They say starting the day with a good breakfast gives you a leg up on the rest of the day, so we thought we’d start out the week with some decent public health news. We’re always bringing you bad public health news, which isn’t what we want to do. We live for the news to be good. That’s what we work for. So here’s some good news. Well, I’d call it good news and bad news:
UNICEF today released new figures that show the rate of deaths of children under five years of age continued to decline in 2008.
The data shows a 28 per cent decline in the under-five mortality rate, from 90 deaths per 1000 live births in 1990, to 65 deaths per 1000 live births in 2008. According to these estimates, the absolute number of child deaths in 2008 declined to an estimated 8.8 million from 12.5 million in 1990, the base line year for the Millennium Development Goals (MDGs).
?Compared to 1990, 10,000 fewer children are dying every day,? said UNICEF Executive Director Ann M. Veneman. (UNICEF Press release)
I only gave you the lede. There’s a lot of other good stuff, too. For example, worldwide childhood mortality has been going down for several decades now, and the pace of decrease is actually accelerating. In the nineties it decreased by 1.4%. Since 2000 it’s gone down a further 2.3%. The biggest gains are in some of the world’s poorest countries. Malawi, a country among the top ten in childhood mortality, might be able to make the UN 2015 goal of decreasing its under five death rate by two-thirds from the 1990 level. The gains are attributed to the kind of international health efforts by WHO, UNICEF, the Gates Foundation and many, many others. While we argue about whether WHO should have called the flu pandemic earlier, they and their workers continued the very tough and often dangerous job of immunizing babies against measles, setting up programs to distribute insecticide-treated bednets, providing vitamin A supplementation and getting villages access to clean water. Malawi is a dramatic example of one of those interventions, provision of insecticide treated bednets. In 1990 the country had 225 child deaths per 1000 live births. Last year the number was 100:
In 2000, only 3 per cent of children under five slept under a mosquito net – a key means of preventing malaria, whereas by 2006 this had risen to 25 per cent. Malawi has focused its limited resources on improvements in health and health systems and the use of the most effective interventions, with the result that significant numbers of children?s lives have been saved.
Malawi deserves tremendous credit for this achievement, but it wouldn’t have happened without the hard work of thousands of technical aid workers from UN agencies and NGOs. Saving the lives of 10,000 children a day is a big deal. Said another way, not doing those things would be like slaughtering 10,000 children a day. So that’s the bad news. The data show that the lives of millions of children can be saved each year. Almost half the deaths in children under the age of 5 are in just three countries: India, Nigeria, and the Democratic Republic of Congo. India is a technologically advanced country. Nigeria is which with oil profits, mostly plundered by corrupt politicians. The Congo is a benighted, war ravaged country where the children that survive are given guns to shoot each other. And Africa’s best developed and most well endowed country, South Africa, has slid backward, presumably the result of equally backward attitudes of the previous government to HIV. When mothers are sick, their children die. It’s pretty simple.
So the good news is that things are getting better, even in the poorest countries. The bad news is that we could be doing even better still. It’s easy not to care about babies living far away in circumstances very different from ours, living lives we can’t even imagine. Some people might even welcome the deaths of these children on the grounds that our planet is over populated already and Nature is culling the herd. I have two responses. The first is practical. Decades of data regularly show that when infant and child mortality decrease, so does the birth rate. That’s the way Nature regulates population. If there is high infant mortality, the population ramps up reproduction. So if we are serious about the population problem (and we should be), then getting infant and child mortality under control is the surest way to do it.
My second response is a bit different. Last night two of my three grandchildren spent the night with us. They are 14 months and 26 months old. For Mrs. R. and me, they have faces and personalities, they give hugs, they laugh and cry and they look to their mom and dad and last night their grandpa and grandma to keep them safe. While they are our own grandchildren, they could be anyone’s. Just as they are worth everything to us, other babies and children have parents and grandparents to whom they, too, are everything.
In this business I am confronted on a daily basis with how much misery there is in this world. Not all misery can be prevented. It’s good news that there is less of this kind, a kind that we can prevent. It would be better news if there weren’t still so much misery we’ve already shown we can prevent but haven’t. Is it so different than killing 10,000 children a day with guns or bombs? Or does it just feel different?