Vector Issue 12 - 2011

It would be simplistic to assume that
MDG 4 is sufficient for improving
child health. We know that health is
much more than preventing deaths.
Children need a safe environment to
prosper in, a future and the chance to
become what they aspire to, without
being hindered by race, gender or place
of birth. If we achieve MDG 4 – which
would be the case for most countries
in Latin America and some countries
in South East Asia – that would be
encouraging, but still not enough.
Today, the greatest determinant of
a child’s future is the country they
are born in. Addressing this inequity
requires more than reducing death
rates.
it can target high density areas, and
neglect scattered rural communities.
Such details will never be reflected by
one national figure for child mortality.
And then there is sustainability, and
the effect that global support for
particular areas can have on the health
system. Generous external donors can
identify HIV and malaria as a problem,
and fund initiatives to address these
at a scale that engulfs other ongoing
health programs. And hence, the
bigger picture can become clouded
with multiple, well funded diseasespecific
programs that are highly
dependent on external support and
management.
The Millennium Development Goals
are a remarkable step forward. But
we do need to be cognisant of their
constraints. What is the problem with
focussing on reducing national death
rates? The most obvious problem is
data. Most developing countries do
not have vital registration systems,
i.e., no population records of births
and deaths. Therefore, indicators,
like child mortality, are calculated
using indirect methods, such as
surveying a representative sample
(much like political opinion polls).
The inaccuracies in these methods are
obvious when we compare mortality
rate estimates from say WHO and
UNICEF, which can be significantly
different depending on the methods
used to derive the estimate.
The more worrying problem is equity.
Within every society, there are the rich
and poor; the privileged and underserved.
But within the under-served,
there is a continuum. A country can
reduce its mortality rates by targeting
a large population of marginally
disadvantaged groups, neglecting
smaller populations of extremely
disadvantaged minority groups. Or
annual
number
of child
deaths
has
dropped
from
12.5
million
in 1990 to
8 million
in 2009
There is much to be hopeful about.
For one, the annual number of child
deaths has dropped from 12.5 million
in 1990 to 8 million in 2009. We are in
an era of increasing global awareness
to the plight of people in every corner
of the globe, and increasing interest
by health professionals in engaging
in global health. The science of just
how to reduce child deaths, support
the development of health systems
and work towards health is gradually
improving. However, it is important to
always emphasise that MDG 4 is the
right step on a long path towards much
more.
1.UN. Summit on the Millennium Development Goals. [Online]. 2010 [accessed 1st
November 2010]. Available from: URL http://www.un.org/millenniumgoals/
2.UNICEF. The State of the World’s Children. New York: United Nations Children’s
Fund; 1984
3.UNICEF. Progress for children: MDG4. [Online]. 2007 [accessed 1st November 2010].
Available from: URL:http://www.unicef.org/progressforchildren/2007n6/index_41799.
html
4.You D, Jones G, Hill K, Wardlaw T, Chopra M. Levels and trends in child mortality,
1990-2009. The Lancet. 2010; 376(9745):931-33
www.ghn.amsa.org.au
vector FEB 2011
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