Opportunities to have a healthy childhood are very different in certain parts of the world than others. The problems a child faces in Ethiopia, India or Brazil, to name just a few examples, are very different from those in any other European country. Thus, the health status of children around the world reflects the inequality, injustice and injustice we face as a global society.
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To be honest, we have to be clear that there has been a drastic reduction in child mortality worldwide in the last few decades, which can be counted as a success. However, this undeniable progress has relevant nuances: there are major differences between regions and between the level of industrialization they display. Today, in certain African or Asian countries, a girl may be up to 14 times more likely to die before the age of five than if she were born in Spain. The rationale for this gap is complex, although we can cite a number of causes, many of which are interrelated. The fragility of health systems, poverty, hunger, the consequences of climate change, gender inequality, the lack of basic water or housing services, difficulties in accessing quality education or staying in areas of armed conflict are just some of the reasons.
All of this contributes to the fact that communicable diseases remain prevalent in many countries, and although noncommunicable diseases are expected to increase, a high mortality situation persists, with infectious causes predominating.
In certain African or Asian countries, a girl may be up to fourteen times more likely to die before the age of five than if she were born in Spain
In addition to diseases of the neonatal period, infectious diseases remain one of the leading causes of death in children under the age of five, particularly in sub-Saharan Africa and Southeast Asia. And easily preventable or curable diseases such as pneumonia, diarrhea or malaria are still causing trouble. In these circumstances, a globalized world forces us to take care of the problems in the poorest countries, because the World Health Organization (WHO) reminds us that “the results achieved by each state in promoting and protecting health are all are valuable.”
But even if the pandemic has highlighted the need to shape the future together, the rise in temperature on our planet will test all our resources and our perspectives as a global society, as it will affect all areas. All of this will take place in a world predicted to be home to 10 billion people by 2060, most of whose childhood will be in the areas hardest hit by the climate emergency. This, together with the loss of biodiversity and pollution, constitutes what the UN has come to call the “triple planetary crisis”.
It is also important to emphasize that its impact will be particularly severe and disproportionate for children living in an environment with limited resources: shortages of food and drinking water, natural disasters or the change in the epidemiological profile of certain infectious diseases, such as malaria, are already tangible examples the possible consequences. There will also be problems with children’s mental health and massive migration movements. This makes the care of migrant children in particular, and mental health problems in general, a fundamental area to be tackled in the future both in the countries of origin and in the receiving countries.
Gender inequality and racism remain the main causes of poor child health around the world
On the other hand, it must not be forgotten that children from vulnerable populations will also be affected by a range of systemic disadvantages such as caste, class, ethnicity, gender and religion. Gender inequality and racism, among others, remain the main causes of poor child health around the world.
All of these factors together are a reminder of the inequalities that affect children’s health, and before which we cannot remain mere spectators. Because the notion that a child should not die from an obstetric complication, their quality of life should not be compromised by a preventable infection, or their life should be jeopardized due to a lack of basic medical resources is shared across cultures and societies. As pediatricians in particular, and as a society in general, we are ethically committed to this vision.
Our response must be to promote health, quality and universal clinical care, invest in innovation and technology, and encourage rigorous research, but also actively fight for their rights. Therefore, to meet these challenges, global health requires a biosocial approach that understands that diseases are not only the translation of biological and clinical phenomena, but also economic, social, political, historical, and cultural determinants. From this interaction arises the suffering of many children, who are at the center of global health and should be at the center of its efforts. Our goal is to ensure them a hopeful future and take on this challenge based on values such as equality, equity or justice.
Rosauro Varo Cobos He is a pediatrician, researcher and volunteer, works for the Barcelona Institute for Global Health (ISGlobal) and runs the blog “Universos paralleles” in the digital magazine “FronteraD”.
Lola Madrid Castillo is a pediatrician, epidemiologist and researcher at the London School of Hygiene and Tropical Medicine.
Quique Bassat He is a researcher at the Catalan Institution for Research and Advanced Studies (ICREA) and Director of the ISGlobal Malaria Program.
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