The UN report millennium goal for global health for childhood mortality was to reduce the under five year old's mortality rates by two thirds between 1990 and 2015. A recent report1 looking at progress noted that the rate declined by more than a half, dropping from 90 to 43 deaths per 1000 live births, but most countries did not reach the millennium target. However, of the 195 countries with available estimates that did meet the target 24 are low or lower-middle income countries.
The report noted:
- Children of mothers with secondary or higher education are almost three times as likely to survive as children of mothers with no education.
- The first day, week and month are the most critical for the survival of the child and the report urges a continued focus on this critical period.
- There has been an impressive success in increasing measles vaccination coverage since 1990 but there is some concern that the momentum seems to have stalled in the last few years due to weak immunization public health systems.
So what are the lessons for UK?
The report estimated that under –five mortality rates declined from 9 to 4 deaths per 1000 live births. So although there was progress, the UK did not meet the target of 3 deaths per 1000 live births. Many of the global issues raised are pertinent to the UK, albeit with a different emphasis on the key priorities.
- The importance of the mothers’ education for good outcomes for the child – so we need to ensure that our young people have a good rounded education and continue to focus on reducing teenage pregnancies.
- The value of good public health systems in the early years to ensure universal coverage of public health programmes, to prevent both infectious diseases and other challenges in early years. The UK needs to continue to ensure our established systems to prevent infectious disease is maintained eg coverage for immunization.
- Variation because of socio-economic factors remains a major concern. The evidence strongly shows the importance of early years for as a building block for future health and wellbeing, including educational attainment, there needs to be a focus on how our public health and health system supports good parenting and child development for all, including targeting vulnerable groups.
- The importance of prevention from pregancy to birth and the first year of an infant’s life is now well known. The work of the Maternity Review, led by Baroness Cumberlege, will be crucial in ensuring that as well as raising quality of maternity services, there is a strong focus on importance of prevention in this important stage of life.
Finally the report notes that despite improvements every day in 2015, 16,000 children under five continue to die, mostly from preventable causes. Child survival must remain a focus of the new sustainable development agenda. In the UK, for the current and future generations, we must continue to make the case for investment in the early years if we are to make continued progress.
Dr Ann Hoskins, Deputy Director of Health and Wellbeing, Public Health England
1 Levels and trends in child mortality report 2015: estimates developed by the UN Inter-agency Group for Child Mortality Estimation