Child mortality

The Slippery Target

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IMG_24582015 is fast drawing to a close, and with it the culmination of the Millenium Development Goals.

Among the eight MDG, Goal 4 which was to Reduce Child Mortality made progress but failed to be achieved.

The Sustainable Development Goals replace the MDG for the period 2016-2030, and continue with a more ambitious reach to continue to address the impact of poverty.

My good friend Trish shared this document today The Slippery Target for Child Survival in the 2030 Agenda for Sustainable Development from the Health and Human Rights Journal. It is a short document that is well worth reading to see how difficult it is to set targets in a world where there is great discrepancy in levels of child mortality between countries.

Information worth noting. It helps define the challenge before us.


The face of child survival

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IMG_0266In many respects, for a person who has spent their entire life within the confines of the Western world, the Millennium Development Goals which are soon due to expire can best be measured in images.

IMG_0313The eight MDG are simple and easily defined, which is their best feature.

One of the problems with the MDG has been the need for education of what they actually are. Still today, if you walked down the main street of any capital city of any large Western economy, most people in the street wouldn’t know what you were talking about if you mentioned the MDG.

IMG_0300Too much time and money has been spent explaining and educating these MDG. Most of the publicity campaigns I have seen appeared to look something akin to massive, extravagant, community cake stalls. What outcome was really achieved by all of that?

IMG_0294Like it or not, systemic change requires some degree of education. This is the cost of a new idea.

IMG_0351But here I want to talk about child mortality, the reason behind the 10 City Bridge Run. We are focusing on child survival: the positive side of child mortality.

IMG_0378What does child survival look like? Healthy children. Rather than celebrate it, we take it for granted.

IMG_0283Child mortality largely goes unseen. My friends from Sierra Leone, all who I have met outside of their country in different parts of the world, all are well educated, eloquent, intelligent, and seemingly no different to you or I. There is not a tag around their neck that proclaims they are from the country with the highest rate of child mortality.

IMG_0277This has been one of the failures of the MDG. They have created an image of something created by large NGOs involved in helping to address these problems through a series of well selected photographs to tug at the heart strings and wallets of people in the West who might fund their causes. It becomes the tool for the charity muggers who provide the customer facing face of these organisations as their massive fundraising and messaging campaigns ramp up.

IMG_0261The stories told through these campaigns create a narrative of the issue. The statistics take on a life of their own. ‘What might that look like?’ we ask ourselves in our mind’s eye.

This post is not about trying to fight the system. Rather, it is about celebrating images of healthy children with healthy mothers. That is the work of the 10 City Bridge Run. There is enough misery to go around. Let’s celebrate life instead.

Crossing the River of Myth

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The avuncular Hans Rosling was back recently staunchly arguing why child mortality is more readily overcome now than ever before. He shows that it is our dated perspective mistakenly informed through myth we cling to that which holds us back. We are closer to a solution than we think or know.

Let Hans tell the story himself below:

Race against time

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Half marathon
Half marathon (Photo credit: bostjan_rudolf)

Does it really matter if the Millennium Development Goals are not achieved? Of the eight goals set, there are a few that will be achieved (or have already been satisfied) before the 2015 time horizon. Others might not cut it.

Child mortality is one of those measures that is looking doubtful of meeting the 2/3 reduction of 1990 measurement of under-five death before 2015.

It is a race against time, and we as a global community as close to halving the 1990 level. Reduced from around 12 million deaths of under-five children in 1990 to an approximated 6.4 million deaths in 2013.

The stunt which frames the 10 City Bridge Run will illustrate this through running across two distances:

  • 2.4 km. A participative run involving a large group running 2.4 km together across a bridge. There are 2.4 million children too many dying this year in 2013 above what is required to achieve the Millennium Development Goal 4 (reduce child mortality by 2/3 from 1990 levels before 2015).
  • Half-Marathon. 10 half-marathons will be run in 10 cities across 10 countries as a stunt to show we have halved 1990 levels, and while that is good, it is now a race against time in this marathon journey to end child mortality.

This running is framing the conversation asking: “how can we use our networks to improve the delivery of child survival?”

There are a lot of people who have been working hard on this issue for more years than I have been aware of it. How can we find, learn about, then share best practice to make a difference in the lives of literally millions of people where the need is at its greatest?

This is a race we want to win. Together.

Reframe: Improving Child Survival

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Child in slum in Kampala (Uganda) next to open...
We need to find the stories of hope. The stories of possibility. Stories to reframe this narrative.

My last post was a month ago, but in that space of time I have covered a very large distance in many different respects. I wrote as I travelled from Sydney to London to attend the Commonwealth Study Conference, otherwise known as CSCLeaders. That trip proved to be a turn-key moment in gaining a new sense of clarity about this initiative.

It has taken me some time to process everything that has taken place. One month in fact. There is much to share, but here I just wanted to start with one brief comment.

I have reframed the 10 City Bridge Run following the input of many people and much reading over the last month. The emphasis, I believe, needs to be placed on child survival not child mortality.

Let me explain why:

  • Child mortality is easy to explain, and is a very tangible and very troubling measure.
  • The 10 City Bridge Run is an initiative about how we might use our networks for the better.
  • I have come to the realisation that together we cannot actually reduce child mortality. Larger organisations and countries can through their effort, but even then the reduction of child mortality is a lagging indicator of their success in something else.
  • Where we can have success is in improving child survival. Through increased child survival, the result is a reduction of child mortality.

This is a subtle shift, but an important one. It means the entire effort goes towards working out what we can do to save lives, rather than spending time recording facts about deaths. Yes, the two go hand-in-glove, but as for directing the efforts of a network, we are better focused on documenting what is best practice in child survival.

Already, there is good data. It is shared widely. But we are still falling short.

This is not about reinventing the wheel, but rather bringing the considerable resources of an extended network of bridge builders to bear on working out where we can best make change to improve child survival.

Just over ago in this blog, I wrote these words:

Changing the name doesn’t change the facts. We are still falling short, and there is more work to be done. But with a renewed focus, maybe at least we can have a clearer view on where our emphasis is best placed.

I didn’t recognise this insight at the time, but now can see that what I had instinctively observed. We are working towards compiling a sharable resource documenting best practice in child survival. This is our journey. Let’s go together!

This video, produced last year, explains this concept well:

From child mortality to child survival: what’s in a name?

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Description unavailable
Same the world over (Photo credit: Save the Children)

Ok, so there seems to be a new phrase entering the lexicon of child health.

‘Child mortality’ is being used less frequently in favour to the use of ‘child survival’.

What’s in a name? Does this really make a difference at all? I think it does. It is a more optimistically framed language, which sets our minds looking towards the solution, rather than the seemingly impossible wall of death to overcome.

Changing the name doesn’t change the facts. We are still falling short, and there is more work to be done. But with a renewed focus, maybe at least we can have a clearer view on where our emphasis is best placed.

Change your thinking: it is a matter of perspective

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Hans Rosling at TED
Hans Rosling at TED (Photo credit: Wikipedia)

The avuncular Hans Rosling joins us again to explain where the focus on child mortality ought to be placed across the world’s 7 billion people, and whether tackling this issue will make a difference.

In his idiosyncratic way to craft a story that is as simple as it is engaging, he presents one of the most pressing and complex problems very clearly.

His message: Yes, there is hope for the future! We can make a difference in this lifetime to child mortality.

He does leave us with one request: change your thinking. Stop thinking about developed and developing countries, because it is unhelpful in focusing on those people where the real need is found.

Good message to reflect on next time you go to grab a coffee mug: we can make a difference.

Photoessay: Committing to Child Survival

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Huellas de Vida | Footprints of Life
Huellas de Vida | Footprints of Life (Photo credit: victor_nuno)

Here is a beautifully presented photo-essay by UNICEF that helps to tell the story about what work is going on around the world to combat child mortality. It doesn’t cost you to look a these photos, except for your time.

Take a look through this link here which opens the photoessay. Leave a comment below with what your favourite frame was and why.

The 10 City Bridge Run is funded through the pre-sale of a book called ‘Life Bridge’ which will feature 100 photographs of ‘human bridges’. Describing a human bridge in words is best achieved through drawing inspiration from a quote by Ophelia Dahl, cofounder of Partners in Health and daughter of renowned children’s book author Roald Dahl, quoted Adam Hochschild who wrote about the importance of “drawing connections between the near and the distant”:

Linking our own lives and fates with those we can’t see will, I believe, be the key to a decent and shared future… Imagination will allow you to make the link between the near of your lives with the distant others and will lead us to realise the plethora of connections between us and the rest of the world, between our lives and that of a Haitian peasant, between us and that of a homeless drug addict, between us and those living without access to clean water or vaccinations of education, and this will surely lead to ways in which you can influence others and perhaps improve theworld along the way.

You too can join this journey but supporting this effort, and receive a copy of the book Life Bridge when it is published early next year. Please visit Your support is important.

Tiffany Eyes Off Grace’s First Birthday Cake (…meanwhile, somewhere in Sierra Leone…)

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Tiffany wants Grace’s cake

My good friends Nick and Liz have a daughter. Her name is Grace, and last weekend we all gathered in their backyard to celebrate her First Birthday Party. It was a beautiful day, lovely weather, too much food to eat, and many friends (old and new) to mingle with.

You can see from the photo that her friend Tiffany perhaps enjoyed it more than anyone, while she eyed off the birthday cake. I imagine she was thinking: ‘If everyone is looking the other way, would anyone notice if I just had a little taste of this cake before it was cut?’

Most of us have been to this sort of party before. Many of you will be parents who have had the pleasure and privilege to celebrate this occasion for your own child or children.

Such a stark contrast with other countries that for one reason or another don’t make it onto the radar of what gets printed in our newspapers. It is a tragedy unfolding every day.

We live like royalty in comparison. Even with problems we all encounter: the boss is a jerk, coffee was too bitter, missed the 7.05 bus, caught in a traffic jam for 45 minutes this morning.

Here is some food for thought. I hope this brings some perspective as to why I am about to run 10 sub-marathons each of 24 km in 10 cities across 10 countries all inside of one month. To open a conversation asking how might we use our networks to alleviate child mortality. Consider these facts:

  • About half of under-five deaths occur in only five countries:India, Nigeria, Democratic Republic of Congo, Pakistan, and China.
  • India (24%) and Nigeria (11%) together account for more than a third of all under-five deaths.
  • The highest rates of child mortality remain in sub-Saharan Africa where 1 in 9 children dies before the age of 5. That is more than 16 times the average for developed regional (1 in 152).
  • By 2050, 1 in 3 children will be born in Sub-Saharan Africa, and almost 1 in 3 will live there, so the global number of under-five deaths may stagnate or even increase without more progress in the region.
  • The proportion of under-five deaths that occur within the first month of life (called the ‘neonatal’ period) has increased 17% since 1990, from 36% to about 43%. This is because progress in reducing the neonatal mortality is slower than that in the mortality for older children.
  • Almost 30% of neonatal deaths occur in India.
  • Sub-Saharan Africa has the highest risk of death in the first month of life and is among the regions showing the least progress.
  • Historical trends show that for most countries progress has been too slow and that only 15 of the 66 countries with a high under-five mortality rate (at least 40 deaths per 1,000 births) are on track to achieve Millennium Development Goal 4.

This information is taken from the 2012 Report Levels and Trends in Child Mortality developed by the UN Inter-agency Group for Child Mortality Estimation published in 2012.

There is some good news. Sub-Saharan Africa has in the last decade seen a faster decline in its under-five mortality rate, with the annual rate of reduction doubling since the decade before. We are making progress, much work attention is needed, and now.

Happy birthday, Grace.

10.24 Reflections on the United Nations

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John R. Bolton
John R. Bolton (Photo credit: Wikipedia)

24 October was ‘United Nations Day’, commemorating the anniversary when the UN Charter came into effect in 1945. The UN is a large organisation. Massive, in fact.

John Bolton was appointed as the United States Ambassador to the United Nations in 2005 by President Bush. The position is also known as the United States Permanent Representative the the United Nations. His criticism of the United nations made this a surprise appointment to many, where he had earlier openly shared his strong views which were often critical of the organisation. In 1994, he said:

…there is no United Nations… there is an international community that occassionally can be led by the only real power left in the world, and that’s the United States, when it suits our interests, and when we can get others to go along.

And then in 2005, he famously remarked:

The Secretariat Building in New York has 38 stories. If you lost ten stories today, it wouldn’t make a bit of difference.

Unsurprisingly, he was also highly critical of the Millennium Development Goals. Looking at it from his perspective, this is understandable: it was always a target full of rhetoric and seemingly unachievable, so what was the point of exhausting resources for a measure that was simply beyond reach?

The other side of the coin is to take a pragmatic approach that argues that it is more than just a matter of idealistic and wishful thinking, but that an aspirational goal is worth striving towards. We might fall short, but in the process how much can we achieve?

I was responsible for monitoring much of our correspondence with the United Nations when I was in the Army at the time that John Bolton was the US Permanent Representative. Like others, I was amused at his blunt delivery which put a lot of noses out of joint. Years earlier, I recalled how there was in fact a lot of inefficiency in the United Nations that was plainly obvious when I was deployed to East Timor as part of the broader UN force.

Now we stand at the end of a moment of truth as it were. The next three years will be telling, and will reflect any momentum generated over the last short period. It is also a window that can be influenced through new ideas, even though a short period.

The question would be, how able is the UN really about to respond to such opportunities? Was Bolton right? Is a quarter of the UN just a waste of space?

I chose to look at 10.24 as more than just an anniversary. To me it is a personal goal I have set: to run 10 sub-marathons each of 24 km. By doing this, I aim to stimulate a conversation that will take place in Seoul on 24 January 2013 asking how might be use our networks to reduce child mortality.

We need people like Bolton. His unyielding cynicism is an important part in generating the creative tension we need to make change happen. But you also need people to push people like Bolton a little harder and show that change is possible.

Will you join me and be one of those people? Please join me on this journey. Support me at to make a difference.