Revisiting child and adolescent health in the context of the Sustainable Development Goals

The year 2020-five years since 189 countries signed the Sustainable Development Goals (SDGs)-has been consumed by the global response to COVID-19.To date, this pandemic has resulted in over 38 million cases and well over a million deaths [1].One collateral effect of COVID-19 has been the setting aside of many SDGs and efforts to track progress towards them.Attention to children during the pandemic has concentrated on school closures, food insecurity, and access to care within health systems taxed by COVID-19 mitigation and response efforts [2].The situation of child and adolescent health before COVID-19, and consequences of the pandemic on specific health targets for SDG 3, therefore deserve attention.As the Millennium Development Goals (MDGs) ended in 2015, activities and plans addressed the global compacts for reducing child mortality.A focus was on determinants, such as maternal and child undernutrition, gender inequities, and intersecting vulnerabilities.Because adolescents were largely ignored in the MDG process, advocacy and effort were invested to make them central to the SDG agenda.The renewed global strategy for Every Woman Every Child, launched by the UN Secretary General in 2013, was a segue to the SDGs and an effort to go beyond survival toward a transformative agenda that included healthy development [3].Advocacy for the integration of health, nutrition, and early child development led to the development of the nurturing care framework [4].As we examine the situation more than 5 years into the SDGs, several concerns emerge.Despite progress, the field remains fragmented, with limited actions in countries to develop integrated strategies for reproductive, maternal, newborn and child health (RMNCH), or inclusion of adolescent health within national plans [5].Work on the drivers of adolescent health, well being, and empowerment is underway but has yet to translate into a reasonable global strategy.This lag stems from complex, multilevel social influences during adolescence [6], insufficient disaggregation of data on adolescents, suboptimal measurement and a lack of well-defined indicators [7-9], and limited evidence on the differential impacts of social policies and programs [8] within adolescence and between adolescence and adulthood.Within health systems, many nutrition programs remain poorly integrated with other RMNCH programs and few have substantive links with sectors outside health.With the unfinished agenda for maternal, newborn and child deaths, rigorous studies to address mechanisms and hitherto unrecognized causes of excess mortality are just beginning to yield results, albeit with older pediatric age groups remaining significantly understudied, even at the simplest descriptive

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