For children, early death risk recedes, but inequality worsens

Global report finds sharp drop in adolescent deaths, but an uptick in disability. Jeff Glorfeld reports.

Worldwide, child mortality is down, but good health is far from global.


Children and adolescents everywhere are more likely than ever to live to see their twentieth birthdays, despite a widening gap between rich and poor countries in the quality and availability of healthcare, according to an analysis of the latest Global Burden of Disease report.

The report, prepared by the Institute for Health Metrics and Evaluation (IHME), based in the US, assesses data collected from 1990 to 2017 on children and adolescents from birth up to age 20 in 195 countries and territories, and is published in the journal JAMA Paediatrics.

The number of child and adolescent deaths decreased by 51.7%, from 13.7 million in 1990 to 6.6 million in 2017, write the report’s authors, led by the IHME’s Robert Reiner.

The sharpest fall was among children aged one to four years, mostly owing to global declines in deaths from diarrhorea, respiratory infection and other common infectious diseases.

However, people in the target ages also saw a 4.7% rise in morbidity – calculated as an aggregate 145 million years lived with disability.

Further, the authors write, inequity between rich and poor regions increased, with low and low-middle socio-demographic locations experiencing 82.2% of deaths, up from 70.9% in 1990.

The leading causes of disability in the poorest areas were neonatal disorders, lower respiratory infections, diarrhorea, malaria, and congenital birth defects, while neonatal disorders, congenital birth defects, headache, dermatitis and anxiety were highest-ranked disability causes in the richest locations.

Overall, other leading causes of disability include iron-deficient anaemia, vitamin A deficiency, and mental health disorders.

The Global Burden of Disease report – the third of its kind – aims to provide tools to quantify health loss from diseases, injuries, and risk factors, so health systems can be improved.

It was compiled by more than 3600 researchers in about 145 countries. It includes statistics on premature death and disability caused by more than 350 diseases and injuries, by age and sex, from 1990 to 2017, allowing comparisons over time, across age groups, and among populations.

In 50 countries, the probability of death between birth and age 20 being caused by self-harm or interpersonal violence increased between 1990 and 2017, led by Syria, Iraq, Yemen, Central African Republic, South Sudan, Libya, Venezuela, Mexico and Lesotho.

Referring to “the Sustainable Development Goal (SDG) era”, part of the United Nations’ 2030 Agenda for Sustainable Development, adopted in 2015, the report says: “The effects of acute and chronic infectious diseases, nutrition, physical functioning, mental health, and intellectual development set the stage for both individual prosperity and the future human capital of all societies.”

The authors note that the development goals, targets and indicators “remain largely silent on the unique social, environmental, and biological determinants of health occurring in adolescence across the socioeconomic development spectrum”.

This “blind spot” in health targets, planning and prevention “fails to capture the complex transitions occurring during adolescence in particular”.

Overall health improvements were slowest in adolescents. “Few locations showed any evidence of improvements in health among adolescents that exceeded the trends expected with general societal development gains,” the authors write.

In emphasising adolescence as “a key phase” of human development, this lack of progress has the potential “to influence individual and societal outcomes for periods substantially longer than the teenage years”.

“In terms of family and home life, key issues include the improvement of sanitary and living conditions, stable food systems, quality education, and gainful employment,” the researchers write.

“Also, HIV/ AIDS remains an imminent threat to the health and wellbeing of older children and adolescents in many countries.”

The researchers add that a “vast unfinished agenda” in child and adolescent health remains. The incidence of malaria is much reduced across Africa in general but there are many countries, especially in western sub-Saharan Africa, where parasite transmission, acute illness, and mortality from malaria remain high.

The report also singles out “the large and growing burden of mental health and substance use disorders among older children and adolescents” as “an emerging threat” to the health of young people.

“Many additional non-health SDG indicators also focus on reducing poverty, expanding education, stabilising environments, strengthening economies, and reducing overall socioeconomic inequality within each country and throughout the world, all of which are relevant to the health and wellbeing of young persons,” the authors write.

They note that these measures of population health are influenced by data availability and time lags in the reporting of health information, which may mean the estimates are based on data already out of date.

In calling for a continuation of the progress made in the past 27 years, they warn that increasing numbers of disabled children and adolescents living in poverty has the potential to increase the stress on already overburdened health systems.

Jeff Glorfeld is a former senior editor of The Age newspaper in Australia, and is now a freelance journalist based in California, US.
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