The possibility of facing a healthy childhood is very different in certain areas of the world with respect to others. The problems faced by a child in Ethiopia, India, or Brazil, to give some examples, are very different from those of any European country. Thus, the state of health of children around the world reflects the inequality, inequity and injustices that we face as a global society.
To be honest, we must clarify that in recent decades there has been a drastic reduction in infant mortality globally, something that can be considered a success. However, this undeniable progress has relevant nuances: there are great differences between regions and between the levels of industrialization that they present. Today, in certain African or Asian countries, a girl can be up to 14 times more likely to die before the age of five than if she had been born in Spain. The justification for this gap is complex, although we can cite a series 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 residence in areas of armed conflict, are just a few reasons.
All of this contributes to the fact that in many countries communicable diseases continue to predominate and, although non-communicable diseases are considered to be increasing, a situation of high mortality with a predominance of infectious causes continues.
In certain African or Asian countries, a girl can be up to fourteen times more likely to die before the age of five than if she had been born in Spain
Along with diseases of the neonatal period, infectious disease remains one of the leading causes of death among children under five years of age, especially in sub-Saharan Africa and Southeast Asia. And easily preventable or curable diseases, such as pneumonia, diarrhea or malaria, continue to wreak havoc. Given these circumstances, a globalized world forces us to worry about the problems in the poorest countries because, as the World Health Organization (WHO) reminds us, “the results achieved by each State in the promotion and protection of health are valuable to everyone.”
But if the pandemic has highlighted the need to face a future together, the increase in temperature on our planet will test all our resources and our perspectives as a global society, since it will affect all areas of it. All this will take place in a world that expects to reach 10 billion inhabitants in the year 2060, and where most of its childhood will live in the areas most vulnerable to the climate emergency. Along with the loss of biodiversity and pollution, this constitutes what the UN has come to call the “triple planetary crisis.”
It is also important to emphasize that their impact will be particularly serious and disproportionate on children who live in environments with limited resources: scarcity 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 of its possible consequences. There will also be problems in the mental health of children and in the appearance of massive migratory movements. This will make care for migrant minors in particular and psychological problems in general a fundamental area to address in the future, both in the countries of origin and in the receiving countries.
Gender inequality and racism remain major causes contributing to poor child health around the world
On the other hand, it cannot be forgotten that children from vulnerable populations will also be affected by a series of systemic disadvantages such as caste, class, ethnic origin, gender and religion. Among them, gender inequality and racism remain major causes contributing to poor child health around the world.
All these factors together are a reminder of the inequities 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, see her quality of life affected by a preventable infection, or put her life at risk due to the lack of basic medical resources is shared across cultures and societies. As pediatricians in particular and as a society in general, we have an ethical commitment to this vision.
Our response must go through the promotion of health, quality and universal clinical care, investment in innovation and technology and the promotion of rigorous research, but also through the active fight for their rights. To face these challenges, global health therefore requires a biosocial approach that understands that disease is not only the translation of biological and clinical phenomena, but also of economic, social, political, historical, and cultural determinants. From this interaction arises the suffering of many children, who should be the main focus of global health and be at the center of its efforts. Our goal is to try to ensure a hopeful future for them, accepting this challenge based on values such as equality, justice or equity.
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