The number of children under 5 years old who died in 1993-more than 12.2 million-equals the entire populations of Norway and Sweden combined. Of such deaths in the developing world, the great majority could have been avoided if those countries enjoyed the same health and social conditions as the world's most developed nations. The gap between the developed and the developing world in terms of infant and child survival is one of the starkest examples of health inequity.
In 1993, the estimated global figure for mortality among children under 5 years old was 87 per 1,000 live births, an encouraging fall from rates of 215 during the period 1950-1955 and of 115 in 1980. Yet in parts of the developed world only 6 out of 1,000 liveborns die before reaching age 5, whereas in 16 of the least developed countries the rate is over 200 per 1,000, and in one country it is 320 per 1,000.
Worldwide infant mortality-deaths of children under 1 year old-varies from 4.8 per 1,000 live births to 161-a 33-fold difference. The gap in infant mortality between the developed and developing world narrowed by 50 percent during the years 1960-1993, from 113 to 54 per 1,000 live births. But, at the same time, the gap widened between least developed and developing countries.
Malnutrition contributes substantially to childhood disease and death but often goes unrecognized as such. In 1990, more than 30 percent of the world's children under 5 years old were underweight for their age. As many as 43 percent of children in the developing world-230 million-have low height for their age. Micronutrient malnutrition is estimated to affect at least 2 billion people of all ages, but children are particularly vulnerable. As a result of iodine deficiency-a public health problem in 118 countries-at least 30 000 babies are stillborn each year and over 120,000 are born mentally retarded, physically stunted, deaf-mute or paralyzed. A quarter of all children under age 5 in developing countries are at risk for vitamin A deficiency.
There have been improvements in child health, and 1993 saw the number of children dying from vaccine-preventable diseases reduced by 1.3 million compared to 1985-an amount equal to the population of Trinidad and Tobago. Nevertheless, around 2.4 million children under 5 years old are still dying every year from such diseases, particularly measles, neonatal tetanus, tuberculosis, pertussis, poliomyelitis and diphtheria. There are also worrying signs that recent immunization gains are being eroded or even reversed by economic and social conditions.
Every year in the developing world acute respiratory infections, particularly pneumonia, kill more than 4 million children under 5 years old-one death every 8 seconds-and are a leading cause of disability. They account for 30-50 percent of visits by children to health facilities everywhere. Significant reductions in mortality could be achieved by treating the underlying bacterial infections with low-cost antibiotics for a few days.
Diarrheal diseases, resulting from unsafe water and poor sanitation coupled with poor food handling practices, are responsible for a further 3 million deaths a year among children under age 5 in the developing world-one every 10 seconds-and are a graphic example of the deadly synergy of poverty and lack of knowledge. Worldwide, there are an estimated 1.8 billion episodes of childhood diarrhea annually. Many of the deaths from diarrhea could be prevented by using oral rehydration salts, which cost just US $0.07 on average.
Health of School-Age Children and Adolescents
Across the world some 2.3 billion people, about 40 percent of the total population, are aged under 20. Although teenagers and young adults are generally healthy, they are among the most vulnerable in terms of the diseases of society-poverty, exploitation, ignorance and risky behavior. In squandering the health of its young, the world squanders its tomorrows. The behavior patterns established in adolescence, highly influenced by the adult world, are of immense importance to an individual's life span and to public health as a whole.
In many countries, health services are not meeting adolescent needs and there are concerns that education, training and jobs for the young are inadequate. Education is a vital, although often unrecognized, contributor to the well-being and sensible fertility practices of young people, because schooling is closely linked with health status and pregnancy rates. A blackboard and piece of chalk can be as influential as antibiotics and contraceptives in protecting health. Improving the education of adolescents in general, and girls in particular, is one of the most effective ways to promote equity, enhance development and protect health for all.
The desire for sex and a fulfilling relationship are powerful driving forces for most young people, who at the same time are under pressure to engage in sexual relationships too early. Yet many young people are denied even basic knowledge about their own bodies or the means to protect themselves from unwanted pregnancy and sexually transmitted diseases (STDs). These diseases are most frequent in younger sexually active people and appear to be increasing worldwide. The highest rates for notifiable STDs are generally seen in the 20-24 age group, followed by those aged 15-19 and 25-29. In nearly all parts of the world, the peak age of infection is lower in girls than in boys.
At the same time, HIV and AIDS are having a devastating effect on young people. In many countries in the developing world, up to two-thirds of all new HIV infections are among people aged 15-24. Overall, it is estimated that half the global HIV infections have been in people under 25 years- with 60 percent of infections of females occurring by the age of 20. Thus, the hopes and lives of a generation, the breadwinners, providers and parents of the future, are in jeopardy. Many of the most talented and industrious citizens, who could build a better world and shape the destinies of the countries they live in, face tragically early death as a result of HIV infection.
Other health dangers facing adolescents include tobacco, alcohol and other drug misuse, their exploitation as cheap and often illegal labor and the worrying growth in the numbers of street children. Recent estimates suggest there may be as many as 100 million street children, at high risk for malnutrition, infectious diseases, STDs, including HIV/AIDS, and criminal and sexual exploitation. The rise in accidents, violence and suicides involving young people in many parts of the world is a cause for deep concern.
