August 21, 2016
Written by Baby Science Live Coverage Team
“Progress is fragile.”
With three simple words, Dr. Richard Horton, Editor in Chief of The Lancet, opened the first plenary of the International Congress on Pediatrics with a compelling reminder of why we’re here in Vancouver. Dr. Horton shared the story of one young child living his most vital years surrounded by the harsh realities of conflict in Syria. Evidence is mounting in the harmful affects of a violent, conflict-driven environment on the developing brains of children. Dr. Horton’s reminder brought to focus the future we are all gathered here to discuss — how can we help to develop the healthiest children?
The global public health community has come a long way since the dire conditions of child health in 1990, in part because of the ambitious Millennium Development Goals launched now more than 15 years ago. In 1990, 12 million children died before their fifth birthday; by 2015, partnerships across civil society, UN agencies, the private sector, and the scientific community, had achieved a 54 percent reduction in under-5 child deaths through evidence-based approaches to improve child survival. Still, we know there is much more to be done before every child can celebrate a safe and healthy fifth birthday.
Thanks to the scientific community, we know a great deal about the blind spots of the Millennium Development Goals and have the data to shape the Sustainable Development Goals, adopted just this year. Incoming president of the International Pediatrics Association, Dr. Zulfiqar Bhutta, identified three key areas in child health where pediatricians have the unique opportunity to contribute, shape and step up to the plate for children everywhere.
Newborn deaths account for at least 44 percent of all deaths among children under age five globally, resulting in 2.9 million deaths annually. An additional 2.6 million babies die before or shortly after birth in the last trimester of pregnancy, causing 7000 women a day to experience a stillbirth. Of the 2 million stillbirths each year, 50 percent of them occur in the crucial 48-hour intrapartum period. But unfortunately, stillbirths are not an indicator in the new Sustainable Development Goals. Both Dr. Bhutta and Dr. Horton charged the pediatrics community with prioritizing these “forgotten” babies and working together beyond the health sector to address the determinants of stillbirths.
45 percent of under-five deaths are due to malnutrition, going beyond access to food to stunting, vitamin deficiencies, anemia, breastfeeding and more. Ending malnutrition in all its forms is, at its heart, an equity issue, explained Dr. Bhutta. At the sub-regional level, it’s no surprise that geographic clusters of poverty are the same clusters of malnutrition and under-5 mortality, Dr. Bhutta noted, referencing evidence from his home country of Pakistan. The scientific community has done too good of a job in recording data at the national level; to address links to poverty and malnutrition, we need to disaggregate data to sub-regional levels so as to tackle inequities head-on, at their source. Pediatricians are living, serving and caring on the front lines; we can integrate nutrition more deeply into healthcare, a major force in elevating child mortality and poverty.
With success in decreasing child mortality, the community has somewhat forgotten about adolescents. Dr. Horton urged pediatricians to think of pediatrics as caring for the life course of individuals, going beyond child survival and towards shaping thriving adolescents. The challenge of adolescence lies in the ‘nuances of health,’ the determinants beyond health that are affecting young peoples’ outcomes, like the diseases of poverty: infectious disease, undernutrition, HIV, and sexual health and rights. The inequities facing adolescents are exasperated by poverty, putting the necessity for action on adolescent health at the center of the IPA agenda, pledged incoming president Dr. Bhutta.
From healthy newborns and thriving children to transformative adolescents, the opportunity in pediatrics to impact global health outcomes may be unlike any other. That’s why IPA is teaming up with the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics on a new initiative, “Joining Hands for the Unfinished Maternal and Child Health Agenda.” Pediatricians are the strongest advocates for their patients — children who need quality care now more than ever before. As Dr. Bhutta closed, “We have to become a part of the solution.” And this week in Vancouver is the time to start.