Committing to Child Survival: What are the Priorities?

Americans are broadly supportive of the efforts to reduce the tragic toll of AIDS, in part because they know that many children are affected by the disease and children's health has always been one of the highest priorities voiced in public opinion polls. But the truth is that most children who die in the developing world aren't dying from AIDS. They are dying from the same preventable killers as have stalked them in the past such as diarrhea, pneumonia, and malaria. These three diseases were the leading killers of children in 1980 and still are today, accounting for nearly half of all child deaths globally. Three of ten deaths are due to neo-natal causes and occur within the first 28 days of life, mainly as a result of asphyxia at birth, complications of pre-maturity, sepsis and tetanus. AIDS accounts for 3 percent of child deaths in the world, with this percentage significantly higher in a few African countries.While overall trends (.pdf) in child survival have been positive in recent years, progress has been uneven with child mortality rates increasing in at least 15 countries in the last 17 years, and stagnating in at least 13 others. In Angola and Niger, 26 in every 100 babies born will die before the age of 5 years, while the comparable rate in Europe is fewer than one in every 100, revealing the vast disparities that still exist. Over 10 million children this year under the age of 5 will die, with the overwhelming majority of these deaths - 99 percent! - occurring in poor countries. In light of these numbers, it is surprising that child mortality has not received more attention.The good news is that for nearly all major causes of child death, there are affordable solutions ready to be implemented that have already been effective in a wide variety of contexts (see, for example, the success stories from Millions Saved). Experts conclude that approximately two-thirds of child deaths could be prevented by interventions available and affordable for widespread use today such as Vitamin A supplements, oral rehydration therapy (ORT), and measles and tetanus immunizations. The Advanced Market Commitment launched in February 2007 for a pneumococcal vaccine could potentially drastically reduce child deaths due to pneumococcal disease (approximately 1 in 10 child deaths). Yet, although every year twice as many children die from any cause as adults die from AIDS, tuberculosis, or malaria, U.S. funding for child survival programs has declined 20 percent since 1997. The U.S. Commitment to Global Child Survival Act of 2007 introduced by Congress last month could help reinstate child survival as a global priority. A bipartisan effort, this legislation would establish guidelines and increase resources for child and maternal health programs, authorizing $600 million for 2008 with incremental increases through 2012. These funds would ensure that more life-saving interventions reach children who need them, while also possibly strengthening overall health systems since child health funds are mainly used at the primary care level. The legislation could also have the long-term effect of highlighting the causes of child death in the political sphere and the media. In the face of other growing global concerns, this is an important step towards ensuring that child survival is not forgotten and that progress continues towards achieving the child mortality reductions targeted by the Millennium Development Goals.