Approximately 5000 children under 5 years died on 11 September 2001 from diarrhoea, about double the number of persons who were killed when two airplanes crashed into the World Trade Towers in New York. For many years prior to that day, and every day since then, approximately 5000 children under 5 years have died from diarrhoea, by and large preventable by eliminating poverty. In 2003 global expenditure on anti-terrorism measures was quoted to be approximately $US551 billion. The UN Millennium Project has estimated that to cover basic needs in health, education, water, sanitation, food production, roads and other key areas, and achieve the Millennium Development Goals of the poorest countries would cost $US160 billion per year. This can be achieved by the wealthy countries of the world donating 0.7 % of their Gross Domestic Product (GDP). Only 5 of the 13 wealthiest OECD countries currently meet that target. The contribution from the USA (which currently contributes 0.15%) would be approximately $US60 billion – the same as the cost of the Iraq war per year for the first two years, similar to the Bush administration’s tax cuts to those earning more than $US500,000 per annum and approximately what Western Europe spends on alcohol every 6 months.
Between 1990 and 2002 child health outcomes, particularly under 5 mortality rates world-wide have been improving except in the Commonwealth of Independent States (former Soviet Republics) and some Sub-Saharan African countries, where under 5 mortality has deteriorated, and rates in Sub-Saharan Africa remain high. However, as overall rates have been falling, inequalities and inequities in child health outcomes within and between nations have been increasing. From 1970-2000 under 5 mortality decreased by 71% in high income countries, but by only 40% in low income countries.
The aim of this chapter is to describe broadly the determinants of child health, to question the current approach to improving child health outcomes, particularly in low and middle income countries, and discuss possibilities for improving child health in poor countries and reduce inequalities and inequities, considering strategies at a global, national and local level.
Alperstein, G. (2007). The global context: International child health. In M. Kibel, H. Saloojee & T. Westwood (Eds.), Child health for all (p. 6). South Africa: Oxford University Press.