The UN Millennium Development Goals, a blueprint for development agreed to by all the world's countries and leading development institutions, includes the goal of reducing the under-five child mortality rate by two-thirds by 2015. While this goal is laudable, says a team of public health researchers in this week's PLoS Medicine, this reduction could still leave the children of the poor worse off.
The problem arises, say Daniel Reidpath (Centre for Public Health Research, Brunel University, Uxbridge, UK) and colleagues, because the child mortality goal (Millennium Development Goal 4) is presented in terms of the raw, average under-five mortality for a country. "While this makes for simple reporting," they say, "the figure masks distributional information about which parts of society contribute most (or least) to the magnitude of that rate. In other words, the measure is equity-blind, unable to distinguish between a fair and an unfair social distribution of the burden of under-five mortality."
Reidpath and colleagues argue that a country could achieve the goal of reducing the average under-5 mortality by two thirds by 2015 (an apparent "success"), but fail to address the ongoing problem of high under-five child mortality amongst the country's most vulnerable groups. Such a failure, they say, would violate the spirit of the Millennium Declaration that the world's leaders have agreed upon, which states:
"We recognize that, in addition to our separate responsibilities to our individual societies, we have a collective responsibility to uphold the principles of human dignity, equality and equity at the global level. As leaders we have a duty therefore to all the world's people, especially the most vulnerable and, in particular, the children of the world, to whom the future belongs."
The focus on the average or raw under-five mortality rate in Millennium Development Goal 4, say Reidpath and colleagues, without regard to the social distribution of the burden of under-five mortality, "will likely result in resource allocation being driven by expedience and lead to an increasing inequity."
Funding: No specific funding supported the production of this article.
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