Print version ISSN 0042-9686
Bull World Health Organ vol.81 n.3 Genebra Jan. 2003
Healthy environments for children
Executive Director, United Nations Children's Fund, UNICEF House, 3 United Nations Plaza, New York 10017, USA
The state of the world's children is the best measure of human well-being, and the health of children is the best measure of the health of our planet.
Clearly, neither planet earth nor children are in a healthy state. The largest single cause of childhood illness and death is diseases caused by unsafe water and poor or non-existent sanitation. One in four of the nearly 11 million children who die each year before reaching their fifth birthday, almost all in developing countries, succumb to infections related to water and sanitation. Millions more are malnourished or physically and mentally disabled. Hundreds of millions of school-aged children and adolescents are infected by parasites that cause or exacerbate malnutrition, anaemia and other conditions.
Young children pay the greatest price for our failure to ensure universal access to safe water and sanitation. WHO's estimates show that over 40% of the disease burden due to unhealthy environments falls on children under the age of five, even though they comprise only about a tenth of the world's population. In under-five-year-olds, unhealthy environments contributed to most of the 1.3 million deaths from diarrhoea, two million deaths from acute respiratory infections, 1 million deaths from malaria and other infectious diseases, and 400 000 deaths from injuries a total of 4.7 million easily preventable deaths in the year 2000 alone.
This enormous burden of preventable sickness and death is a tragedy for children and their families. It is also a blow to development, because it deprives communities and society as a whole of incalculable human potential.
The toll on children is, of course, a reflection of the chasm between the long-held consensus that safe water and adequate sanitation are a basic human right, and the reality that is allowed to persist. It is unconscionable that in the 21st century more than a billion people lack clean water and two and a half billion people nearly half the world's population still lack adequate sanitation.
Achieving truly sustainable development means creating a world that is fit for children to live in and that means a world with safe drinking-water and adequate sanitation for everyone. The 1989 Convention on the Rights of the Child, now the world's most widely embraced human rights treaty, affirmed the right of every child to enjoy the highest attainable standard of health. It called upon countries to combat disease and malnutrition through measures which include the "provision of clean drinking-water and sanitation services." The 1990 World Summit for Children proposed bold, time-bound targets for universal access to safe water and adequate sanitation. Ten years later, the UN Millennium Development Goals called for halving the number of people living without sustainable access to safe drinking-water. A World Fit for Children, the outcome document of the UN General Assembly's Special Session on Children in May 2002, reasserts the right of children to a clean and safe environment. Uniting these global commitments is the recognition that to build a healthy, sustainable human environment, you absolutely must begin with children.
In A World Fit for Children, the Special Session adopted a powerful and feasible agenda for building such a world. The targets for 2010 outlined in this document serve as markers towards the achievement of the Millennium Development Goals. The four main pillars of the plan are promoting healthy lives for children; providing quality education; protecting children from abuse, exploitation, and violence; and combating HIV/AIDS.
UNICEF believes that to make a real difference in the lives of children, governments and their international and domestic partners must commit the resources and energy needed to reach the Millennium Development Goals and the goals for health, education, water and sanitation defined in A World Fit for Children. They must ensure that in the course of this decade, every primary school in the world will be equipped with separate sanitary facilities for boys and girls and have a source of safe drinking-water. This is a vital step towards dismantling the barriers that keep children and especially girls out of school, or cause them to drop out, or inhibit their performance. Something as simple as providing safe water and clean facilities in schools will not only help cut the enormous burden of disease that inhibits children's school enrolment and ability to learn, but encourage millions of them to enrol in school and stay there.
And governments and their partners must focus on improving children's environmental health in an integrated way that addresses the overall needs of the young child. One of five priorities in UNICEF's medium-term strategic plan for 200205 is the promotion of the integrated approach to early childhood, the high-risk, high-opportunity period from before birth to the age of eight. Integrated early childhood policies and programmes can create the conditions that will ensure each and every child the best possible start in life.
The young child's interdependent needs for survival, growth and development require the harmonization of efforts to improve health, nutrition, clean water and environmental sanitation, psychosocial care and early learning, child protection, and women's rights. Judicious, context-specific integration of the contributions from five programme areas is needed: health, nutrition, water and environmental sanitation, education, and protection. This must be undertaken to strengthen family and community capacities for caring for young children, ensure better access to quality basic services and needed commodities, and improve the policy environment.
The world we seek, a world of sustainable development and sound environmental, social and economic policies in short, a world fit for children has remained a dream deferred for more years than we can count. But by working together under enlightened leadership, with committed partners, and with a commitment of resources to the plan of action set out in A World Fit for Children, we can make that dream a reality for each and every child.