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| PERSPECTIVE |
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| Year : 2021 | Volume
: 7
| Issue : 1 | Page : 4-7 |
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Global child health: What are the threats our children are facing?
Venkatraman Radhakrishnan
Department of Medical Oncology and Pediatric Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| Date of Submission | 30-Apr-2021 |
| Date of Acceptance | 14-May-2021 |
| Date of Web Publication | 29-Jun-2021 |
Correspondence Address:
Dr. Venkatraman Radhakrishnan
Department of Medical Oncology and Pediatric Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijcfm.ijcfm_29_21
Disparities across the world are widening day by day. Children are the most vulnerable population impacted by the disparities. As governments and civil societies are successfully tackling traditional threats to children such as malnutrition, infectious diseases, and inadequate neonatal care, newer threats such as climate change, child trafficking, and childhood obesity are emerging. Threats like the COVID-19 pandemic, although not directly impacting children's health, have caused a significant effect on the delivery of child health services. The present article examines the current and future threats faced by children worldwide and offers solutions to mitigate those threats. Keywords: Child health, global health, pediatric
How to cite this article:
Radhakrishnan V. Global child health: What are the threats our children are facing?. Indian J Community Fam Med 2021;7:4-7 |
How to cite this URL:
Radhakrishnan V. Global child health: What are the threats our children are facing?. Indian J Community Fam Med [serial online] 2021 [cited 2023 May 28];7:4-7. Available from: https://www.ijcfm.org/text.asp?2021/7/1/4/319934 |
| Introduction | |  |
A 1-year-old girl was born premature and had low birth weight. She has had frequent episodes of pneumonia and diarrhea during her infancy, and she is severely malnourished. Her parents are farm laborers in the Rajasthan state of India. Her mother took a day off from work to get her vaccinated against measles. However, she was turned back at the community health center as there was a shortage of measles vaccine supplies due to the COVID19 pandemic. If she develops measles, her chance of survival is slim. Rajasthan has one of the highest infant and under-5 mortalities in India. There are millions of children like her across the world who are unable to get essential health care due to the COVID19 catastrophe and other reasons unrelated to the pandemic. They face an existential threat from old and newly emerging challenges alike.
The United Nations (UN) convention on the “Rights of the Child” was adopted in 1989 and is the most widely ratified treaty in human rights.[1] The treaty has been approved by all UN member states except the USA. The convention states that childhood lasts until 18 years and is different from adulthood, and all children have the right to grow, learn, play, develop, and flourish with dignity.[1] If we need to fulfill the ambitious goals of the “Rights of the Child” convention, we need to identify and neutralize the threats that can stop us from achieving these goals.
There is gross inequity in access to health care for children across the world. Even within countries, inequities exist among various regions. However, over the years, there has been a gradual improvement in children's survival across the world. In the previous three decades, under-5 mortality has reduced by more than half. It was 12.6 million in 1990 and has declined to 5.6 million in 2017.[2],[3] This still is about 15,000 childhood deaths a day due to preventable causes such as preterm birth complications, birth asphyxia, pneumonia, congenital anomalies, diarrhea, and malaria.[2],[3],[4] These causes can be prevented or treated with simple, affordable interventions, including immunization, adequate nutrition, safe water and food, and quality primary health care.[4] Most of these deaths occur in low- and middle-income countries (LMICs).
Infectious diseases and inadequate neonatal care have been identified as significant threats to children's health worldwide over the last few decades. The global community has worked toward solving them, which is reflected in reducing childhood mortality rates, as mentioned above. However, we are facing newer and emerging threats that are impacting the health of children.[5] We need to stop or minimize these threats if we want to have a healthy global community in future. Some of the major threats that the children of the world are facing are discussed below.
| Childhood Obesity | | |
One of the most critical public health challenges in the 21st century identified by the World Health Organization (WHO) is childhood obesity. The number of obese children and adolescents in the world increased from 11 million in 1974 to 124 million in 2016.[4] Childhood obesity is a significant risk factor for chronic noncommunicable diseases (NCD) such as diabetes, ischemic heart disease, hypertension, stroke, and cancer in adults.[5] These NCDs place a significant strain on countries' health-care systems and reduce the workforce's productivity due to absence from work due to sickness. Urbanization, junk food, smartphones, and lack of playing space are all responsible for the obesity epidemic. The obesity epidemic is no longer restricted to wealthy nations; it is also starting to appear in developing countries. Countries need to intervene fast to stop the epidemic of childhood obesity if they want to reduce the burden of NCDs among adults in future. Measures such as taxing junk food, providing safe play areas for children, and encouraging physical activity in children can reduce the rate of childhood obesity.
| Environment and Child Health | | |
Rapid industrialization over the last century has increased the emissions of greenhouse gases that are damaging the environment and leading to global warming.[6] Developing countries like India and China, which are trying to become economic powerhouses, are asking for developed nations to cut down emissions. Still, the latter is unwilling to give any concessions and wants the developing countries to reduce emissions. Climate change is a significant threat to the health and safety of children. Unseasonal droughts and floods are forcing families to migrate as agriculture becomes unviable. Migration leads to a severe impact on a child's physical and mental health due to a lack of access to immunization, clean drinking water, health facilities, and schools.[6] Children are also affected by environmental pollution as this can increase the incidence of respiratory diseases. Many cities in the World like New Delhi and Mexico City are struggling with alarming levels of air pollution that are not safe for human habitation.[7] However, Countries need to implement the Paris climate accord for reducing greenhouse emissions for the future of our children. The USA walking out of the agreement is a significant setback for the cause of controlling climate change.
| Neonatal Care and Impact on Future Health | | |
An essential but often ignored aspect of childhood is the fetal period, which together with the neonatal and infant period contributes significantly to long-term health, cognitive development, and economic outcomes.[8] Poor fetal growth or undernutrition in the first 2 years of life leads to permanent damage such as reduced adult height, poor school performance, and reduced adult income.[4] These children are also at risk of other NCDs if they put on weight rapidly in later childhood. It is estimated that 250 million children under 5 years will not reach full growth potential.[4] Most of these children live in LMICs. Maternal health is a vital component of child health. Ensuring adequate growth of the fetus needs mothers to be provided with good antenatal care, including nutrition support, promoting breastfeeding, iron supplementation, tetanus immunization, and safe delivery practices.[9] Evidence shows that the promotion of gender equality per se can address most childhood undernutrition issues and reduce mortality.[4],[9] Therefore, we need to focus on integrated maternal and fetal health to ensure a healthy children's future.
| Child Marriage and Teenage Pregnancy | | |
In many cultures, children are married before they attain the age of 18 years.[10] Child marriages are common in LMICs. Child marriages lead to teenage pregnancies. Such pregnancies are harmful to the mother and the child. They lead to increased maternal morbidity and mortality and increased childhood undernutrition and deprivation.[10] Teen pregnancies are not limited to LMICs; they are also seen in high-income countries (HICs) and are associated with similar consequences. Governments need to act and enforce strict legislation to ban child marriages. However, in many countries, child marriages have strong cultural and historical roots, which might prevent the enacting of child marriage legislation.
| Impact of Covid-19 Pandemic on Child Health | | |
The COVID-19 pandemic has substantially impacted health-care delivery and the economy irrespective of a nation's political, military, and economic power. Sovereign nations are relocating essential health care and financial resources to fight the COVID-19 pandemic.[11] The COVID-19 pandemic has had a significant impact on child health. It is a threat because it has the potential to erase gains over the decades. A modeling study by Roberton et al. estimates that there would 1,157,000 additional child deaths and 56,700 additional maternal deaths due to the indirect effects of COVID-19 on the health system across the world in the worst-case scenario.[12] These additional deaths would represent an increase of 45% in under-5 child deaths per month and a 39% increase in maternal deaths per month.[12]
Children are facing many indirect consequences of COVID-19 pandemic such as psychological impact due to school shutdowns, disruption in immunization services, decreased funding for child health programs, reduction in screening, and intervention program for malnutrition as staff are relocated for COVID-19-related work, poverty due to rising unemployment, and delayed treatment of severe diseases like cancer due to lockdowns and utilization of health services for the COVID-19 pandemic.[13],[14] The United Nations Educational, Scientific, and Cultural Organization has estimated that till June 2020, 63% of students in 123 countries had disruption of their school education.[14]
Measles and polio immunization campaigns have been suspended in 27 and 38 countries, respectively, as of mid-May 2020, and these include countries with ongoing measles and polio outbreaks.[15] Further, between March and June 2020, about 67 countries reported moderate-to-severe disruptions or outright suspension of routine immunizations services.[15] There has been a 69% reduction in measles–mumps–rubella vaccination coverage in India since the onset of the COVID-19 pandemic.[15] The WHO estimates that nearly 3 million fewer children received diphtheria, pertussis, and tetanus vaccines between January and June 2020 than in the corresponding period in 2019.[16]
| Child Labor | | |
Child labor is a work that deprives children of their childhood, their potential, and dignity, and that is harmful to their health. The majority of child labor is practised in LMICs. Data from the United Nations Children's Fund (UNICEF) suggests that 168 million children worldwide are involved in child labor.[17] The International Labor Organization estimates that out of the 152 million children doing child labor, 73 million are involved in hazardous work.[18] Poverty is the biggest driver of child labor. The developing countries in Africa and Asia account for nine out of every ten children in child labor. Nineteen percent of children in low-income countries are engaged in child labor. This is in contrast to 9% of children in lower-middle-income countries, 7% in upper-middle-income countries, and 1% in upper-income countries.[18] Therefore, poverty eradication should be a priority for improving child health. However, capitalism and globalization have fueled the need for cheaper products, and child labor helps in this cause by reducing production costs and increasing profits. HICs can eradicate child labor by implementing strict laws that ensure companies do not employ children in developing countries for producing their goods. There is a need for all UN members to pass a resolution to ban child labor.
| Child Abuse | | |
Child abuse covers many situations ranging from physical violence, sexual abuse, child trafficking, social and emotional neglect, and exploitation, including child soldiers.[19] Child abuse as a threat for the children of this world has remained like the tip of the iceberg, with most of the issues remaining unseen and unheard. Many nations do not have legislation to protect against child abuse, and even if they have, these legislations are not effectively implemented. Poverty, illiteracy, and corruption contribute to child trafficking.[19] The world over the last two decades has woken to the problem of human trafficking. However, more needs to be done to eliminate trafficking. Increasing conflicts in various regions of the world like Syria, Iraq, Afghanistan, and Somalia have led to the recruitment of children as soldiers to fight wars. Children should be holding pens and pencils and not guns.
| Threats to Child Health and Sustainable Development Goals | | |
In 2015, the countries across the world agreed to the sustainable development goal (SDG). The SDGs are 17 interlinked goals that are designed to achieve a better and sustainable future for all.[20] The target to achieve these goals is the year 2030. The recently published WHO-UNICEF-Lancet Commission on “A future of the world's children” stresses that children are a vital component of the SDG targets, and each of the goals is closely linked with childhood.[4] The SDGs identify threats that have been discussed above. However, very few countries report the threats identified for children like data indicators related to violence (physical, sexual, and psychological) for adolescent women (indicator 5.2.1 and 5.2.2), information on the prevalence of child marriage (5.3.1), child labor (8.7.1), literacy (4.4.1), children living below poverty line (1.2.1), and human trafficking (16.2.2).[4] Without data on the threats to child health, it will not be easy to find solutions.
| Recommendations | | |
Childhood obesity, climate change, child marriage and pregnancy, COVID-19, child labor, poor fetal and maternal health care, and child abuse are the most significant health-related threats that children face worldwide. They exacerbate the older known threats like infectious diseases, malnutrition, and poor neonatal care. These threats are not mutually exclusive as they all interact with each other, and the interactions are multiplicative rather than additive. The consequences of these threats can be immediate, like in teen pregnancy or delayed like in obesity. Some threats like the COVID-19 pandemic have both short and long-term adverse effects on the children's physical, mental, or social well-being.
There is no one solution to the threats to children mentioned above. Addressing the threats would need building robust health systems, good governance, and effective enforcement of the law. Governments, organizations like WHO, UNICEF and UN, civil society, and nongovernmental organizations need to cooperate and collaborate to ensure that every child has a bright future and the threats they face today are addressed with utmost urgency.[21]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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