News Roundup [abridged Versions Appear In The Paper Journal]

Unicef report calls for children to move to the top of the health agenda

BMJ 2000; 321 doi: (Published 16 December 2000) Cite this as: BMJ 2000;321:1490
  1. Susan Mayor
  1. London

    The poverty and neglect still suffered by millions of children in the world is a “waste of human potential,” warned an assessment of the wellbeing of children published this week by Unicef (the United National Children's Fund).

    Unicef's latest assessment of the wellbeing of children, The State of the World's Children 2001—reported a lack of investment in child health in many countries around the world, despite growing realisation of the importance of sustainable development in other areas.

    The executive director of Unicef, Carol Bellamy, argued: “Investment in the development and care of our youngest children is the most fundamental form of good leadership. The world is squandering human potential on a massive scale as hundreds of millions of the world's youngest citizens flounder in poverty and neglect in their first years of life.”

    The report focused particularly on the health of children aged 3 years and under, arguing that these early years are critical to how the rest of childhood unfolds. It suggested that ensuring a child's rights is a process that must begin very early, even before a child is born, because investing early in a child's health, education, and nutrition is a relatively efficient and effective way of guaranteeing positive future returns through savings on health and social services.

    The report stated: “The time of early childhood should merit the highest priority attention when responsible governments are making decisions about laws, policies, programmes and money. Yet, tragically, both for children and for nations, these are the years that receive the least.” It pointed out that early childhood services tend to fall across several services—health, nutrition, and education—which may explain the lack of integration and leadership.

    Almost 11 million children aged under 5 died last year, most from preventable causes. The major causes of death in children age under 5 in 1998 were perinatal conditions (20%), respiratory infections (18%), diarrhoeal diseases (17%), diseases that are preventable through vaccines (15%), and malaria (7%). In older children, teenage pregnancy remained a particularly worrying issue. The report noted that nearly 15 million girls aged 15-19 years give birth each year, accounting for more than 10% of all babies born worldwide.

    In many developing countries, more than one-third of women continue to give birth in their teens. The issue has a major impact on health, with the risk of death from pregnancy-related causes being four times higher in this age group than for women over the age of 20 years.

    Unicef has called on governments and international agencies to fund early childhood care fully, from before birth to teenage years, but with a particular emphasis on the ages up to 3 years, estimating that $80bn (£57bn) a year is need to give every newborn in the world a good start in life. The organisation prioritised four key points:

    • Early childhood care is a human rights issue. All children are entitled to registration at birth, sound nutrition, health care, clean water, adequate sanitation, basic education, and an opportunity to reach their full potential.

    • Early childhood care is grounded in sound science and practical experience. Comprehensive early care should provide the building blocks for social and intellectual competence.

    • Early childhood care is a solid investment. For every $1 spent on early childhood care there is a $7 return through cost savings, based on studies showing that participants in preschool and day care are less likely to experience illnesses and drop out of school.

    • The three major challenges are poverty, conflict, and HIV/AIDS. Effective interventions against these challenges these would bring major benefit to the health of the world's children.

    The Unicef report gave examples of how simple, positive interventions could improve child health. It described a home based programme carried out by a non-governmental organisation in Ambanganga, Sri Lanka. The programme—Sithumwama (which means “raising a child with enjoyment”)—promotes early childhood care, including education by volunteer home visitors about health childcare practices and cognitive stimulation.

    Ms Bellamy concluded: “The state of the world's youngest children is not nearly as good as it could be. It will only get better when we alter current priorities and accept the sound economic, social, and political sense that it makes sense to prioritise the world's youngest.”

    Dr Vincent Orinda, senior adviser on child health, UNICEF, New York, said: “We need to work with families and communities at local levels to improve child health and nutrition. It's at the household level that decisions are made by parents and caregivers that impact on the growth, development and survival of children.”

    The State of the World's Children 2001 is available from Unicef at: 020 7405 5592; cost £7.95 or $12.95, plus postage and packing. The text will also be available at (where the report can also be ordered online)

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