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International Health

From the Chair
Robert Black, MD, MPH

Bob BlackAs the world approaches 2015, it is clear that many countries will meet the Millennium Development Goal 4 of a two-thirds reduction in child mortality from the 1990 baseline, but also that many other countries especially in South Asia and sub-Saharan Africa may not. More intensified effort and additional funding in the remaining three and a half years will push all of these countries closer and some may reach the goal. And this additional effort would create the momentum for faster changes in the years after 2015.

In June 2012 there will be a ministerial meeting led by the US, Ethiopia and India in Washington, DC, to call for a coordinated strategy to end preventable child deaths in a generation. More specifically this meeting will endorse a goal that all countries achieve an under-5 mortality rate of below 20 per 1,000 live births in 2035; the global average mortality rate at that date will be 15 per 1,000. This will bring all countries into the current range for industrialized countries and reduce global child deaths to less than 2 million from 7.6 million in 2010 in spite of increased births.

The recent Lancet paper (Liu, et al.) on trends in cause-specific child deaths from 2000-2010 provides crucial information on the major causes of death that must be addressed to achieve these new mortality targets and on the diseases and countries that have sustained the annual rates of reduction that will be necessary and can serve as benchmarks for others. In the last decade the global average annual rate of reduction has been 2.6% but 5.5% will be needed to reach the new mortality targets. In short, we must find ways to “bend the curve” and accelerate the reduction of deaths. This will require delivery of current interventions to full and equitable coverage, as well as adding new interventions, such as malaria vaccine, that will be available in the next two decades.

The Lives Saved Tool (LiST) is ideal for predicting the impact of these interventions on child mortality and is being used to guide how countries can achieve their 2035 goal and the implications for global mortality rates. The information on trends in child mortality and the projections of future causes of death are critical for improving allocative efficiencies, directing human and financial resources to the most important causes of child mortality. Planning using LiST can help maximize technical efficiencies by using these resources to have the greatest impact. Of course, estimates of the causes of child mortality and causes of death and of potential intervention effects are based on imperfect data and have substantial uncertainty. But I can agree with Bertrand Russell who said,

When one admits that nothing is certain, one must, I think, also add that some things are more nearly certain than others.

One thing that is certain is that we have the ability to end preventable child deaths in the next generation. We must find the will and the means to do so.