India celebrated Children’s Day on Sunday. It came two days after World Pneumonia Day. There was a strange appropriateness to that coincidence for it allowed us to stop and ponder over the many health challenges — pneumonia being a salient one among them — that confront India’s children. As a paediatrician, I’ve witnessed firsthand the suffering of the youngest citizens of the world, especially in India.
About 26 million children are born in India each year. The present generation is of particular interest to economists and policy makers, as it will grow up to power India’s “demographic dividend” — the largest population of young, working people in any single country — in the first half of the 21st century.
Yet, this generation of young Indians will be underserved and denied its potential without significant investments in healthcare and childhood disease prevention. Each year, the world loses over eight million children under five years of age. Currently, India accounts for 20% of these deaths. Of these, one in three is caused by diarrhoea or pneumonia, the leading causes of childhood deaths in India. This is far too much to accept from a country like India, which is one of world’s fastest growing economies.
Each year, pneumonia claims over 1.5 million children under the age of five across the globe — 20% of these deaths occur in India. Recent data show that approximately 120,000 children in India died from diarrhoea caused by rotavirus — the leading cause of diarrhoea across the world. To put it into perspective, China, with a larger population than India, lost only 27,000 children to rotavirus-caused diarrhoea in the same year.
India has made unprecedented gains in IT and other technologies in the last decade. It’s time for India’s economic and social sector progress to be matched by robust action in childhood disease prevention and treatment. In fact, the government has taken note of this and has started to respond. The National Rural Health Mission places emphasis on the health of mothers and their children. This has made pregnancy and childbirth a far less hazardous enterprise. Since the launch of the Janani Suraksha Yojana (JSY) Programme in 2005, safe deliveries, particularly in hospitals, have increased from 48% of births in 2002-2004 to 53% in 2007-2008. Some of the most significant progress has been made in states like Rajasthan and Madhya Pradesh.
Continuing to take these strides forward will require us to focus attention on what happens to these children after they are born. It’s not just the first hours of a baby’s life that are important; the first five years of life are critical to a child’s development. India needs to protect its demographic dividend from ever-present threats to its health and well being. We have the tools and financial resources to achieve this goal. A majority of childhood deaths can be avoided by deploying a combination of available strategies — preventive measures like clean water, oral rehydration therapy for diarrhoea and early treatment of pneumonia with antibiotics and immunisations. Take diarrhoea for example; less than 30% of Indian children who suffer from this disease receive oral rehydration solution (ORS), the simple mixture of salts and sugars proven to prevent deaths if used as soon as diarrhoea occurs.
These figures wouldn’t be so harrowing if we had adequate prevention. Many families do not have appropriate water supply and sanitation facilities, which are essential to eradicating diarrhoea and a host of other public health concerns. New rotavirus vaccines have been shown to reduce mortality and hospitalisation from diarrhoea in many countries. Similarly, new vaccines have been shown to reduce death and suffering from pneumonia. Currently, these vaccines are available to only a small, largely urban and relatively affluent segment of India’s children. We need to ensure universal access to these lifesaving interventions.
There are wider implications of the public health challenge that India’s youngest citizens face. India is a signatory to United Nations’ Millennium Development Goals (MDG), which aim to address some of the world’s most pressing issues in health, gender, environment and education by 2015. MDG4 aims to reduce childhood mortality by two-thirds by 2015. If the poorest children in India are denied access to proven interventions like ORS for treatment of diarrhoea, antibiotic treatment for pneumonia and vaccines, India won’t achieve MDG4.
The price of our failure won’t be theoretical or statistical; it will be paid by our children. In the words of the Chilean Nobel Laureate Gabriel Mistral, “We are guilty of many errors and many faults, but our worst crime is abandoning the children... children cannot [wait]. Now is when their bones are being formed, their blood is being made and their senses are being developed. To them we cannot answer ‘tomorrow.’ We must answer ‘today’.” As one of the world’s high-profile economies, and as a model for other developing countries, India has to put its will and effort behind the MDGs — and behind a comprehensive childhood health programme. Historically, as countries have become more developed, childhood mortality and disease risk have declined. There is a happy symbiotic relationship between these phenomena. A wealthy country has more resources to invest in public health programmes, which include comprehensive disease prevention or treatment strategies. In turn, it is well-documented that healthy children grow up to be healthier adults and contribute more effectively towards their personal and countries’ economic well being.
As India takes its rightful place in the premier league of nations, it cannot escape reality. Today’s children deserve it, and India’s future children deserve it. Most poignantly, the memory of the first prime minister of India, Jawaharlal Nehru, who loved India so dearly and in whose honour we celebrate Children’s Day, deserves it.
Mathuram Santosham is Professor, Departments of International Health and Paediatrics at Johns Hopkins University The views expressed by the author are personal