United Nations Millennium Development Research Articles

The Science of Sustainability

The question of what can be achieved in 1000 days has preoccupied kings, queens, presidents, and, very recently, the Secretary-General of the United Nations (UN). Ban Ki-moon has not only appealed for a last big push to reach as many as possible of the UN's Millennium Development Goals (MDGs) by the deadline of 31 December 2015, he is advocating the establishment of objectives that should succeed the MDGs as well. Strong clues about the shape of the post-2015 agenda can be found in two recent reports, one published last month by a High-Level Panel * convened by Ban Ki-moon and chaired by the presidents of Indonesia and Liberia and the prime minister of the United Kingdom, and the other released this month by the Sustainable Development Solutions Network. † Both reports list the eradication of poverty as the number-one priority and set out complementary goals concerned with gender equality, education, health, food, water and sanitation, climate change, energy, employment, natural resources, governance, peace, and finance. These reports are unlikely to be the last contributions to the debate, but the proposed goals represent a call to action for the science community.

Assistive/rehabilitation technology, disability, and service delivery models

The United Nation's Millennium Development Goals do not explicitly articulate a focus on disability; similar failures in the past resulted in research, policy, and practice that are not generalizable and did not meet the needs of persons with disabilities since they were developed for an "average" population. Academics and professionals in health and other disciplines should have a knowledge base in evidence-based practices that improve well-being and participation of people with disabilities through effective service delivery of assistive technology. Grounded by a theoretical framework that incorporates a multivariate perspective of disability that is acknowledged in the convention on the rights of persons with disabilities and the World Health Organization's International Classification of Functioning, Disability and Health, we present a review of models of assistive technology service delivery and call for future syntheses of the fragmented evidence base that would permit a comparative effectiveness approach to evaluation.

Social, economic, political and health system and program determinants of child mortality reduction in China between 1990 and 2006: A systematic analysis.

BackgroundBetween 1990 and 2006, China reduced its under-five mortality rate (U5MR) from 64.6 to 20.6 per 1000 live births and achieved the fourth United Nation’s Millennium Development Goal nine years ahead of target. This study explores the contribution of social, economic and political determinants, health system and policy determinants, and health programmes and interventions to this success.MethodsFor each of the years between 1990 and 2006, we obtained an estimate of U5MR for 30 Chinese provinces from the annual China Health Statistics Yearbook. For each year, we also obtained data describing the status of 8 social, 10 economic, 2 political, 9 health system and policy, and six health programmes and intervention indicators for each province. These government data are not of the same quality as some other health information sources in modern China, such as articles with primary research data available in Chinese National Knowledge Infrastructure (CNKI) and Wan Fang databases, or Chinese Maternal and Child Mortality Surveillance system. Still, the comparison of relative changes in underlying indicators with the undisputed strong general trend of childhood mortality reduction over 17 years should still capture the main effects at the macro-level. We used multivariate random effect regression models to determine the effect of 35 indicators individually and 5 constructs defined by factor analysis (reflecting effects of social, economic, political, health systems and policy, and health programmes) on the reduction of U5MR in China.ResultsIn the univariate regression applied with a one-year time lag, social determinants of health construct showed the strongest crude association with U5MR reduction (R2 = 0.74), followed by the constructs for health programmes and interventions (R2 = 0.65), economic (R2 = 0.47), political (R2 = 0.28) and health system and policy determinants (R2 = 0.26), respectively. Similarly, when multivariate regression was applied with a one-year time lag, the social determinants construct showed the strongest effect (beta = 11.79, P < 0.0001), followed by the construct for political factors (beta = 4.24, P < 0.0001) and health programmes and interventions (beta = −3.45, P < 0.0001). The 5 studied constructs accounted for about 80% of variability in U5MR reduction across provinces over the 17-year period.ConclusionVertical intervention programs, health systems strengthening or economic growth alone may all fail to achieve the desired reduction in child mortality when improvement of the key social determinants of health is lagging behind. To accelerate progress toward MDG4, low- and middle-income countries should undertake appropriate efforts to promote maternal education, reduce fertility rates, integrate minority populations and improve access to clean water and safe sanitation. A cross-sectoral approach seems most likely to have the greatest impact on U5MR.

Nutritional status assessment of school children in Mangalore city using the multicenter growth reference study WHO 2007 Z-scores

Context: One of the the United Nation's Millennium Development Goals (MDGs) is the reduction of maternal and child mortality. The 'green revolution' has increased food supply in Asia, and hunger and under nutrition have been decreasing since 1981. However, instead of having to deal with surplus food grain, South Asia and India are still facing high levels of hunger. Although some south Indian cities are witnessing a technology boom, one in every 11 children die within the first 5 years of their lives either due to malnutrition or due to non availability of even simple technology and health care. Aim: To assess the nutritional status of schoolchildrenin Mangalore city. Settings and Design: A cross-sectional study. Materials and Methods: A total 1630 students from 11 schools were enrolled for the study. The sample size was calculated assuming the prevalence of undernourished in Mangalore city as 20% and a relative precision of 10%. Statistical Analysis: The BMI (body mass index), Z-scores, and World Health Organization (WHO) Multicentric Growth Reference Study (MGRS) growth chart was used for analysis. Results: Our study population of 1630 students comprised 830 (50.9%) males and 800 (49.1%) females. On analysis, 82 children (5.03%) were found to be undernourished, 37 (2.3%) were overweight, and 16 (1%) were obese. Undernourishment was more prevalent in boys (6.87%) than in girls (3.12%).Obesity was marginally higher among males (1.2%) as compared to females (0.8%) (P=0.003). A total of 15 boys (1.8%) and 22 girls (2.8%) were found to be overweight. Conclusions: The nutritional status of the students in our study is better than has been found in other studies. However, there are cases of under nourishment that need attention. At the same time, there is a need to deal with obesity and overweight in schoolchildren in order to prevent the impending epidemic of noncommunicable disease.

2050: Ending the odyssey of the great white plague: Part of a series on Pediatric Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni

The United Nation's Millennium Development Goal of tuberculosis (TB) elimination by 2050 may be a realizable goal by concerting efforts of the numerous stakeholders involved in the development of novel antituberculous therapeutics. Improving pre-clinical models by the research community is one aspect of the drug development pipeline that will continue to require refinement. Better in vitro and animal models are needed to expand the chemical scaffolds of anti-TB agents. These constructs must be designed and utilized in a manner that is also pertinent to the pediatric population by addressing varying age-based drug metabolism rates. Novel technologies that utilize nanomedicine and genomic research may as well have a significant impact on future therapeutics; however, their development must acknowledge the key populations whose underlying disease pathology continues to drive the pandemic – both adults and children with latent TB, HIV/AIDS and diabetes. Challenging the long-standing orthodoxy of applying equivalent TB treatments for standard first line regimens among the adult and pediatric populations must also continue to be a major focus in future drug development strategies. Studies that include pediatric populations will require a greater variety of medication formulations, biomarkers that do not rely on sputum production and diagnostic technologies that are efficacious in paucibacillary disease. Significant programmatic barriers currently exist in key aspects of the described drug development pipeline, but strategic approaches can overcome these roadblocks – including the complex regulatory requirements involving the inclusion of children in drug trials. All such endeavors will require not only more focused research initiatives, but greater institutional support from the pharmaceutical industry, non-governmental organizations and national health sectors.

Tuning in to secure food

When Winnie Asege's crop was hit by cassava brown streak disease a few years ago she was faced with two problems. She had very little to eat and nothing to sell says Emily Arayo, Uganda national coordinator of the African Radio Research Initiative, a project run by Canadian nongovernmental organization Farm Radio International. This is food security, or rather food insecurity, at its most basic: a woman standing in a field looking at rotten tubers and wondering how she and her children are going to survive. impact is global too. In recent years rising food prices have sparked civil unrest, fuelled inflation and led to economic measures by some countries. Global food prices hit new record highs in December 2010, according to the Food and Agriculture Organization (FAO). While the reasons for volatile food prices are as diverse as climate change, commodity speculation, changing dietary habits, increased population and global trade issues, at bottom food security is simple: it means everyone gets to eat. This is the idea enshrined in the United Nations Millennium Development Goal 1, part of which seeks to cut by half the prevalence of underweight children aged less than five years and to halve the proportion of the global population struggling to survive below the minimum level of dietary energy consumption of about 1825 calories a day (FAO definition) between 1990 and 2015. [ILLUSTRATION OMITTED] So, with four years to go, how close are we to achieving this goal? According to the United Nation's Millennium Development Goals report, released in September 2010, not very: Overall progress in reducing the prevalence of hunger has not been sufficient to reduce the number of undernourished the report says. In other words there has been no change since the MDGs were announced in 2000. A similarly discouraging picture is painted by the FAO, which also released a report in September 2010 stating that, while the number of hungry people worldwide had decreased from more than one billion in 2009 to 925 million people in 2010, this small decline was largely attributable to resumed economic growth and a fall in food prices since 2008. preceding period saw a similar lack of progress. From 1990-2000, the proportion of undernourished people declined globally from 16% to 14%. The reality is that the proportion of hungry people in the world has only decreased by half a percent from 14% in 2000 to 13.5% today, says Oxfam's food and agriculture spokesperson Chris Leather, adding that any improvement that may have happened--and he has doubts about the numbers--has more to do with two years of good harvests rather than good policy. Some countries may be doing better in terms of food security compared to 10 years ago, Leather says, citing Brazil, Ghana, Malawi and Viet Nam as examples, but overall the picture remains fairly bleak. This is particularly true of the developing world, where, according to FAO economist David Dawe, 16% of the total population lives in hunger. Finding ways to enable those people to feed themselves is one of the biggest challenges we face Dawe says. This situation is unlikely to change unless international development partners and national governments live up to pledges made in the past few years, and notably in July 2009 in the Italian city of L'Aquila, where world leaders pledged USS 20 billion in aid over three years to a food security initiative. …

Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.

Maternal deaths drop by one-third from 1990 to 2008: a United Nations analysis

With only five years left until the 2015 deadline to achieve the United Nation's Millennium Development Goals (MDGs), slow progress in MDG 5 (Improve maternal health) has been of concern to the international community. The latest estimates issued by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF) and The World Bank in September 2010 provide evidence of progress in all regions of the world, including in sub-Saharan Africa where data had previously shown limited change.1 According to estimates presented for 172 countries and territories in the interagency report, approximately 358 000 maternal deaths occurred worldwide in 2008. There was a steady decline in the maternal mortality ratio, which relates the number of maternal deaths to the number of live births. At the global level, the maternal mortality ratio fell by 34% from 1990 to 2008. The biggest declines in this ratio were seen in eastern Asia and northern Africa (63% and 59%, respectively). Although such progress is encouraging, it will be insufficient to meet the MDG target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. This would require an average annual decline of 5.5%. Improvements documented in this study fell short of this goal for the world as a whole with an annual decline of 2.3%, and for sub-Saharan Africa, in particular, where the estimated rate of decline was only 1.7%. The effect of HIV/AIDS in sub-Saharan Africa is likely to have contributed to the slow pace of decline in maternal mortality. Overall, it was estimated that there were 42 000 deaths due to HIV/AIDS among pregnant women in 2008. About half of those were assumed to be maternal. The contribution of HIV/AIDS was highest in sub-Saharan Africa where 9% of all maternal deaths were estimated to be due to HIV/AIDS. There was much variability between countries in 2008, with a maternal mortality ratio of 290 deaths (per 100 000 live births) in developing regions as compared to 14 deaths (per 100 000 live births) in developed regions. Not surprisingly, 99% of maternal deaths in 2008 occurred in developing countries. Levels and trends of maternal mortality varied widely within regions as well. For example, in sub-Saharan Africa, where an overall reduction was noted for the first time, some countries (e.g. Benin, Cape Verde, Equatorial Guinea, Eritrea, Ethiopia, Mozambique and Rwanda) experienced declines in maternal death rates since 1990, whereas in other countries (e.g. Botswana, Kenya, Lesotho, South Africa, Swaziland and Zimbabwe) death rates increased. WHO, UNICEF, UNFPA and The World Bank have published periodic estimates of maternal mortality every five years since 1990.2,3 Earlier this year, a study by the Institute of Health Metrics and Evaluation reported a different set of estimates based on an alternative methodology, which showed a faster pace of progress than earlier estimates.4 This study estimated a total of 342 900 maternal deaths for 2008 and a rate of annual decline of 1.3% between 1990 and 2008. The estimates summarized here were derived using a larger data set and an improved method than that used for the previous rounds of interagency estimates. The estimation methods were reviewed by an external technical advisory group and will be published separately. We used all available national data on maternal mortality from the late 1980s to the present, analysed the variability of such data over time and space and included formal estimates of uncertainty. We adjusted the data, where appropriate, for the incomplete recording of maternal deaths and for over-counting in cases where a data source includes deaths that occur during pregnancy but are due to incidental or accidental causes. The country consultation that was done while developing these estimates has helped identify increased data collection efforts in recent years, including special systems to capture data on maternal deaths. However, the global database on which estimates are based remains weak: it is crucial to develop improved mechanisms for counting maternal deaths so that we may better understand the true magnitude of maternal mortality. These new estimates show a decline in maternal mortality greater than expected during 1990–2008. The study is the first to suggest that there has been a decline in sub-Saharan Africa. Several factors could account for this observation. Countries are increasingly adopting strategies and policies, such as free obstetric care or risk-pooling mechanisms, with the goal of increasing the coverage of effective health services. During the same period, the proportion of deliveries attended by skilled health personnel rose from 53% to 63% and the proportion of women who report using a method of contraception increased from 52% to 62% in developing countries.5 However, there is still much work to be done in improving health systems to prevent maternal deaths in developing countries.

ICT4D and the Siyakhula Living Lab: an anthropological contribution to digital development

Anthropologists are increasingly interested in the reception and adaptation of Information and Communications Technologies (ICTs) at the local level, especially when these are intended or adapted for social change in the kinds of societies and communities anthropologists study. The process has been increasingly driven by the spread of landline telephones, radio, television, personal computers, the Internet (1.0 and now 2.0), basic cell phones and now internet-enabled or ‘3G’ cell phones. These successive technological innovations, now collectively grouped as ICTs, have had the effect of shrinking distance by increasing the reach of both those who control these technologies and those who can access them. With radio and TV, and even the Internet until recently, communication tended to be one-way: from the centre to the periphery both between and within countries. This was never the case with landline telephones, which offered two-way communication from the outset; but landlines rarely extended into the rural areas of developing countries, and even where there was access, the poor generally could not afford domestic installation. Cellular phones, though even more expensive in terms of call charges, operate beyond the reach of landlines, are portable and no longer as dependent on frequent charging from mains electricity as before. The wireless networks that run them now offer access to the Internet almost everywhere—for those who have 3G handsets and/or wireless-connected computers—and include such useful adaptations to Third World conditions such as ‘pay as you go’ and ‘please call me.’ Moreover, the Internet itself has become more interactive with its 2.0 technologies. If ‘development’ (as opposed to modernisation) is about agency and empowerment for those who currently lack it, then there is development potential in the newest ICTs despite their control by major multinational corporations. Informatics professionals and elements of the ‘development community’ reaching as high as the World Bank and the United Nations (Millennium Development Goals) regard ICT4D (ICTs for development) as a potential redeemer of half a century of mostly failed interventions on behalf of the world's poor. But how feasible is ICT4D? How is it being received and what are its direct and indirect impacts? This paper is the outcome of four years of engagement with an ICT4D research project founded in Dwesa-Cwebe on the Wild Coast of the Eastern Cape in South Africa. It assesses not only the potential and snags of ICT as a development tool, but also, via a baseline research project completed in 2008, provides a sense of the setting, the needs of the community and the potential of the ‘Living Lab’ approach to ICT4D.

Vaccine Use Gaining as 2015 Deadline for Health Goals Nears

One major component of the ambitious United Nations (UN) Millennium Development Goals (MDGs), set a decade ago, is to expand global vaccine use while reducing health and financial burdens from vaccine-preventable diseases. With five years left to meet the 2015 deadline, health ministers, donors, and UN agency chiefs met in New York City last September to review progress. In developing countries such as Kenya, Nicaragua, and Afghanistan efforts to reach those goals are already paying off.

Viewpoint: Childhood undernutrition: A failing global priority

Undernutrition remains a significant underlying cause of death among children worldwide. Although alleviating hunger is part of the first United Nation's Millennium Development Goal and a declared global priority, undernutrition continues to be prevalent in low-income and middle-income countries throughout the world. The authors review the problem and policies and recommend how, particularly in this time of global economic difficulties, to improve policies to prevent undernutrition. They advocate even greater urgency.

Impact of Corporate Governance on Foreign Direct Investment in Nigeria

The United Nation's Millennium Development Goals for Africa suggest the need for these economies to attract substantial amount of foreign direct investments (FDI) to stimulate growth by investing in essential development infrastructures. However, investors are skeptical of opaque corporate governance structures both at firm and macro levels because of the attendant risk to their investments in an environment of weak legal system and poor human right records. Recent events indicate that a number of these economies have realised the importance of good governance systems and the need to signal transparency and accountability both at firm and country levels and have embarked on significant corporate governance reforms. In this paper we did a trajectory of corporate governance reforms in Nigeria and using time series data spanning over a decade we empirically investigated the determinants of foreign capital inflow arguing that in addition to the factors identified in the literature, FDI is positively related to improvement in corporate governance (CG). The paper further argued that although corporate governance prescriptions should be contextualised within the distinctive nature of the developing economies, this should not be stressed too strongly in order not to discourage potential foreign investors. The paper also attempted to identify future directions of the relationship between CG initiatives and FDI in Nigeria.

Social, Economic, and Political Factors in Progress Towards Improving Child Survival in Developing Nations

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: a community based cross sectional study.

BackgroundIn Ethiopia, the existence of iron deficiency anemia is controversial despite the fact that Ethiopia is one of the least developed in Africa with a high burden of nutrient deficiencies.MethodsThe first large nutrition study of a representative sample of women in Ethiopia was conducted from June to July 2005 and a systematically selected sub-sample of 970 of these subjects, 15 to 49 years old, were used in this analysis of nutritional anemia. Hemoglobin was measured from capillary blood using a portable HemoCue photometer. For serum ferritin, venous blood from antecubital veins was measured by an automated Elecsys 1020 using commercial kits. Diets were assessed via simplified food frequency questionnaire. The association of anemia to demographic and health variables was tested by chi-square and a stepwise backward logistic regression model was applied to test the significant associations observed in chi square tests.ResultsMean hemoglobin ± SD was 11.5 ± 2.1 g/dL with a 29.4% prevalence of anemia. Mean serum ferritin was 58 ± 41.1 ug/L with a 32.1% prevalence of iron deficiency. The overall prevalence rate of iron deficiency anemia was 18.0%. Prevalence of anemia, iron deficiency, and iron deficiency anemia was highest among those 31-49 years old (p < 0.05). Intake of vegetables less than once a day and meat less than once a week was common and was associated with increased anemia (p = 0.001). Although the prevalence of anemia was slightly higher among women with parasitic infestation the difference was not significant (p = 0.9). Nonetheless, anemia was significantly higher in women with history of illness and the association was retained even when the variable was adjusted for its confounding effect in the logistic regression models (AOR = 0.3; 95%CI = 0.17 to 0.5) signifying that the most probable causes of anemia is nutrition related and to some extent chronic illnesses.ConclusionModerate nutritional anemia in the form of iron deficiency anemia is a problem in Ethiopia and therefore, the need for improved supplementation to vulnerable groups is warranted to achieve the United Nation's Millennium Development Goals. Chronic illnesses are another important cause of anemia.

An Overview: Tourism Non-governmental Organizations and Poverty Reduction in Developing Countries

This article illustrates how select non-governmental organizations (NGOs) are using tourism as a development tool for poverty reduction. These tourism-oriented NGOs are becoming increasingly relevant as an alternative and legitimate source of development aid to many developing countries, since the turn of the 21st century. Many NGOs based in the developed world, in their quest to meet the United Nation's Millennium Development Goals, are partnering with developing world NGOs and communities to help create locally initiated solutions to poverty. These partnerships ensure community involvement and more direct benefits to communities, while creating sustainable solutions that preserve their culture and environment. Although there are several distinct types of tourism NGO providing both financial and non-financial benefits to poor and indigenous communities, this article focuses on three−educational and advocacy organizations, “voluntourism” organizations and tour company foundations−that have made substantial contributions to poverty reduction through sustainable tourism. Is this an effective means of providing communities with socially and environmentally responsible tourism in developing countries in Africa, Asia and Central and South America? This article suggests that it is; however, the lack of uniform standards for measuring the success of these organizations complicates efforts to ascertain the exact levels of poverty reduction.

Bottlenecks and Benevolence

This article looks at how Goal 6 of the United Nations (UN) Millennium Development Goals (MDGs) impacts on the well-being of the people affected by Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS). The focus is on a specific aspect : how the aid emphasised by Goal 6 is channelled towards community groups responding to the HIV/AIDS crisis. It does so by exploring the institutional mechanisms used by one of the key international organisations involved in the realisation of the MDGs—the World Bank and its Multi-Country HIV/AIDS Programme (MAP) in Kenya, Tanzania and Uganda. The article explores the role of local government, rivalry between different forms of civil society organisations, the problems associated with effective delivery and community feedback, donor responses to these problems and how these factors impact upon the immediate and long-term realisation of Goal 6, and the position of communities within it. Key to which are themes of conditionality and divisions between implementation and decision-making. The article is based upon extensive qualitative research into MAP in East Africa.

Brock Chisholm, the World Health Organization, and the Cold War

Brock Chisholm, the World Health Organization, and the Cold War

Partnerships in African crop biotech

Even in sub-Saharan Africa's most progressive nations, agbiotech partnerships are still often poorly oriented to end users, fragmented in scope and of limited impact in achieving the United Nation's Millennium Development Goals.

The grand challenges of the Gates Foundation: what impact on global child health?

Millions of children in poor countries die each year from preventable diseases.1 This is not news. Since their inception, international organizations including the World Health Organization (WHO) and the United Nations (UN), have dedicated countless hours and millions of dollars to alleviating this problem. More recently, a number of private foundations have become active in the work of childhood survival. The Bill and Melinda Gates Foundation, one of the leading financial supporters of global health, recently announced over US$ 450 million to be distributed in grants to 43 projects that address the Foundation's 14 Grand Challenges (Box 1).2 The programme aims to stimulate the creation of novel ways to prevent, treat and cure the diseases that kill millions of people each year in developing countries. In this paper we will explore the potential impact of some of goals of the Grand Challenges for global child health within the context of current international health initiatives including the Integrated Management of Child Diseases created by the WHO and UNICEF, the UN's Millennium Development Goals, and the Bellagio Study Group's assessment of the current state of global child survival in the developing world.

EHPnet: Millennium Ecosystem Assessment

The Millennium Ecosystem Assessment (MA) is the largest assessment to date of the health of the world’s ecosystems. Launched in 2001 by United Nations (UN) secretary-general Kofi Annan and authorized by governments through four international conventions, the MA is intended as a tool to inform decision makers and the public. The documents flowing forth from this work, which was completed in March 2005, have been prepared by 1,360 experts from 95 countries, with an 80-person independent board of review editors. The documents draw on information gathered from the scientific literature, existing data sets, and scientific models, and incorporate knowledge gleaned from the private sector, workers in the field, indigenous peoples, and local communities. Information about the MA, as well as the documents it has released, are available online at http://www.millenniumassessment.org/. The findings of the MA are grim. Over the past 50 years, humans have changed ecosystems faster and more extensively than during any other comparable time period in human history. These rapid changes have grown out of increasing demands for natural goods and services, such as food, fresh water, timber, fiber, and fuel. The MA also finds that ecosystem changes have brought about substantial gains in human well-being and in economic development, but that these gains have come at the cost of degrading ecosystem services and increasing poverty for some groups of people. The report predicts that ecosystem change could accelerate during the next 50 years and contribute to nonachievement of the UN Millennium Development Goals. Yet, there is some hope that this situation can still be reversed, and the report sets forth options for improving ecosystems by 2050. These fall under three scenarios: “Global Orchestration,” “Adapting Mosaic,” and “TechnoGarden.” The Global Orchestration scenario reflects a globally connected society focused on international trade and economic liberalization that also takes strong steps to reduce problems such as poverty and inequality and to invest in public infrastructure and education. The Adapting Mosaic scenario focuses on local-scale activities, and investments in human and social capital emphasize education to bring about a better understanding of the nature of ecosystems. At the core of the TechnoGarden scenario is the use of technology and highly managed, often engineered ecosystems to deliver ecosystem services. A fourth scenario, “Order from Strength,” emphasizes heightened security and a fragmented society, to the detriment of the environment. The MA homepage provides the latest news related to the project, while links along the right side of the page access the numerous partners in the MA. These partners include the UN Development Programme, the UN Environment Programme, the World Bank, multiple universities, and others. The Reports section of the site provides links to the major documents produced by the MA. Each report can be downloaded for free in English and several other languages; there is also information on how to order printed copies. The Resources section assembles slide presentations, figures, tables, maps, posters, logos, and brochures that can be used by the media. All are available to download for free. The About the MA section of the website provides a thorough history of how the work came about, how it was funded, how it was undertaken, and how it may continue in the future. This section also includes a page devoted to the many subregional assessments that are being carried out in conjunction with the MA. Links to each provide details of the areas covered by the assessments, the institutions carrying out the assessments, the features of the ecosystem being assessed, key features of the assessments, and the time frame and budget for the work.