It is no longer wishful thinking to imagine a world where the child mortality rates in the poorest countries reach those of wealthier nations, and where every child's right to survive can be realized.
That is the encouraging conclusion of several teams of development experts, whose modelling shows that even countries with the highest rates of child mortality can greatly reduce preventable deaths by expanding coverage of proven treatments for the diseases that kill the greatest number of children.
It is also the message being carried forward at a high-level forum convened by Ethiopia, India, and the United States in Washington this week, as leaders and decision makers from every sector recommit to the cause of child survival.
The Forum is a Call to Action, a global pledge to lower child mortality rates in high-burden countries to 20 deaths per 1,000 live births by 2035, and to continue progress in those nations already below that rate -- thus saving the lives of an additional 45 million children by 2035.
This pledge, A Promise Renewed, should be universal, because young children die of preventable causes everywhere in the world.
To reach this goal will take political will and a deeper focus on reaching the hardest to reach.
Over the last 40 years, more effective, affordable treatments, new ways of delivering critical health services to the poor, and sustained government efforts have more than halved the number of children under the age of five who die every year mostly from preventable causes.
That is a significant victory -- but it remains a partial one. Because despite everything we have learned about saving children's lives in the past decades, our efforts still do not reach millions of children.
7.6 million children under five still died in 2010 mostly from causes we know how to prevent and diseases we know how to treat. Child deaths are increasingly concentrated in the poorest countries, specifically in Sub-Saharan Africa and South Asia. And in many countries disparities between poorest and wealthiest children are actually growing -- often masked by national averages that show overall progress.
In 18 out of a sample of 26 countries where the national under-five mortality rate has declined by 10 per cent or more since 1990, the gap between child mortality rates in the richest and poorest quintiles has remained unchanged or even grown.
This is wrong -- and all the more unjust because it is unnecessary. In fact, studies show that efforts to reach the hardest to reach are cost-effective, averting more deaths for every extra dollar invested than the path we are now on.
So there is no justification, in either principle or practice, for leaving the most disadvantaged mothers and children behind. Not when we have the tools, the treatments, and the technology to do otherwise.
This means focusing first on the diseases that kill children the most and hit poor children the hardest: diarrhoea, pneumonia, pre-term birth complications, and malaria.
It also means expanding national immunization programs, which already save 2 million children every year and, with the introduction of new vaccines, have the potential to save many more.
Child survival clearly depends on improving maternal and neonatal health, strengthening services along the continuum of care to reach more newborns and mothers, too.
We also must focus more attention on educating girls and women. A recent analysis shows that better educated mothers have a greater collective impact on reducing child mortality than increasing gross domestic product.
At the same time, better nutrition and safe water and improved sanitation can all boost child survival in the most disadvantaged communities, just as scaling up new uses for existing technology -- expanding SMS texting, mobile apps and other technology -- can help us reach farther into most remote places.
And in all that we do, we must also do a better job monitoring our progress, so we can learn from our successes and setbacks, and identify new obstacles that stand in our way.
The pledge leaders are taking in Washington is ambitious. For some countries, it will require accelerating the annual rate of reduction in child mortality. For all countries, it will require greater disaggregation of national averages, to find the children being left behind.
But our goal is attainable, even in difficult economic times. Indeed, in such times, it is imperative -- as the poorest children suffer most and their gains can so easily be wiped out.
This is not the first time we have witnessed such global convergence in the cause of children -- from the 1990 World Summit for Children, to the 2002 UN Special Session on Building a World Fit for Children, to the launch in 2010 of UN Secretary General Ban Ki-moon's Every Woman Every Child movement.
Implicit in each of these landmarks was a fundamental promise to children: That we would do everything we could to help them survive and thrive.
We've kept that promise for millions. Now we have a chance to renew that promise, and reach millions more. If we succeed, we will no longer have to imagine a world where the right to survive can be realized for all children, everywhere. Our children, and their children, will live in it.
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