For Ashok Talyan, putting children first is more than a sentimental
idea. With him, it's a question of pragmatism.
Dead and dying children are a part of daily life for Talyan, a
32-year-old physician and district medical officer in Uttar Pradesh,
India's most densely populated province.
Twenty-three per cent of children in Uttar Pradesh die before the age of
five — 30 times the average in wealthy nations like Canada.
On a tour last summer of one of the medical clinics Talyan works at in
Adampur, a village of 7,000 where families live in crudely constructed
huts without running water or electricity, it wasn't hard to see why so
many young kids are dying.
The village's government-run clinic has only a few beds. The families of
patients — mostly children dying from parasitic diseases, pneumonia or
diarrhea — must pay for all the drugs. The water in the clinic is
polluted. Electricity is only available a few hours a day.
"Most of these kids wouldn't get sick if a dollar or two per person
annually was spent on public health in the region," Talyan said.
The situation offers insight into India's greatest human tragedy: More
than a million newborns die in India annually. A further 1.5 million
children die before the age of five from diseases of all kinds.
But India is just part of a larger global tragedy: More than 10 million
children under five die each year worldwide. Ninety per cent of those
deaths are concentrated in the world's 42 poorest countries.
Almost all of these children die from easily and inexpensively
preventable diseases, a fact that is causing critics to complain that
efforts to wipe out AIDS, malaria and polio — the "gang of three," as
one UN adviser calls them — are consuming a share of international
health aid resources disproportionate to the number of lives saved.
"The national health systems in many disease-ravaged countries need to
be strengthened to tackle basic problems like diarrhea and pneumonia,"
says Harvard University researcher Catherine Michaud. "That effort needs
to be better balanced with existing programs" like those tackling AIDS,
TB, malaria and polio.
Michaud hastens to insist that not a cent of the money currently
directed towards AIDS and other diseases should be diverted. What's
needed, she says, is new money for new programs to tackle children's
In 2000, the member states of the United Nations committed to reducing
child mortality by two-thirds — seven million deaths — by 2015. They
also committed to reducing maternal mortality by three-quarters. Those
commitments are part of a global drive to reach seven key international
development objectives known as the Millennium Development Goals.
With the clock ticking toward 2015, international aid researchers such
as Michaud are calling for a rethink of how wealthy nations deliver
health aid to countries where massive numbers of mothers and children
die from easily preventable causes.
In recent years, new funding for international health programs has
mostly been directed toward AIDS, tuberculosis, malaria and polio. The
Global Fund to Fight AIDS, Tuberculosis and Malaria was established
under UN leadership in 2002; to date, 27 nations and 30 corporations and
philanthropic groups have pledged $4.7 billion to it.
Under UN leadership, $4 billion in international aid has also been
devoted to polio eradication since 1988.
And in 2003, the Bush administration launched a five-year, $15 billion
But there is no co-ordinated international fund or effort to fight
diarrhea and pneumonia, even though health researchers increasingly
argue much more money should be spent tackling these cheaply treated
According to a 2003 study by Robert Black, a professor of international
health at Johns Hopkins University, diarrhea and pneumonia account for
43 per cent of deaths of children under five, while malaria accounts for
nine per cent, and AIDS for just three per cent.
Another study by UN Millennium Project director Jeffrey Sachs and
vaccine researcher Peter Hotez suggests a group of "neglected tropical
diseases" — mostly water-borne parasitical diseases such as
schistosomiasis and hookworm — threaten the poor in Africa and Asia in
roughly similar measure to HIV/AIDS, TB, or malaria.
Sachs and Hotez point out that, unlike costly programs required to fight
AIDS and TB, many common killers can be defeated for less than $1 (U.S.)
per person annually.
They say 500,000 lives, mostly children's, could be quickly and cheaply
saved if aid programs were expanded to include the neglected diseases
Numerous international health researchers agree. In a series of papers
published since 2003 in Britain's two leading medical journals, The
Lancet and British Medical Journal, scores of scientists
support what Richard Horton, editor of The Lancet, calls "the
coming decade for global action on child health."
"Over 10 million under-five deaths had been ignored for far too long by
governments and even international agencies," Horton says. "Three years
ago, a group of concerned child-health experts proposed not only to
synthesize knowledge about child survival but also to catapult the child
back onto the policy map of global health.
Jennifer Bryce, a freelance community health researcher in Ithaca, N.Y.,
can take much of the credit for that success.
After 10 years helping co-ordinate child mortality research for the
World Health Organization in Geneva, Bryce resigned two years ago in
order to speak freely in a series of Lancet articles co-authored
with researchers from Brazil, Pakistan, the U.K., the U.S. and the WHO.
Bryce says millions of easily and cheaply preventable children's deaths
have been overlooked amid massive international concern about AIDS, TB,
malaria and polio.
In a Lancet study titled "Can we afford to save the lives of 6
million children each year?" Bryce and her colleagues argue that only $5
billion in additional aid — about $877 per child saved — is required to
achieve much of the two-thirds reduction in child mortality agreed upon
by world leaders in the Millennium Development Goals.
These figures are based on a decade's worth of evidence gathered by
senior researchers around the world indicating that the biggest killers
of children are pneumonia and diarrhea, both of which can be easily and
cheaply suppressed in even the poorest nations.
"Five billion dollars is affordable," Bryce and her colleagues argued in
their eight-page paper. "It reflects a choice being made by policymakers
and donors — a choice that allows 6 million children to die each year,
over 16,000 each day."
On the phone from Ithaca, Bryce is even more emphatic.
"Child survival missed the media boat," she says of the massive
attention devoted to AIDS and other high-profile diseases. "The biggest
killer is not malaria, or AIDS or TB. It's pneumonia, which is easily
treatable with cheap antibiotics supplied by trained people in
strengthened public-health systems. We can save millions and millions
and millions of kids with things that are not fancy."
Speaking from Pelotas in southern Brazil, epidemiologist Cesar Victora
Victora says the methods he and Bryce advocates were implemented long
ago with striking results in Brazil and several other nations.
"We've had massive increases in child survival figures," he says about
Brazil. "With bolstered public health services, we tackled diarrhea and
pneumonia. These simple steps saved millions and millions of lives."
At the WHO, David Evans has a further arsenal of scientific evidence to
offer in support of the growing chorus of calls for rapid,
cost-effective action to save children's lives.
Evans co-authored a series of five papers in the British Medical
Journal last year arguing that the Millennium Development Goal to
reduce child mortality is doable without great expense through programs
distributing vitamin A and antibiotics for pneumonia, along with
breastfeeding promotion, bolstered re-hydration programs for diarrhea
patients and training for birth attendants and midwives.
UNICEF, meanwhile, estimates recent efforts to promote breastfeeding
currently save 6 million lives a year. Even so, UNICEF estimates only 39
per cent of infants in developing countries are exclusively breastfed,
suggesting a further two million children per year could be saved
through universal breastfeeding.
A UNICEF pilot project underway in 11 West African nations strongly
bolsters the science behind the new child-survival crusade.
Launched in 2002 thanks to a $30-million grant from the Canadian
International Development Agency (CIDA), the project provides a package
of health programs to 17 million people in West Africa.
UNICEF calls its approach the Accelerated Child Survival and Development
Program; it is largely based on the research marshalled by Bryce and
The package concentrates on distributing vitamin A and anti-malarial
insecticide bed nets (malaria is a major killer in Africa), along with
boosting routine immunization programs, promoting breastfeeding, and
bolstering re-hydration programs for children with diarrhea.
Rudolf Knippenberg, UNICEF's chief health advisor, calls it the most
important push worldwide to prove the UN goal of reducing child
mortality by two-thirds is realistic and cost effective.
"It's a very down-to-earth approach that balances the needs for simple
health technologies, improved public health systems, and modestly
increased funding for child survival," Knippenberg says.
The results of the pioneering, Canadian-funded effort have been very
encouraging so far: 20 per cent of child deaths have been prevented — a
percentage that amounts to
18,000 lives saved annually, at a cost of about $500 per life.
Knippenberg says UNICEF now hopes to extend the program across the
entire continent of Africa and is negotiating with the Canadian
government for new funding.
"Given the results which have been achieved, we're very keen to discuss
further options with UNICEF," CIDA spokesman Pierre Naud said last week.
Partly to help promote that effort, UNICEF is flying Sir Roger Moore,
the star of James Bond films such as Live and Let Die — to Toronto next
Knippenburg said he hopes the new Canadian government continues its
"There's no doubt," he said, "that child survival is an idea whose time
Paul Webster is a Toronto-based freelance journalist who reports on
international development, science and health.