Today, I’m excited to announce results of a new UNICEF study. They will make a big difference in what UNICEF will do – and a much bigger difference for the children we serve.
What we found can change how they will live—and how many will live.
We release this study ten years after the countries of the world dedicated themselves to meeting the Millennium Development Goals (MDGs) by 2015.
We’ve made progress since then. Great progress. But not enough.
And so, in two weeks, many world leaders will meet here in New York for the Summit called by UN Secretary-General Ban ki Moon to review our progress and consider a question at the heart of our mission.
Can we move faster?
At UNICEF we’ve spent four months examining in great detail whether a new approach could do just that.
The study we release today shows we can.
You’ve already received the two reports detailing our findings – “Narrowing The Gaps To Meet The Goals,” and “Progress for Children,” our report on progress towards the MDGs.
You’ve also gotten a user-friendly version of the study we offer to the statistically-challenged.
After I’m done you’ll hear from my friend Carolyn Miles, the Vice-President of Save the Children.
Right now, I’ll talk briefly about three things: Why we conducted this study.
How we did it.
What we found.
We began it because one trend alarmed us.
Even in many countries making progress toward the MDGs, we see gaps between the richest and poorest children widening.
UNICEF recently examined 26 countries where the national under-five mortality rate has declined by 10 per cent or more since1990. In 18 of them, the gap between the child mortality rates of the richest and poorest quintiles either grew or stayed the same. In 10 of these 18 countries this disparity rose by at least 10 percent.
Poor children in developing countries are 2-3 times
more likely to be underweight …
less likely to attend school … and;
more likely to die …
than children in the richest quintile.
At UNICEF those figures have already led us to refocus all the more on the most deprived children. That is our mission. That’s also the mission of the UN. The Secretary General’s recent “Global Strategy for Women and Children’s Health” report specifically calls for “focusing on the most vulnerable.”
Many accept that focusing on those most in need is right in principle and even sound in logic. But they have often questioned whether, in practice, such strategies are worthwhile, given their cost and difficulty.
And it is hard to reach the very poor. They often live in remote areas. Even those in urban areas find themselves marginalized by weak transportation links and limited physical infrastructure.
But over the last decade, there’s been mounting evidence that new technology and new ways of delivering interventions might mean the traditional view no longer applies.
So, four months ago, we asked ourselves:
Because the needs are greatest in those areas, would the benefits of concentrating on them now outweigh the costs of reaching them?
We decided to find out by carefully studying a representative group of developing countries.
Today, I announce what we found. Credit for the achievement belongs to a team that’s worked exhaustively on this issue ever since, led by Rudolf Knippenberg, Mickey Chopra, and Nick Alipui, all of whom are here this afternoon.
Bear with me for two minutes, while I try to reduce the highly complex process that led to this announcement.
The team went through three steps.
1. First, after an exhaustive review of some sixty countries, they chose fifteen—based on different levels of deprivation and different patterns of inequity. They grouped those countries into four typologies, ranging from low-income countries with high deprivation and high inequality between the most deprived and the affluent, to middle income countries with less deprivation and less -- but still significant -- inequality.
2. Next, they created two model strategies.
A model equity focused approach: enhanced efforts to focus on those worst off – emphasizing community outreach. Then they made a model of the current path: a broad approximation of contemporary approaches, lending significant but less focused attention to the most deprived groups and areas.
3. Finally, the team created a complex simulation, with more than 180,000 variables. They ran each of the two approaches through the four typologies using methods that both the World Bank and UNICEF use in analyzing the most cost-effective ways to attack development bottlenecks.
They consulted a range of experts; they submitted the work more than once to peer-review; and spent a day in late July with leading authorities we asked to review the work.
All along, I have emphasized that we had to go where the facts led us. There can be a strong desire to please a new boss. I asked our team to bend over backwards to avoid that—and they did.
And I’m more than pleased by what they came up with. I’m excited – by the results.
So were many of our outside experts, one of whom wrote that UNICEF had “challeng[ed] some of my preconceived ideas and… made me think that the equity focus can be persuasive on an instrumental as well as a values basis.”
And—finally—here is what we found.
The equity-focused approach:
Proved considerably more cost-effective and more sustainable than the path we are on.
For example, in low-income, high-mortality countries, every $1 million invested saved 60% more children’s lives.
And it therefore accelerated progress towards health-related MDGs faster than the current course.
Let me emphasize: this study in no way casts doubt on or calls for a reversal of what we and our partners have accomplished. It only helps us find the best way to build upon what we’ve achieved.
But we should begin that work immediately.
Mark Twain once wrote, “Do the right thing. It will gratify some and astonish the rest.”
And I admit: at times, watching the preliminary work of this study, I was surprised.
But this study demonstrates that an approach focused on the most marginalized is right in principle and right in practice.
It doesn’t just suggest change. We believe it compels it.
For whenever you point out all the progress that has been made in saving children, you can’t ignore what’s not yet done. Yes, while in 1975 more than 40, 000 children less than five years old died every day of unnecessary causes -- in 2007 it was about 25,000 – and today?. Well below 24,000. That’s wonderful progress. And all of those children who would have died are now teenagers leading, hopefully, happy lives.
But it still means that many more than 20,000 kids died yesterday. And will today. Unnecessarily.
If more than 20,000 kids died today in some disaster, the world would talk about nothing else. Because those 20,000 died of a mosquito bite, or a microbe, too few people will talk about them at all.
We should talk about them. For if we go where the facts and the model of this study lead us – if we focus on the most deprived and forgotten children … millions of them will survive. Will go to school. Will live productive lives.
So, in this final push to the MDGs, we all should look at our programs through the prism of equity.
Let’s take advantage of what we have learned in the last decade.
We have an extraordinary opportunity to do not only the right thing, but the most practical...
So when 2015 arrives we can say that:
We not only saw the growing gap between rich and poor—but we narrowed it.
We not only reached the most unreachable – but reached the most in need.