Joe was a normal looking child. He looked about the right weight, had a cheery smile and laughed loudly when he played with his many friends. Sadly, Joe fell ill and died a week before his fifth birthday.
Today, some 30 million infants in developing countries are not protected by routine vaccination. And some 11 million children under five die each year, mostly of preventable causes. The under-five mortality rate, one of the best single indicators for measuring social progress, fell by a mere 5% during the 1990s; this is hardly progress enough.
Why are children being betrayed like this? The answer is both simple and complex. It is simple because most countries under-invest in their children’s well-being. Governments in developing countries spend, on average, less than 15% of the national budget on basic social services – some $150 billion. Industrialised countries channel, on average, about 11% of their targeted aid – some $4 billion – to these services. It is not enough. About $100 billion more per year is needed in global spending on basic social services for each and every child to get a good start in life. This may appear as a large sum of money, but it represents only a third of 1% of total world income. That is not a lot of money, particularly if spending it means giving vulnerable children the right to live. Put crudely, it represents a rare investment opportunity. At the Copenhagen Social Summit in 1995 the world’s leaders suggested as a rough guideline that 20% of budgetary expenditure and 20% of aid flows should be allocated to basic social services.
But though the goal of reducing child mortality requires relatively little money, it is certainly not being reached. It is here that the arguments become more complex. It is one thing to invest more in children, but quite another to achieve the equity and efficiency needed to make the investments work. It is partly a question of management, but also a matter of dealing with major hurdles, like the spread of HIV/AIDS, malaria, diarrhoeal diseases and pneumonia, all of which demand vaccines to be developed. Add to this the problem of halting armed conflicts and reducing the crippling debt burden, and the issue of reducing child mortality becomes more than a question of mere budgets.
These are major challenges, though there are some relatively simple things that can be done. For example, education, particularly of girls, is key, not just in its own right, as other articles in this Spotlight emphasise. Rather, the risks of under-five mortality and child malnutrition are closely associated with the level of education of the mother; a child is about two to three times more likely to be malnourished or to die before five when its mother is illiterate than when the mother has completed primary education!
There is also a relationship between education and HIV/AIDS control. In several African countries, HIV infection rates are falling rapidly among educated people. Even in the most affected countries that have seen their under-five mortality rate increase in the 1990s, the risk of premature death among children whose mother has post-primary education has declined. Simply put, education provides protection against HIV infection and other deadly childhood diseases.
The widening education and mortality gaps reflect the growing income inequities between the rich and poor in many countries. Children are a particularly sensitive group that have fallen victim to these trends. A small increase in the global budget and a little bit of imaginative policy-making in education and other social areas would greatly reduce premature child deaths in developing countries. And kids like Joe would be able to grow up and celebrate many more birthdays as a result.
• UNDP, UNESCO, UNFPA, UNICEF, WHO, and the World Bank “Implementing the 20/20 Initiative: Achieving universal access to basic social services”, 1998. UNICEF, New York.
• UNICEF, “Poverty Reduction Begins with Children”, New York, 2000.
• Vandemoortele J.: “Absorbing social shocks, protecting children and reducing poverty”. UNICEF, Staff Working Paper EPP, 2000-01, New York.
©OECD Observer No 223, October 2000