The 2015 Millennium Development Goals and child mortality: Hope, tempered

africa trio kidsBeginnings—whether a new year or a new century—offer an optimal time for evaluating goals. Quality improvement literature reminds us that goals should be specific, measurable and timely, and that progress checks are crucial. With one year left to achieve the ambitious Millennium Development Goals (MDGs), global child health stakeholders are assessing gains and gaps.

In 2000, the United Nations set the MDGs, and homed its sights on child mortality in MDG 4, aiming to cut mortality among children younger than age 5 by two-thirds by 2015, from the 1990 base figure of 12 million.

By 2012, the figure was nearly halved to 6.6 million.

“There’s a hopeful sense,” says Judith Palfrey, MD, director of Boston Children’s Hospital’s Global Pediatrics Program in the Department of Medicine. At the same time, the goal remains “seriously off target for many countries,” wrote Zulfiqar Bhutta, MB, BS, PhD, from the Hospital for Sick Children in Toronto, and Robert Black, MD, from Johns Hopkins University in Baltimore, in The New England Journal of Medicine in December.

Palfrey agrees, noting that while some countries are on track to meet the goal, some have stagnated and some have regressed. “It may be that there are some intractable issues,” she says. The countries that have failed to make progress are marked by corrupt governments, armed conflict or both.

Palfrey, Bhutta and other global health experts are looking ahead to determine how to reach the child mortality target and maintain global health. Suggestions include:

  • Increased investment. The authors of a December 13, 2013, report from The Lancet Commission on Investing in Health contended that the world could eliminate health disparities by 2035 by increasing annual investment in global health from $50 billion to $70 billion annually.
  • Focus on social determinants of health. “Even in the wake of the tsunami in Indonesia, more kids were being killed by cars than by conditions,” says Palfrey. “As we become a more technologically-based society, we have to be aware that we are affected by social determinants of health.” That means addressing lifestyle diseases like obesity, automobile safety, tobacco use and gun control.
  • Think beyond early survival. While some countries struggle just to achieve child survival through improved childbirth care and infectious disease control, a middle group of countries needs help with improving living conditions among newborns and children who, ten years ago, might have died soon after birth. Partnerships between local governments and academic medical centers can play an important role in building care models for these children.
  • Mentorship matters. The United States Agency for International Development spearheaded Survive and Thrive, a program that pairs members of U.S. health care associations with peers in developing countries to strengthen the skills of health care workers in developing countries and promote maternal, newborn and child health.
  • Partner with effective institutions. A blank check cannot ensure real improvements in global health. For investments in global health to be effective and cost-effective, partners need to insist on open and accountable public institutions, says Palfrey. That means transparency about spending and measuring, tracking and sharing outcomes.
  • Sustainability is key. The U.N.’s Sustainable Development Goals put sustainable development and economic transformation at the forefront of global health. “We can’t keep having rich countries give 0.7 percent of GDP to poor countries. That’s not sustainable,” says Palfrey. The global health emphasis has shifted to include employment and economic growth. This helps developing nations and their citizens become self-sufficient, which, in turn, encourages investment in public health and educational infrastructure and supports mental health as well as physical health.

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