PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1088-1089 (doi:10.1542/peds.2004-1775)
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COMMENTARY |
International Pediatric Congress
Executive Director, UNICEF
3 UN Plaza
New York, NY 10017
Abbreviations: UNICEF, United Nations Children’s Fund • UN, United Nations • HIV, human immunodeficiency virus • AIDS, acquired immunodeficiency syndrome
Child survival (and the overall health and well-being of children) lies at the heart of everything the United Nations Children’s Fund (UNICEF) does. We believe every child has the right to grow to adulthood in health, peace, and dignity. We share this vision and mission uniquely with pediatricians and the national organizations that represent them at the 24th International Pediatric Congress. Here I summarize UNICEF’s current perspective on the work to be done. Active participation by the global pediatric community as allies can hasten achievement of our shared goals.
Our commitment to child survival is as old as UNICEF. In the 1940s and 1950s, UNICEF provided food and basic health interventions to children in war-torn countries; in the 1960s and 1970s, UNICEF expanded its work into virtually every developing nation in which children’s lives were at risk; in the 1980s, UNICEF helped inspire a global child-survival "revolution"; and in the 1990s, UNICEF led efforts to help the world achieve its first set of global goals focused on the health and well-being of children.
The United Nations (UN) Secretary General’s report on progress in reaching the World Summit goals was the evidence base for determining the new goals at the 2002 UN Special Session on Children. The report revealed that the 1990 World Summit for Children target of reducing the child mortality rate to <70 deaths per 100 000 live births (or a one third reduction, whichever resulted in a lower rate) by the year 2000 was achieved in only 5 of the 53 highest burdened countries (with mortality rates >100 per 100000 live births in 1990), and a global decline of only 10% was achieved, compared with the 33% required to achieve the summit target.
Today UNICEF has 5 priorities, all of which focus on saving children’s lives and improving their chances of becoming productive citizens. The UNICEF priorities, immunization, early childhood development, girls’ education, human immunodeficiency virus [HIV]/acquired immunodeficiency syndrome [AIDS] prevention, and care and child protection, underpin the Millennium Development goals endorsed at the 2000 UN Millennium Assembly. They are also central to the program of action adopted by the nations of the world at the UN Special Session on Children in 2002.
In an effort to provide special support to achieve the Millennium Development goal on child survival (to reduce the mortality rate among children <5 years old by two thirds by 2015), UNICEF is hosting a new Child Survival Partnership. The partnership has a 2-pronged strategy. First, the partnership encourages better use of existing resources; second, it advocates for additional resources to scale up programs for child survival at global and country levels.
As pediatricians know, a number of factors contribute to the persistent child mortality rate. More than 10 million totally preventable child deaths still occur every year. Some are the direct causes of illness (eg, pneumonia, acute respiratory infection, diarrhea, measles), and others are affected by indirect causes such as conflict, marginalization, and HIV/AIDS. Malnutrition and a lack of safe water and sanitation are factors contributing to more than half of these deaths.
Six million children could be saved annually by basic, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, and improved breast-feeding practices and oral rehydration therapy. We know what it takes to improve child health and survival, but millions still die because they lack access to these basic services.
There is ample evidence of what works, but health and nutrition systems are faced with major implementation constraints. The public health environment has changed dramatically, and a number of new issues challenge child survival and well-being:
- Inequity and marginalization (eg, geographic, socioeconomic, cultural, gender) are increasing.
- Decentralization policies have not always been effective in channeling resources to the poorest communities
- The complexity of health and nutrition situations (eg, over- and undernutrition, epidemiologic transitions, emerging drug resistance) is increasing.
- The impact of HIV/AIDS has reversed the mortality gains achieved during the 1980s.
- Health financing has increased globally but is fragmented in a number of separate, sometimes competing initiatives.
- New partnerships have emerged that present both opportunities and challenges. Enhanced partnership with the pediatric community is one of those opportunities.
UNICEF’s 60 years of experience tells us that, despite persisting and new challenges, we can turn back child mortality and meet the Millennium Development goals by 2015. We have seen already that vitamin A supplementation can save more than a quarter of a million lives; oral rehydration therapy prevents 1 million deaths; and immunization programs can save the lives of nearly 4 million children.
Human development cannot be sustained anywhere unless children are protected everywhere and their rights to sound nutrition, basic health, quality basic education, shared parenting, full development of their potential, and clean water and adequate sanitation are fulfilled.
At UNICEF, we are unshaken in our belief that investing in children and mothers today, and empowering families to do the same, will ensure the well-being and productivity of future generations for decades to come. Reaching the poor and disadvantaged is not only a moral imperative: it is technically doable and financially feasible.
We are living through difficult and uncertain times. However, in a world in which poverty and ignorance threaten human security as surely as any weapon of mass destruction and HIV/AIDS and armed conflict have already caused more devastation and heartbreak than any terrorist could dream of, hope resides in the knowledge that together we can change the world with children.
Within the medical profession, pediatricians are acknowledged leaders concerning prevention of disease and maintenance of healthy growth and development. Pediatricians understand the powerful long-term influences of risk and protective factors including families, schools, and the broader community. This is true whether a child lives in a developing country, in marginal and unsafe conditions, or in the midst of plenty. Pediatricians also understand the importance of understanding the synergies that affect a child: how abuse or malnutrition affects their health, how health affects their ability to go to school, and how good nutrition and health affect their ability to acquire the skills and self-image necessary for adulthood in the 21st century. Unlike others in the medical profession that may address 1 point or event in a child’s life, pediatricians follow the life of a child—of many children.
We do not have enough pediatricians around the world, especially in the countries in which they are most needed. Pediatricians, as a community of practitioners, similar to UNICEF, have the sole mandate of taking care of children. You also understand your role as key advocates for children. Let me, an outsider, emphasize the need for you to do even more. Although carrying out your unique role in health services for individual children, your strong voices also are critical in each of your countries to advocate for programs and policies essential to the physical, emotional, and social health of all children. As respected individuals and members of your national pediatric organizations, you are influential when you speak up for children. UNICEF welcomes our partnership with you and counts on support. Together, we can save children’s lives and ensure the ongoing health and well-being for all children.
UNICEF, the International Pediatric Association, your regional and national pediatric organizations, and each of us as individuals need to work together to create a world fit for children.
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FOOTNOTES |
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Accepted Aug 13, 2004.
Carol Bellamy is the Executive Director of UNICEF. Prior to joining UNICEF, Ms. Bellamy was Director of the United States Peace Corps. Having served as a Peace Corps volunteer in Guatemala from 1963 to 1965, she was the first former volunteer to run the organization, which works in more than 90 countries.
The 24th International Pediatric Congress, held in Cancun, Mexico, on August 15–21, 2004, brought together 7000 pediatricians from every continent. An International Pediatric Congress, organized by a host country selected under the auspices of the International Pediatric Association, occurs every 3 years. The American Academy of Pediatrics is 1 of more than 100 national pediatric organizations that constitute the International Pediatric Association. This commentary summarizes Dr Bellamy’s speech at the opening session of the International Pediatric Congress.
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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