Framing an agenda for children thriving in the SDG era: a WHO–UNICEF–Lancet Commission on Child Health and Wellbeing

Abstract

The Millennium Development Goal (MDG) era witnessed an unprecedented drop in mortality among children younger than 5 years and in undernutrition across all regions. However, the poorest children remain 1·9 times more likely than others to die before reaching the age of 5 years.1UNICEFWHOWorld BankUNLevels & trends in child mortality, report 2015. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. UNICEF, WHO, World Bank Group, United Nations, New York2015Google Scholar If these child mortality trends persist, the Sustainable Development Goal (SDG) child mortality targets (reducing neonatal mortality to at least as low as 12 per 1000 livebirths and under-5 mortality to at least as low as 25 per 1000 livebirths in all countries by 2030) will not be met in 47 countries, 34 of which are in sub-Saharan Africa. Additionally, undernutrition is prevalent in some regions, with an estimated 151 million children affected by stunting worldwide.2UNICEFGlobal Nutrition Report 2017: nourishing the SDG.https://data.unicef.org/resources/global-nutrition-report-2017-nourishing-sdgs/Date: 2017Date accessed: October 31, 2018Google Scholar This situation is further complicated by burgeoning overnutrition together with vitamin and mineral deficiency in early childhood and their links to adult non-communicable diseases. Reversing current trajectories requires not only applying lessons learned from the MDG era but also addressing all the determinants of child health and wellbeing that will impact whether today's children achieve their maximum potential in every situation. Indeed, evidence shows that about 50% of the reduction in child mortality in low-income and middle-income countries (LMICs) between 1990 and 2010 was due to indirect influences beyond the health sector.3Temmerman M Khosla R Bhutta ZA Bustreo F Towards a new global strategy for women's, children's and adolescents' health.BMJ. 2015; 351: h4414Crossref PubMed Scopus (35) Google Scholar The focus on the health of children must expand beyond mortality to include healthy growth, development, and wellbeing.4de Onis M Branca F Childhood stunting: a global perspective.Matern Child Nutr. 2016; 12: 12-26Crossref PubMed Scopus (533) Google Scholar A multisectoral approach that addresses all the determinants (social, economic, cultural, political, environmental, and commercial) of child health and wellbeing resonates with the SDGs' promotion of an integrated approach to global social and economic development.5UNThe Sustainable Development Goals report 2017. United Nations, New York2017https://unstats.un.org/sdgs/report/2017/Date accessed: October 28, 2018Google Scholar There is increasing recognition, for example, of the importance of early life determinants (stimulation, socialisation, and a stable, clean environment) on child social and economic potential over the life course. The 2016 Lancet early child development Series reported that 250 million children (43%) younger than 5 years in LMICs are at risk of not reaching their developmental potential,6Black MM Walker SP Fernald LCH et al.Early childhood development coming of age: science through the life course.Lancet. 2016; 389: 77-90Summary Full Text Full Text PDF PubMed Scopus (1101) Google Scholar with widespread consequent impacts. Further, WHO estimates that 27% of all child deaths now arise from environmental causes7WHOInheriting a sustainable world: atlas on children's health and the environment. World Health Organization, Geneva2017Google Scholar and almost 90% of the world's children do not breathe clean air. Clean water and sanitation remain beyond the reach of billions of people, and conflict and insecurity affect the domestic stability of and access to health care, good nutrition, and early child education for many children globally. Coordinated action across multiple sectors is required for all children to be able to develop their maximum potential in every country and community. All nations aspire to see their children develop and flourish as a human right and as the basis for a strong economy. In this context, there is a need for guidance and agreement on maximising child health and wellbeing in the SDG era. In response to this need, and after reviews of several global child health approaches and policies,8Costello AM Dalglish SL on behalf of the Strategic Review Study TeamTowards a grand convergence for child survival and health: a strategic review of options for the future building on lessons learnt from IMNCI. World Health Organization, Geneva2016Google Scholar, 9Hazel E Bryce J IIP-JHU iCCM Evaluation Working GroupOn bathwater, babies, and designing programs for impact: evaluations of the Integrated Community Case Management Strategy in Burkina Faso, Ethiopia, and Malawi.Am J Trop Med Hyg. 2016; 94: 568-570Crossref PubMed Scopus (17) Google Scholar WHO and UNICEF have initiated a Lancet Commission on Child Health and Wellbeing, with support from the Bill & Melinda Gates Foundation. The Commission's findings will be published as a report in The Lancet, expected in 2019. The Commissioners are drawn from every geographical region and from disciplines including maternal and child health, nursing, nutrition, epidemiology, human rights, education, environmental and political science, economics, anthropology, and social science. The Commissioners met in Dakar, Senegal, in February, 2018, to reflect on the state of the world's children and agreed on a process of elaborating a cross-sectoral agenda on child wellbeing that reflects realities in the SDG era. Consensus emerged around the need to address influences during the first two decades of life, with “child” denoting those aged 0–18 years. Five working groups have been established with experts from many disciplines and global regions to collectively address the following areas. A group on leadership and governance will address how to secure commitment and accountability at all levels of government, as well as among donors, international organisations, non-governmental organisations, faith-based organisations, and corporations. A second group will use a systems lens for multisectoral action, and examine how to bring together diverse systems across different sectors to maximise the health and wellbeing outcomes for children in the first 18 years of life, and how to increase accountability for enabling child health and wellbeing across all platforms and levels. A group on financing and economics will consider challenges around microeconomic modelling for financing and focus on identifying the new partnerships, investment policies, and priorities that will increase the chances of more children thriving by 2030. Equity focused data and information for action and accountability that build capacities for accountability and agency will be addressed by a fourth group. Finally, a fifth group will explore family, household, and community approaches to health and wellbeing, and will identify priorities for governments and districts in different settings and how to support the most marginalised communities to build resilience and tackle the drivers of their disadvantage. This Commission will take a whole of government approach, addressing health and development beyond mortality, and will encapsulate children's perspectives and visions. Of course, context is key. The problems facing Nigeria, Nicaragua, and the Netherlands are different. But there are commonalities. The Commission will focus on the “how to” as opposed to the “what”, the process rather than content. This approach will go beyond a focus on national and ministry decision making. Districts and communities are where multisectoral approaches work best. And community engagement is critical to success; we intend to capture the views, hopes, and dreams of children and young people. At the same time, country ownership and political leadership are necessary. Our Commission will be mindful to align with country level planning processes that address realities on the ground. The methods and findings of the Commission will be inclusive, participatory, and incorporate the perspectives of adolescents and other constituencies, as appropriate. The Commission's report will not only examine the successes and lessons learned from previous efforts but will also strive to balance optimism with acknowledged harsh realities. Solutions for child health and wellbeing will be viewed through the lens of protection, promotion, prevention, and treatment. We want to build the case for a coordinated response from government, business, and civil society that acknowledges the interdependent nature of the challenge to sustainably improve children's lives in different settings. And we shall suggest monitoring indicators that nations can use to assess progress between now and 2030. Investment in our children is the first step towards cultivating a healthy, productive society, and should be central to any government's policy and in line with the statutes of the Convention on the Rights of the Child. We are confident that the experience and passion of our Commissioners for this topic can benefit generations of children to come. This online publication has been corrected. The corrected version first appeared at thelancet.com on November 9, 2018 This online publication has been corrected. The corrected version first appeared at thelancet.com on November 9, 2018 AC-S is Minister of State, Government of Senegal. HC is Former Prime Minister, New Zealand. RB is a coordinator in WHO's Department of Maternal, Child and Adolescent Health. SP is UNICEF's Director of Child Health. We declare no other competing interests. The Commissioners of the Commission on Child Health and Wellbeing are: Helen Clark (Co-Chair), Former Prime Minister New Zealand; Awa Coll-Seck (Co-Chair), Minister of State, Senegal; Aku Kwamie Independent researcher, Ghana; Shanthi Ameratunga, Professor, New Zealand; Jeremy Shiffman, Professor, Department of Public Administration and Policy, American University, USA; Ibrahima Seck, Chief of Staff, Ministry of Health and Social Action, Senegal; Jesca Nsungwa, Assistant Commissioner, Commission on Child and Newborn Health, Ministry of Health, Kampala, Uganda; Ousmane Ndiaye, Deputy Director, Centre d'Excellence Africain, Santé de la Mère et de l'Enfant (CEA-SAMEF); Nono Simelela, Assistant Director General, Cluster of Family, Women's and Children's Health, WHO; David Hipgrave, Senior Health Advisor/Team Leader, Health Systems Strengthening, UNICEF HQ; Sunita Narain, Director General, Centre for Science and Environment, India; Peter Sly, Director, Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Australia; John Borrazzo, Senior Health Specialist (MNCH) Global Finance Facility Secretariat, World Bank, Washington DC, USA; Rana Saleh, Advocacy and Evidence Lead Specialist, Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Lebanon; Fadi el-Jardili, Professor of Health Policy and Systems, Director Knowledge to Policy (K2P) Center, American University of Beirut, Lebanon; Rajani Ved, Executive Director, National Health Systems Resource Center, New Delhi, India; Dina Balabanova, Associate Professor, Department of Global Health and Development, School of Hygiene & Tropical Medicine, UK; Jon Simon, Scientist, Research & Development, Department Maternal, Newborn, Child and Adolescent Health, WHO; Kumanan Rasanathan, Coordinator, Health Systems, Office of the WHO Representative in Cambodia; Aline Simen-Kapeu, Chief Child Survival & Development, UNICEF Guinea; Tim Powell-Jackson, London School of Hygiene & Tropical Medicine, UK; Angela Gichaga Chief Executive Officer, Financing Alliance for Health; Anthony Costello Professor of Global Health and Sustainable Development, University College London, UK; Mariam Claeson, Director, Global Financing Facility, World Bank; Imran Rasul, Professor of Economics, University College London, Co-director, ESRC Centre for the Microeconomic Analysis of Public Policy (CPP), Institute for Fiscal Studies (IFS), Co-director, Entrepreneurship Research Program, International Growth Centre (IGC); Meng Qingyue, Professor in Health Economics and Policy & Dean of Peking University, School of Public Health, Peking, China; Agnes Soucat, Director, Department of Health Systems Governance and Financing, WHO HQ, Karin Stenberg, Technical Officer, Department of Health Systems Governance and Financing, WHO HQ; Enrique Delamonica, Chief of Social Policy and Gender Equality, Nigeria Country Office, UNICEF; Tanya Doherty, Chief Specialist Scientist/ Extraordinary Professor, Health Systems Research Unit, South African Medical Research Council, South Africa; Raul Mercer, Coordinator/Researcher, Center for Research in Population Health, Buenos Aires, Argentina; Mark Tomlinson, Professor, Department of Psychology, Stellenbosch University, South Africa; Zulfiqar Bhutta, Director of Research on Global Child Health, Sick Kids Hospital, Canada; Felicitas Zawaira, Director of Family and Reproductive Health, WHO Regional Office for the African Region; Katherine Rogers, Senior Programme Manager, UNICEF HQ; Raj Bhan, National Science Professor, Indian Institute of Technology, India; Papaarangi Reid, Head of Department, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Asha George, South African Research Chair in Health Systems, Complexity and Social Change, School of Public Health, University of the Western Cape, South Africa; Adesola Olumide, Senior Medical Research Fellow, Institute of Child Health, University of Ibadan/University College Hospital, Nigeria; Harshpal Singh Sachdev, Senior Consultant in Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, India; David Osrin, Professor of Global Health, Institute for Global Health, Faculty of Population Health Sciences, University College London, UK; M Guélaye Sall, Child Survival Expert, Senegal; Nigel Rollins, Scientist, Research & Development, Department Maternal, Newborn, Child and Adolescent Health, WHO HQ; Magali Romedenne, Community Health Specialist, UNICEF West and Central Africa Regional Office; Anshu Banerjee, Director, Department Maternal, Newborn, Child and Adolescent Health, WHO HQ; Stefan Peterson, Chief of Health, UNICEF HQ; and Joanna Vogel, Technical Officer, Department Maternal, Newborn, Child and Adolescent Health, WHO. Department of ErrorColl-Seck A, Clark H, Bahl R, Peterson S, Costello S, Lucas T. Framing an agenda for children thriving in the SDG era: a Lancet Commission on Child Health and Wellbeing. Lancet 2018; published online Nov 2. http://dx.doi.org/10.1016/S0140-6736(18)32821-6—In this Comment, the title should say WHO–UNICEF–Lancet Commission, the affiliation for Awa Coll-Seck should be Ministry of State, and the declaration of interests statement should read AC-S is Minister of State and RB is a coordinator in WHO's Department of Maternal, Child and Adolescent Health. Full-Text PDF