Bellamy addresses the 24th International Congress of Pediatrics
UNICEF Executive Director Carol Bellamy:
Dr. Schaller, Dr. Grange, Distinguished Delegates, Esteemed Guests, Colleagues, Ladies and Gentlemen:
It is an honour to join you for this important discussion of the health and survival of children. It is a particular honour to address a global community of medical professionals whose work, day in and day out, serves not only the basic health and development of children, but promotes the fundamental right of every child to the best possible start in life.
It is also notable that we are gathered in Mexico, a country with whom UNICEF is – this very week – celebrating 50 years of partnership. Mexico has not only made major strides for its own children, but its international leadership has helped elevate child rights on the global agenda. To our Mexican hosts I say, thank you very much for welcoming us so warmly to this beautiful coast.
Cancun is a symbolic place to acknowledge what Mexico has accomplished in child survival over the last 40 years. For it was in remote places like this that four decades ago children were dying in great numbers. In 1960 Mexico had a child mortality rate of 134 per 1,000 live births. Today it has dropped to 29.
That remarkable progress is a credit to foresight and investment by government leaders; to improving economic circumstances; and to advancements in public health technology. But in no small part this kind of success story is due to the community-based efforts of professionals like you. So congratulations. Individually and collectively, you make an enormous difference not only in the lives of individual children, but of entire nations.
I’d like to share with you some of the global trends that we at UNICEF have been observing over the last few years, but before I do, a story:
I am told that back when he was still president of the Soviet Union, Mikhael Gorbachev was asked by journalists traveling with a foreign dignitary if he could sum up the state of the Soviet economy in one word. Just one word.
Gorbachev thought about this a moment, and then said --- “Good.”
He was then asked if he could sum it up in two words. He thought about that, and then said --- “Not good.”
Even in the decade of the 1990s, despite the catastrophe of HIV/AIDS and the spread of armed conflict, global child mortality was reduced by 11 percent.
So if I were asked to sum up in one word the state of child survival in the world today, I might be very tempted to follow Mr. Gorbachev’s lead and say, “good.”
But friends, you know – perhaps better than anyone else in the world – that the state of child survival in the year 2004 is not nearly as good as it could be, not nearly as good as it should be.
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Over the past few years there has been increasing dialogue about where we as a global community are heading with respect to child survival. At the 2000 Millennium Summit in New York, governments made it quite clear that they recognize the direct link between the survival and development of children and women and the survival and development of their societies.
Of the eight major goals set at the Millennium Summit, six relate directly to the health and well-being of children and women. These Millennium Development Goals reflect a thorough recognition by governments that individual well-being is a prerequisite to economic development – not the other way around.
In other words, we cannot defeat entrenched poverty and huge social disparities through economic development efforts alone.
Similarly, we are at a stage where we cannot make major reductions in child and maternal mortality through initiatives in the health sector alone. To reach these crucial goals, enlightened political leadership is necessary. Leadership that is willing to recognize underlying causes and take appropriate steps to confront them.
A remarkable study published by Bristol University and UNICEF last year illustrated very clearly how poverty, discrimination, and social exclusion combine to take the lives of children and women.
The study was fundamentally a disparities analysis, looking at services within countries and correlating access and quality of services to mortality rates and other indicators. Not surprisingly, even in countries with good overall indicators, populations that are marginalized – because of race, religion, caste, ethnicity, geography, or wealth – marginalized communities are much more likely to suffer from very poor survival and health indicators. And not surprisingly, they are also entrenched in poverty.
Latin America offers a clear example of the impact of exclusion and poverty. Child health indicators in this region are among the best in the developing world, yet at the same time we are seeing an alarming erosion of some achievements, especially among marginalized populations. More than 400,000 children under the age of five die needlessly each year in Latin America and the Caribbean; those from indigenous communities or of African descent are disproportionately represented. And with almost 110 million children – 55 per cent of the region's boys and girls – in poverty, Latin America has real work to do to ensure that rights are reaching every child, not just the middle classes.
As trusted professionals looked to for guidance by parents and governments, pediatricians can make a difference by speaking out loudly and clearly not only about the symptoms but also about the causes of these avoidable deaths and lost human and economic potential. It is an effort in which we need you, as a community of practitioners, to raise your voices in influencing policies and ensuring that the rights of all children are fulfilled.
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Child survival has always been the core of UNICEF’s mission. In the 1940s and 50s we emphasized early childhood nutrition and the production of quality milk. In the 1960s and 70s we helped invest in basic health care and immunization. And in the 1980s UNICEF led the child survival revolution that put child health at the center of the global agenda. Through the 1990s we helped governments work toward the goals they set at the World Summit for Children – the first time concrete, time-bound goals had been embraced by every government on earth.
And with the arrival of the Convention on the Rights of the Child in 1989, UNICEF led the global movement to recognize that children are not just objects of our charity and good will, but the holders of rights to whom we have a fundamental human responsibility. It has been a monumental advancement – not only for UNICEF, but for everyone working in development.
Among other things, the Convention and the World Summit goals set the table for the Millennium Development Goals and their emphasis on investing in children.
It is because children have rights, and because their health and welfare hold the key to sustainable human development, that in its own work UNICEF has come to emphasize not only basic health, nutrition, water, and sanitation – our traditional programs and still the core of what we do – but those things that make it possible for more children to survive and thrive in the long run:
- Quality basic education for all, especially girls.
- The protection of children from exploitation and abuse.
- An end to attitudes that say it’s OK to discriminate against children and women.
- Breaking the silence around AIDS in order to prevent its spread among young people.
You know what I am talking about. I can’t think of anyone who understands the forces that hold back our children better than pediatricians do. You are held in respect and you are spoken to in confidence. Every day you see, hear, and touch the real world in which children live.
You know that an immunized child who is beaten or abused is not a healthy child. You know that a healthy child who never goes to school will not stay healthy for long. You know that intelligent children who are marginalized because of prejudice will never reach their potential. And you know that keeping a child alive, healthy, well-nourished, and protected is not a job for Health Ministries alone.
It is a job for Social Welfare Ministries, Education Ministries, Labor Ministries, Justice Ministries, and Finance Ministries. It is a job that goes far beyond government, to civil society, communities, and most importantly, families.
These are among the reasons why UNICEF regards education, especially for girls, as a prerequisite for making long-term gains in child health and survival. Only education can put young women (and young men) in a position to care for their own children with knowledge and confidence; put them on a path to economic and social empowerment that can break the grip of poverty; and provide a means for changing attitudes about violence and discrimination.
In the world we are striving for, children not only survive, but are mentally alert, emotionally secure, socially competent, and able to acquire the knowledge they need to be physically healthy and productive adults.
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The world has changed dramatically since the end of the Cold War in 1990. Apart from the emphasis on human rights as the basis of development, we have seen an explosion in armed conflicts and the spreading devastation of AIDS. And we have seen many of the gains the world made in child survival begin to stagnate, in some countries even to reverse.
It will not be easy for us to reach the Millennium Goal of a two-thirds reduction in under-five mortality by the year 2015. In fact, many countries have done too little since the base year of 1990 and will have to work doubly hard over the remaining years to succeed.
Our latest report on Progress for Children, which will be issued publicly in about eight weeks, analyzes country-by-country how much each country will have to reduce child mortality each year in order to reach the goal. We have provided a pre-publication copy of the report for all of you here at this conference to study. It will be available at the UNICEF exhibit on the ground floor.
Some regions – notably sub-Saharan Africa – have been really hurt by AIDS and the demands it has placed in health systems. Others have suffered setbacks due to conflict or economic dislocation.
It is very clear to us that a changed world requires fresh and updated strategies in the fight for child survival. Most of the broad outlines of what needs doing were covered in a special series on survival by the British medical journal The Lancet last summer. If you have not read it I encourage you to do so.
Many of the key global players in child survival have been meeting to plot out how best to create renewed momentum. I am pleased to announce that a child survival partnership has been formed to ensure that we are all doing our utmost in this crucial area. That partnership which includes USAID, CIDA, Dfid, the Gates Foundation, WHO, UNICEF and others will be hosted at UNICEF in New York but will emphasize innovation at the country level.
This has spurred us to search for new ways to strengthen health care delivery, with a particular focus on bringing health services to people rather than people to services.
We have learned that the health interventions that have the greatest potential to save children’s lives are those that rely on some level of action and knowledge in the household itself – obtaining and using insecticide-treated bed nets, for example. Exclusive breastfeeding for at least the first six months. Use of ORS in the home. And much more.
What this means is strengthening health systems with renewed investment and training, but also extending basic care from the health center into the home, empowering families to do more of what’s needed to keep children healthy.
We know only too well that in resource-poor, remote areas family is the first if not the only source of health management available to a child. The need to empower family and community caregivers with adequate knowledge is one of the key building blocks of an effective child survival strategy that makes inroads where earlier measures did not.
I am pleased to report that a multi-country effort to more effectively bundle child survival services is showing very encouraging results in West Africa. The program, sponsored by the Canadian government, employs highly localized approaches to delivering a national package of interventions, using careful pre-analysis of bottlenecks and extensive engagement with local communities.
This kind of field-testing is what UNICEF does best: testing new approaches, finding out what works, and sharing what we learn so that successful strategies can be used widely. We are optimistic that the work being done in West Africa will help provide new approaches to the challenges we face in child survival.
So to summarize: We’ve done well, but not nearly well enough. Child health and survival face new challenges in a changing world. To succeed we have to apply fresh thinking, not only to our work in traditional health sectors, but in advocating for education, protection, and equality. We have an uphill fight toward 2015, but we have new knowledge, new technologies, and fresh field experiences to draw upon. And we are inspired by the knowledge that millions of children’s lives will be saved every year if we succeed.
My friends: We are living through difficult times. In a world where poverty and ignorance threaten human security as surely as any weapon of mass destruction – and where HIV/AIDS and armed conflict have already caused more devastation and heartbreak than any terrorist could dream of – hope resides in the knowledge by investing our energies and resourcefulness in our children, we can improve our world. We look forward to working with you in close partnership.