A recent UNICEF report on child mortality provides some harrowing data combined with some startling hope. The shock is that 9.7 million children under the age of five years died in 2006. The good news in this bleak statistic is that it is actually down from 12.7 million in 1990, out of populations of roughly 630 million children under age five in both years. The even better news is that the remaining nearly 10 million deaths are themselves almost totally avoidable, at low cost, and in a way which will ease rather than exacerbate the population pressures of poor countries.
Almost all of the deaths (roughly 98 percent) occur in the developing countries. These are deaths, in effect, of extreme poverty and the under-provisioning of health systems in poor countries. The causes of death reflect the unsafe living conditions of the poor (such as vulnerability to tropical diseases, unsafe drinking water, and indoor air pollution) and the lack of access to preventative and curative health services. The main contributors to the high death rates are deaths that occur in the first 28 days after birth, caused by diarrhea (from unsafe drinking water), respiratory infection (often caused by wood-burning stoves), malaria, and vaccine-preventable diseases. It is estimated that around half of all deaths have chronic under-nourishment as a co-factor.
Sixty years ago, at the launch of the World Health Organization, the world’s governments declared health to be a fundamental human right “without distinction of race, religion, political belief, economic or social condition.” Thirty years ago, in Alma Ata, the world’s governments called for health for all by the year 2000, mainly through the expansion of access to primary health facilities and services. While the world missed that target by a long shot, we can still achieve it, at remarkably low cost. Ten key steps can bring us to health for all in the next few years.
First, rich countries should devote 0.1 percent of their gross domestic products—yes, just 10 cents per $100—to the cause of health care in the poorest countries. With a rich-world GDP of $35 trillion, that would create a fund of roughly $35 billion per year—enough for an additional $35 per capita in added health services for the roughly one billion people who need support in the poor countries.
Second, half of the increase should be channeled through the Global Fund to Fight AIDS, TB, and Malaria. The Global Fund has proven to be a highly effective institution which successfully gets interventions to the communities, with little bureaucracy and maximum impact. It has supported the distribution of approximately 30 million anti-malaria bed nets, helped to get around one million Africans on anti-retroviral treatment, and helped to cure over two million people of TB.
Third, the low-income countries themselves should devote 15 percent of their own national budgets to health. That would be a huge effort, but it is feasible. Still, it is far from enough. Consider a poor country at an average income of $300 per year. The total budget might be around 15 percent of GNP, or $45 per capita. Fifteen percent of that figure devoted to health would come to just $6.75 per person per year: not enough to provide adequate basic health care on its own but, combined with $35 per capita from donor aid, it would do the job.
Fourth, the world should adopt a plan for comprehensive malaria control, aiming to bring malaria mortality nearly to zero by 2012 through comprehensive access to anti-malaria bed nets, indoor spraying where appropriate and effective medicines when malaria illness arises. Fifth, the rich countries should follow through on their long-standing and achievable commitment to ensure access to anti-retrovirals for all HIV-infected individuals by the year 2010. Sixth, the world should fill the financing gap of roughly $3 billion per year for comprehensive TB control, another area where known and long-proven interventions are highly effective but chronically under-funded.