Global health experts say two-thirds of the more than 10 million young children who die each year from preventable diseases could be saved with inexpensive, available treatments. They call the high child death rate in poor nations the most pressing moral, public health, and political issue of our time.
The international child survival campaign of the 1980s has long since faltered. During that decade, a program led by the United Nations Children's Fund helped reduce child mortality significantly with cooperation from rich and poor governments and non-governmental groups. With simple interventions, the average number of deaths for every 1,000 births dropped from 117 to 93. Encouraged by that progress, the 1990 World Summit for Children called for a further drop to 70 deaths for each 1,000 births.
But that goal has not been reached. As of 2000, the worldwide average was still 83 deaths, according to Dr. Robert Black of the Johns Hopkins University Department of International Health in Baltimore. "The effort was sustained for some period, but unfortunately has not been continued with the same degree of vigor," he said. "The effort was abandoned before the job was done."
Overtaking child survival programs were other seemingly more important public health priorities, such as the growing HIV pandemic, the re-emergence of tuberculosis, and the continuing malaria problem. But the experts do not rule out complacency.
They point out that the child mortality problem is bigger than AIDS, TB, and malaria combined and involves other ailments such as diarrhea, pneumonia, and measles. Premature birth, lack of breastfeeding, unsafe drinking water, and tetanus also play a large role. Underlying half of all child deaths is malnutrition.
At a Washington news conference on the topic, Dr. Black emphasized that these issues are neither exotic nor defy medical understanding. "At least six million deaths could be averted if we are able to implement the interventions that we have now," he said.
That means using existing drugs, vaccines, and low-cost techniques such as breastfeeding, bednets treated with insecticide, and oral rehydration therapy.
Where most child deaths occur is no surprise. They are in the world's poorest countries. "The very simple message is poor children die first and are served last," stressed Dr. Black.
Six developing countries account for half of all deaths under age five - India, Nigeria, China, Pakistan, Democratic Republic of Congo, and Ethiopia. Forty-two countries account for 90 percent of all child deaths. To measure another way, 40 percent occur in sub-Saharan Africa and 35 percent in South Asia. Forty percent are of infants less than one-month-old.
The World Health Organization's director of Child and Adolescent Health, Dr. Hans Troedsson, calls the situation a public health failure.
"The frustrating thing is that we have the means to save the majority of these innocent victims of these unnecessary deaths," he said. "Our failures are that we have not been able to scale up those interventions that are proven to be effective - that we are not able to mobilize enough resources to rectify this unacceptable situation."
In a series of papers in the medical journal Lancet, public health experts argue that there is no need to wait for new drugs, vaccines, or technology to reduce this tragedy. World Bank public health specialist Flavia Bustreo said the solution is a matter of political will.
"I'm sending a call to our leaders," she said. "Our leaders all over the world must wake up to this unbearable reality. However, no institution, no government can do this alone. If we are serious in achieving this challenge ahead of us, we have to consolidate. There are too few partners around the table still."
The experts who gathered in Washington to discuss the problem say that the cost of saving the lives of six billion children each year is between $7 billion and $8 billion. Can the world afford it? The Lancet papers note that this is only about twice the cost of putting two new aircraft carriers to sea.
"That sounds like a lot of money, but if you realize that North Americans spend $17 billion a year on pet food, I think we can say this is an investment we should be able to make," noted Robert Black of Johns Hopkins University.
The experts say that by failing its children, the world is failing its own future.