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For some reason the world has taken its eyes off the biggest public health emergency of our time.

Climate change, ongoing natural disasters, food price hikes, the economic meltdown, AIDS – all these things have rightly grabbed global attention but they have also distracted the world from the stark reality that every year nine million children die before reaching their fifth birthday – nearly four million of them in the Asia-Pacific – from largely preventable causes.

A malnourished child recently enrolled at a World Vision nutrition centre in Bangladesh/ Photo credit: World Vision

Every day this silent emergency claims the lives of 24,000 under-fives – one every 3.5 seconds.  The vast majority – some 40% die from complications and infections in the first 28 days of life, another 40% die from mass killers, pneumonia or diarrhoea, while malaria steals the lives of almost one in ten.

Amazing developments in public health information mean that health experts know where and why children are dying, and have largely preventable and relatively inexpensive solutions.  What is lacking – despite earlier promises – is not just the additional aid money needed, but a refocusing on where it is spent, along with government action in high-death countries to slash child mortality rates to meet key UN Millennium Development Goals (MDGs) by 2015. 

Past successes show where money is best spent. Immunisations that help prevent pneumonia, neo-natal tetanus and measles; vitamin A and iron supplements that boost immunity; bed nets to stop malarial mosquito bites; and oral rehydration to help children recover from attacks of diarrhoea are among simple interventions that have helped dramatically cut global child deaths from 19 million in 1960 to around nine million today.

Getting the figures down means focusing on death hotspots, as well as countries where population numbers are so great that even if child death rates have already dropped significantly vast numbers still die needlessly.  Despite past gains the world is way off track in achieving MDG 4 – to cut under-five deaths by two thirds on 1990 rates.

The aid community must share part of the blame for this by creating the perception that high child death rates are an African phenomenon.  This is a hold-over from fundraising and media campaigns focused around child death crises, of which the Ethiopian famine was the iconic example. The image of the starving, stick-thin African child remains part of the collective conscience but it has fostered a short-term rescue approach to children, fatigue among donors who see poverty as never ending and a failure to appreciate that simple solutions implemented over the long term can be extremely effective and sustainable.

Sub-Saharan countries have shocking rates of under-five child mortality, but South and East Asia and the South Pacific together account for 3.8 million deaths. 

Globally 60% of under-five child deaths are in just six countries, among them India, China and Pakistan. The image of an Asia on the rise as an economic powerhouse is not complete without appreciating the massive disparities in the region and within countries, the extreme vulnerability of children, nor of the responsibility of Asian governments to share the benefits of growth.  Indonesia has nowhere near the worst child death rates in Asia but a child born in West Nusa Tenggara is five times more likely to die by five than one born in Bali. The same is true when one compares children born into poor versus wealthy families.

Simply in terms of numbers India has the highest number of childhood deaths for any country in the world. Malnourishment and under nourishment is anyway linked to more than half of under five deaths and in India almost half of all under-fives are malnourished. Children there start life disadvantaged because almost all pregnant women are themselves undernourished and very often anaemic. Children born underweight and lacking in important micronutrients are much more likely to die from diseases that normal weight children would survive. The sad reality is that one child in every five who dies today before their fifth birthday is an Indian.

In the Asia-Pacific there are other child death zones that with targeted aid and government action could be eradicated. In Cambodia, Laos and Timor Leste, almost all women give birth at home or with no skilled help to hand. The result: most child deaths happen immediately after birth contributing to death rates like those in Timor Leste where almost ten percent of children die before they reach five.

Funding simple rural health clinics and workers with basic midwifery skills as well as providing better community engagement on pregnancy and child care and nutrition could rapidly improve children’s chances of survival, as well as their mother’s.

The solutions are often local and inexpensive – or even free at the point of service. In the Philippines volunteer tuberculosis task force members conduct classes on TB in remote villages.  World Vision works with people like Judith Agyam who helps neighbours identify TB symptoms and gets them to the nearest health centre for treatment. This community-based approach is just one example that governments need to look at replicating. Funding expensive health infrastructure does not always effectively reach the most vulnerable or have the most impact.

Sri Lanka’s efforts over the last 40 years, and in spite of civil conflict, have shown what is possible when governments commit to reducing child mortality. Almost all children born on the island do so in a medical facility, contributing to a rapid drop in the child death rate.

World Vision believes that six million under-fives a year could be saved from dying with the right funding, health interventions and government commitment. This is the central motivation for this week’s launch of the agency’s five-year global Child Health Now campaign. It calls on rich countries to ramp up health funding support for developing nations from USD 16 billion a year to USD 42.5 billion by 2015 – equivalent to the personal net worth of a single man, Warren Buffett, America’s second richest person.

More importantly governments with high child death rates need to focus on improving health at the community level. Interventions are as simple as teaching children to wash their hands before eating, showing mothers the importance of exclusive breastfeeding, getting children vaccinated and on vitamin and mineral supplements, and setting up tracking systems to ensure malnourished children are identified and helped.

Governments in countries experiencing rapid economic growth need to extend publicly funded free health care systems as a basic human right to all citizens and ensure clean water and sanitation systems are provided, especially to families living or migrating into urban slums.

The UN and other large international humanitarian agencies, are recalibrating their efforts to save the youngest children and get them the health care they deserve.

In the time it has taken you to read this article 60 children aged below five have died. Failure to rapidly reduce this global holocaust constitutes the greatest child rights violation of our time.