of Methods, Aids, and Ideas for Instructors at the Village Level. Palo Alto, CA: Hesperian Foundation; 1982
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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