Child survival

Abstract

The Child survival series raises the question: what about survival into old age, particularly premature adult mortality and avoidable morbidity?1The Bellagio Study Group on Child Survival Knowledge into action for child survival.Lancet. 2003; 362: 323-327Summary Full Text Full Text PDF PubMed Scopus (185) Google Scholar The latest UN projections2Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat World population prospects: the 2002 revision. United Nations, New York2003Google Scholar indicate increased ageing of the population because of reductions in fertility rates and continued declines in mortality rates, despite the ravages of HIV/AIDS. Although continued investment in child health will remain a priority, global ageing warrants consideration of shifts in health and social-support structures that reflect the expected larger numbers of older people in developing countries.The notion of preventing premature death must expand beyond improvement of childhood survival to a broader concern of preventing premature child and adult deaths. Chronic diseases are on the increase in adults and the corresponding prevalence of leading risk factors has been described; however, this information is based on best estimates from limited input data from developing countries.3Ezzati M Vander Hoorn S Rodgers A et al.Estimates of global and regional potential health gains from reducing multiple major risk factors.Lancet. 2003; 362: 271-280Summary Full Text Full Text PDF PubMed Scopus (457) Google Scholar Despite the large and growing importance of disease and injury burden among adults, there is uncertainty about levels and causes of adult mortality in many developing countries. This lack of information is a serious impediment to effective public-health action to reduce the main killers of adults, since generally no reliable baseline against which to monitor programme effectiveness exists. To improve adult survival, three main areas need attention.First, a commitment to building better structures for public-health programmes at the local level is needed, especially strengthening routine data-collection systems for vital events. A reliable source of age-specific and sex-specific death rates remains an essential component of health statistics for policy development, programme implementation and monitoring, and resource distribution. Such systems have been developed in South Africa and India.4Kowal PR Rao PVC Mathers C the MDS ProjectInformation needs for research, policy and action on ageing and older adults: report on a WHO workshop, Minimum Data Set on Ageing and Adult Mortality Data in sub-Saharan Africa. World Health Organization, Geneva2003http://www.who.int/health_topics/ageing/en/Google Scholar For older adults, longitudinal studies on ageing are needed to complement routinely collected data and have provided important data in developing countries that lack vital registration systems. WHO is collaborating in a multipartner effort to improve health information systems through development of a Health Metrics Network. Furthermore, the World Health Survey will include longitudinal follow-up of adults in selected countries as part of the Study on Global Ageing.Second, the health of older adults should be stated as an important priority of governments. Tanzania provides a successful example of national will to improve adult survival; newly available data is being used to improve health information systems and to formulate policy.5Setel P, Kitange H, Alberti KGMM, Moshiro C. The policy implications of adult morbidity and mortality in Tanzania: from data analysis to health policy—preliminary experiences. Global Forum for Health Research (Forum 2), Geneva, June 25–26, 1998.Google ScholarThird, delivery of effective health services to older adults needs to be achieved. Premature death and poor quality of life from preventable morbidity is common due to poor access to interventions. Acute and chronic care needs should be defined and programmes developed based on sound evidence.Monitoring of adult mortality and morbidity should be included in the Millennium Development Goals. Initial steps have been made by WHO to develop a set of older adult and ageing indicators through the Minimum Data Set on Ageing Project, which could be developed further as part of the proposed Health Metrics Network. Collaborative partnerships with WHO, including governments in developing countries, other international organisations, and non-governmental organisations, are needed to produce national and subnational level information for action on child and adult survival.Funding for the WHO Minimum Data Set on Ageing Project and Study on Global Ageing comes from the US National Institute on Aging's Behavioral and Social Research Program. The Global Burden of Disease in Aging Populations project is also supported by a grant from the National Institute on Aging (PO1 AG17625-01). The Child survival series raises the question: what about survival into old age, particularly premature adult mortality and avoidable morbidity?1The Bellagio Study Group on Child Survival Knowledge into action for child survival.Lancet. 2003; 362: 323-327Summary Full Text Full Text PDF PubMed Scopus (185) Google Scholar The latest UN projections2Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat World population prospects: the 2002 revision. United Nations, New York2003Google Scholar indicate increased ageing of the population because of reductions in fertility rates and continued declines in mortality rates, despite the ravages of HIV/AIDS. Although continued investment in child health will remain a priority, global ageing warrants consideration of shifts in health and social-support structures that reflect the expected larger numbers of older people in developing countries. The notion of preventing premature death must expand beyond improvement of childhood survival to a broader concern of preventing premature child and adult deaths. Chronic diseases are on the increase in adults and the corresponding prevalence of leading risk factors has been described; however, this information is based on best estimates from limited input data from developing countries.3Ezzati M Vander Hoorn S Rodgers A et al.Estimates of global and regional potential health gains from reducing multiple major risk factors.Lancet. 2003; 362: 271-280Summary Full Text Full Text PDF PubMed Scopus (457) Google Scholar Despite the large and growing importance of disease and injury burden among adults, there is uncertainty about levels and causes of adult mortality in many developing countries. This lack of information is a serious impediment to effective public-health action to reduce the main killers of adults, since generally no reliable baseline against which to monitor programme effectiveness exists. To improve adult survival, three main areas need attention. First, a commitment to building better structures for public-health programmes at the local level is needed, especially strengthening routine data-collection systems for vital events. A reliable source of age-specific and sex-specific death rates remains an essential component of health statistics for policy development, programme implementation and monitoring, and resource distribution. Such systems have been developed in South Africa and India.4Kowal PR Rao PVC Mathers C the MDS ProjectInformation needs for research, policy and action on ageing and older adults: report on a WHO workshop, Minimum Data Set on Ageing and Adult Mortality Data in sub-Saharan Africa. World Health Organization, Geneva2003http://www.who.int/health_topics/ageing/en/Google Scholar For older adults, longitudinal studies on ageing are needed to complement routinely collected data and have provided important data in developing countries that lack vital registration systems. WHO is collaborating in a multipartner effort to improve health information systems through development of a Health Metrics Network. Furthermore, the World Health Survey will include longitudinal follow-up of adults in selected countries as part of the Study on Global Ageing. Second, the health of older adults should be stated as an important priority of governments. Tanzania provides a successful example of national will to improve adult survival; newly available data is being used to improve health information systems and to formulate policy.5Setel P, Kitange H, Alberti KGMM, Moshiro C. The policy implications of adult morbidity and mortality in Tanzania: from data analysis to health policy—preliminary experiences. Global Forum for Health Research (Forum 2), Geneva, June 25–26, 1998.Google Scholar Third, delivery of effective health services to older adults needs to be achieved. Premature death and poor quality of life from preventable morbidity is common due to poor access to interventions. Acute and chronic care needs should be defined and programmes developed based on sound evidence. Monitoring of adult mortality and morbidity should be included in the Millennium Development Goals. Initial steps have been made by WHO to develop a set of older adult and ageing indicators through the Minimum Data Set on Ageing Project, which could be developed further as part of the proposed Health Metrics Network. Collaborative partnerships with WHO, including governments in developing countries, other international organisations, and non-governmental organisations, are needed to produce national and subnational level information for action on child and adult survival. Funding for the WHO Minimum Data Set on Ageing Project and Study on Global Ageing comes from the US National Institute on Aging's Behavioral and Social Research Program. The Global Burden of Disease in Aging Populations project is also supported by a grant from the National Institute on Aging (PO1 AG17625-01).