Adolescent Rights: What Progress
Plenary Session: The Social and Political Costs of Inaction
FXB Center for Health and Human Rights, Harvard University
Boston, 8 December 2011
Thank you, Jacqueline. Thank you to the Francois-Xavier Bagnoud
Center for bringing us all together.
And thank you, my former tutor, Amartya Sen. It is an honor to be here with a man who many years ago tried to instruct me in economics … and who has instructed the world in the fundamental role freedom plays in strengthening societies. I look forward to learning from him this afternoon. My remarks today are very much in the spirit and context of his work.
The coming of age of the Convention on the Rights of the Child is the ideal time to reflect on the generation of adolescents who have grown up under its auspices … to take stock of progress made in improving their lives … to consider how we can build on that progress … and to confront what could happen if we do not.
The CRC was and is a milestone in promoting the welfare and protection of children everywhere. It has been more quickly and widely ratified than any human rights treaty to date – and it will be even more effective when it is universally ratified. I hope sooner rather than later.
The CRC is the foundation of all our work at UNICEF: It provides our mission and our mandate. The rights of children and our emphasis on equity, in all our advocacy and programs around the world, are inseparable. Because to the degree children are disadvantaged – for reasons of geography or gender or ethnicity … or because they live with disabilities or disease … or are stigmatized and bullied for any reason – to exactly that degree, their rights are being violated.
So let me here sketch out two propositions for our discussion.
First, that sustainable, tangible progress in children’s global welfare depends – in practice as well as in principle – on a focus on equity.
Second, more broadly, and tentatively, that we should not only advocate for policies that promote equity as an outcome of economic growth, but also –conversely – we should make the case that promoting equity helps produce sustainable growth, a proposition that is supported by a growing body of evidence.
Let me begin with why refocusing on the most vulnerable children is a practical as well as a moral necessity.
Eleven years ago, the global community adopted the Millennium Declaration and the Millennium Development Goals – a set of ambitious targets to reduce global poverty, decrease child mortality, and achieve other development objectives by 2015. Last year, we began to see disturbing evidence that millions of children are being left behind in the drive to achieve the MDGs.
The poorest children. Living in the most isolated communities. Subject to the greatest deprivations.
A UNICEF analysis last year showed that in 18 out of 26 countries where the national under-five mortality rate had declined by 10 per cent, the gap between the child mortality rates of the richest and poorest quintiles had either grown or remained unchanged. And in 10 of these 18 countries, this disparity had risen by at least 10 per cent.
In short, the gap between the richest and the poorest children, on something as fundamental as their mortality rates, was widening. That is wrong. Statistical successes were – and are – masking moral failures.
One possible reason for this is that in the rush to achieve MDG 4 – reducing under-five mortality – there has been a natural impulse to focus on the children who are easiest to reach. To pick the low-hanging fruit. This reflects a common belief in the development community that while it would be nice to reach the communities most in need, it is usually too expensive and too difficult.
But new vaccines and other cost-effective interventions, coupled with innovations like the use of SMS texting by community health workers, now make it easier and less expensive to reach the hardest to reach.
So, we decided to question the conventional wisdom.
“The real voyage of discovery,” Marcel Proust once said, “consists not in seeking new landscapes but in having new eyes.” (I always found quoting Proust useful in my mid-terms here.) And that is what we tried to do: to look at a development orthodoxy with new eyes.
Last year, soon after I arrived at UNICEF, we put a team of our best analysts to work on an extensive modelling exercise to test the cost-effectiveness of an equity-focused strategy to reduce under-five mortality. (I will be glad to discuss the study in more detail later, and have copies of it for those who are interested.)
After a few weeks, the team gave me their preliminary results. They were stunning – so much so that I rejected them and insisted they run the modelling exercise again. When this produced essentially the same findings, we called in a team of outside experts, who spent a day trying to tear the study apart. At the end of the day they applauded our weary analysts – and validated their work. After we published the study, The Lancet and New York Times ran positive editorial comments.
The conclusion of our study? That far from costing more, an equity-focused approach is actually far more cost-effective.
In fact, in those countries with the highest burden of under-five mortality and the worst poverty, for every $1 million investment, a pro-equity approach can save up to 60 per cent more children than our current course. Even in middle income countries, such an approach generally saves as many children per dollar as we do on our current course.
Simply put: A pro-equity strategy is not only right in principle; it is right in practice.
We believe this is big news. It reinforces our re-emphasis now, throughout UNICEF, on achieving results in the most disadvantaged communities around the world.
In a difficult economic climate, when all governments must do more with less, we can take these findings to finance ministers and prime ministers who are considering investments in the health and education of their poorest citizens … or to aid ministers in donor countries who must defend foreign aid programmes to skeptical parliaments. We can show them that doing the right thing is also the most cost-effective thing.
This brings me to my second, more tentative, proposition.
Just as we can argue that investing in children’s welfare in the hardest to reach areas is cost-effective, so we should also develop and make the case, more generally, that investing in the social sectors, especially at a time of global economic difficulty, is vital … not only in terms of human wellbeing but also for the sake of economic growth. That – again – doing the right thing is the best course in practice.
We need to do more work, in analysis and in advocacy, to show first that a society which short changes investments in the future capacity of its people – its health, its education, its social fabric – is a society which is sacrificing its long-term growth. And second, that investments in the health and education of a society’s most disadvantaged citizens – in equity – will lead more reliably to sustained growth.
To paraphrase President Kennedy’s Inaugural address – we must ask not only, as we do now, what growth will do for equity. We must also ask what equity will do for growth.
Perhaps the most obvious case is education.
Last week I heard President Lee Myung-bak give a simple explanation for South Korea’s extraordinary growth over the past half-century. It was due, he said, to investing in “the power of education.” Indeed, no nation has ever become or remained strong without such an investment.
A recent study which tracked 50 countries between 1960 and 2000 shows that every additional year of average educational attainment a nation achieves raises the average annual GDP by around half a percentage point.
There seems to be less evidence for the effects on growth of investment in health. But if you consider, as you are, the costs of inaction, we can see the economic importance of addressing health issues as well.
Consider vaccines, and specifically the global campaign to eradicate polio. We may be on the verge of defeating this evil, crippling scourge once and for all. If we do, the World Health Organization has estimated that governments would save a collective $1.5 billion per year in vaccines, treatment, and rehabilitation.
Similarly, investing in social safety nets for the most vulnerable citizens is not only a moral imperative in times like these. It is important economically.
Many countries that invested in strong social protection systems – through cash transfers to the poorest families, pensions and social security schemes, and the like – before the global crisis are weathering it better than those that did not.
For example, a recent report by the United Nations Economic Commission for Latin America and the Caribbean shows that poverty rates in Latin America have fallen sharply over the past 20 years. Not only because of the higher wages earned by a generation of better educated workers. Not only because more open trade has lowered prices for staple goods. But also because more equitable social policies, specifically targeting the poor, have enabled Latin America to withstand global recession better than other regions.
We also see this in South Africa, where it is estimated that between 2007 and 2009, child poverty would have been nine percentage points higher without the government’s innovative child support grant program.
And the recent report of an International Labor Organization/World Health Organization advisory group shows how earlier investments in the “social protection floor” have helped Brazil and Indonesia during the current economic recession, in part by maintaining more demand for goods and services among the most disadvantaged.
But more: we need to see investment in equity as more than a social protection floor. It can also be an elevator of growth. Because a society in which inequities are growing is a society which Professor Sen calls “unfree” … where people are denied fundamental freedoms and human rights, and so remain bound by poverty, deprivation, and political tyranny.
For political and social as well as economic reasons, such societies are less likely to sustain economic growth.
Indeed, a recent IMF staff discussion note by Andrew Berg and Jonathan Ostry shows that as societies become more equitable, economic growth is more sustainable over time. In fact, they found that a 10 percentile decrease in inequality increases the expected length of a growth spell by 50 per cent.
Many in the private sector, as well, seem increasingly concerned about inequity as a barrier to growth. In a survey by the World Economic Forum in January this year, business leaders identified inequality as one of the greatest risks to global growth and stability.
So let me now briefly illustrate the impact of investments in three more specific areas: adolescents … nutrition … and the impact of climate change on young people, especially the most vulnerable.
First, the focus of your conference: adolescents, emphasizing just two issues: violence and girls’ education.
Adolescence is a critical period in children’s lives – and, for too many, among the most dangerous. It is where we either consolidate gains made in childhood or risk losing them.
We have seen too many losses to violence – as illustrated, painfully, in Brazil. Thanks to steady and strategic investment in interventions like vaccination, the decrease in under-five mortality in Brazil meant that around 33,000 lives were saved between 1998 and 2008. In the same period, Ministry of Health data show that nearly 81,000 Brazilian adolescents between 15 and 19 years of age were murdered.
In short, we lost more than double the number that were being saved. That is a tragedy. For the families of these children, most of all. But also for society, deprived of the contributions those 81,000 young people could have made.
Not educating girls incurs still greater cost.
There are more than 500 million adolescent girls living in the developing world today. Every one of them can potentially help break the cycle of intergenerational poverty, with ripple effects multiplying across her society.
For example, an extra year of primary school can boost girls’ future wages by between 10-20 per cent. When women and girls earn income, they reinvest 90 per cent of it into their families … compared to men, I blush to say, who invest only 30-40 per cent.
And, yet, too often, girls are overlooked and undervalued. Many are treated as commodities…married off too young…only to die in childbirth when they are still children themselves.
Educating girls is the right thing to do; it is the smart thing to do. And it is false economy not to invest in them even in hard economic times.
Or consider another area where the costs of inaction are tremendous: Stunting.
You may not have heard much about stunting – and if so, you are not alone. I recently spoke to a large group of medical experts. When I mentioned stunting, I noted a number of blank faces. So I asked for a show of hands – and only half knew what stunting is. Yet it is a very big deal.
Stunting is the outcome of chronic nutritional deficiency during the first thousand days in the life of a child, beginning in the womb. It affects not only the height of a child, but the full development of the brain. And the damage is permanent…irreversible.
Stunted children cannot learn, nor earn, as much as they could have if properly nourished in early life. Difficulties in learning result in deficits equivalent to a 2 to 3 year loss of schooling…and are later paid for in reduced earning capacity – as much as 22 per cent.
Worldwide, between 170 and 180 million children are stunted. That is the bad news. The good news is that we know how to tackle stunting. And the solution is not only to provide children with more food.
In fact, stunting can occur even in food secure households and food secure countries. For example, in India, a food secure country, 48 per cent of children suffer from stunting – and chronic under-nutrition is one of the many issues Professor Sen is working to address through the Pratichi Trust and the Pratichi Institute.
The solution can be relatively simple, inexpensive and easy to deliver – from improved feeding practices to providing children with micronutrients like Vitamin A, zinc, iron and iodized salt. The impact of such interventions can be tremendous. In fact, the highly-respected Copenhagen Consensus of leading development experts ranked providing young children with such micronutrients as one of the most cost-effective ways to advance global welfare – and a top development priority.
The question is not whether we can afford to do this. The question is can we afford not to?
And, finally, one of the most obvious – and serious – examples of the cost of inaction is climate change.
Just as Carl Sandburg’s fog came in on little cat feet, we should worry that because we are incrementally adapting to the effects of climate change, we are failing fully to recognize what a monumental crisis this portends for younger generations and how it affects children now.
88 per cent of adolescents live in developing countries, many of which are already suffering disproportionally from the effects of rising global average temperatures. A recent Climate Vulnerability Monitor report shows that over 99 per cent of deaths attributable to climate-related changes occur in developing countries – and that over 80 per cent of these deaths are among children.
The effects of climate change could disrupt every context in which children and adolescents live and develop. Families which have lost their livelihoods to drought are less able to afford to send their children to school, or to pay for basic health care. Diseases flourish. Displacement may increase. And hard-won development gains can well go into reverse.
Many young people – children, adolescents and young adults – are well aware that their futures and those of generations to come are jeopardized by climate change. And many are working to address the issue, not only through global youth networks … climate change initiatives … and international meetings – but also in their own countries and communities.
At the UN Climate Change Talks two years ago, a young woman stunned members of the audience by asking a simple question: How old will you be in 2050? Within 24 hours, delegates and the chairperson – who had admitted that he would, theoretically, be 110 by then – were wearing t-shirts emblazoned with that question.
Their message was clear: Tackling climate change demands an intergenerational response – both from those who will inherit this planet and those of us who bequeath it to them.
What I have been seeking to argue here today is that a focus on equity is important to sustainable economic growth. This is a practical argument – and, I hope, a persuasive one. But while we make such practical arguments, let us never forget that human rights…children’s rights…the principles enshrined in the Convention on the Rights of the Child … also and always stand on their own.
… The right of all children to survive, to grow and to thrive ...
… The right of a girl to go to school ...
… The right of a child with a disability to reach his full potential …
… The right of a teenager to be free from violence ...
… and the right of adolescents to shape the future they now inherit.