Entitled to a healthy, thriving future
Authors: None The Lancet Global Health
Journal: The Lancet Global Health (2020)

Since the start of the Sustainable Development Goal era, several impediments to health and wellbeing, including climate change and the commercial determinants of health, have substantially increased in urgency and scale. Today's children are due to inherit these problems and to be most affected by them. Feb 18 saw publication of a WHO-UNICEF-Lancet Commission that emphasises the urgency of improving child health in the context of these intensifying issues, now and sustainably into the future. The report illustrates the high benefit–cost ratio of investment in child health, showing immediate, long-term, and intergenerational benefits that are greater than the sum of their parts. This Commission also introduces a new child flourishing index, which ranks countries on their performance with regard to children's entitlement to not only survive but to thrive, irrespective of their gender, ethnicity, and socioeconomic circumstances. The Commission is a welcome reframing of the child health agenda at a time when these escalating threats perhaps naturally draw our gaze towards non-communicable diseases and older-age morbidity. Yet many of the threats to the world's children are not new. As speakers at the first Global Forum on Childhood Pneumonia (Jan 29–31; Barcelona, Spain) reiterated, pneumonia remains the leading infectious cause of under-5 mortality, despite being broadly preventable by vaccination, hygiene measures, adequate nutrition, curbing air pollution exposure, and rapid treatment with inexpensive products. The Forum gathered policy makers, international agencies, donors, practitioners, researchers, civil society representatives, and youth advocates from more than 40 countries. There was much scope for optimism: the Serum Institute of India highlighted WHO's prequalification of its affordable 10-valent pneumococcal conjugate vaccine and UNITAID announced US$40 million of grants to support the roll-out of child-oriented pulse oximeters at primary-care facilities in nine countries. The advent of the pneumococcal conjugate vaccine and the continued commitment by Gavi to enabling access for high-burden countries has changed the outlook for many children in these countries; yet, in diagnosis and treatment, glaring gaps remain. Pulse oximeters and dispersible amoxicillin are regularly absent or out of stock at the primary-care level, and poverty and inadequate education too often result in delayed care-seeking. Other types of inequality also affect child survival. In this issue of The Lancet Global Health, Cesar Victora and colleagues assess differences in under-5 mortality among 415 ethnic groups in low-income and middle-income countries, finding ethnic disparities in 25 of 36 countries assessed. In these countries, the median mortality ratio between the ethnic groups with the highest and the lowest under-5 mortality was 3·3 (IQR 2·1–5·2; range 1·5–8·5), and these gaps persisted even after adjustment for wealth, education, and place of residence. The underlying explanation is probably complex, but Victora and colleagues posit that discrimination affecting access to services and interventions might be implicated, indicating a target for health system improvements. If health education and services too often fail to reach their targets, corporate power to reach individuals, particularly children, has never been greater. Big business and commercial interests hinder progress in child health: as the Commission states, the vulnerability of children and their caregivers is exploited as they are exposed to marketing for unhealthy foods, e-cigarettes, and breastmilk substitutes, enabled by well resourced and effective lobby groups. Simultaneously, poverty is being exacerbated by right-leaning populist governments defunding social safety nets and promoting market deregulation and philanthropy as posited best-practice solutions to the health funding gap. To many, the most notable part of this year's World Economic Forum in Davos was the continuing denial that progressive taxation is not only preferable but essential to address this funding gap. Many of us could not have predicted the substantial and rapid effects of climate change, conflict, economic inequality, and technological advances on health, yet these factors are now immediate priorities. However, we should not lose sight of the unfinished agenda of pneumonia and diarrhoea as the biggest killers of the world's children. Solutions will require long-term, sustainable strategies to give this and future generations equitable access to health care, education, democratic representation, and a safe living environment. Governmental leaders must be bold and ambitious enough to tackle these problems with child-focused strategies that will reach fruition long beyond their term in office. Association between ethnicity and under-5 mortality: analysis of data from demographic surveys from 36 low-income and middle-income countriesSignificant ethnic disparities in child survival were identified in more than two-thirds of the countries studied. Regular analyses of ethnic disparities are essential for monitoring trends, targeting, and assessing the impact of health interventions. Such analyses will contribute to the effort towards leaving no one behind, which is at the centre of the SDGs. Full-Text PDF Open Access