Global child and youth health

As we were planning this issue of Paediatrics & Child Health, I had a vivid memory of standing around a piano singing “It's a small world after all, it's a small, small world”. This is so true. When Jean and I were first in Kenya, Sunday evenings were dedicated to writing letters home on those light, thin blue paper aerograms. We would be happy to get an answer back within three months. When we were in Uganda a few summers ago, we e-mailed our children and got an answer back that afternoon. We live in a small world and it is very appropriate to have an issue of Paediatrics & Child Health dedicated to the health problems of children and youth everywhere. It is important for Canadian paediatricians to read about the health problems of children in Africa, Asia or Latin America. From a humanitarian perspective, it is our responsibility as privileged physicians in a wealthy country to serve and aid those who are less fortunate than ourselves. If we are going to help children throughout the world, we need to start by understanding and appreciating their health and social issues. It is because of these humanitarian values that many Canadian physicians have gone to work around the world with a variety of nongovernmental or religious organizations. From a justice perspective, all children should be treated equally. It is this lack of equality for all people that has led to the increased tensions in our world today. And from a family perspective, the children in Toronto, Vancouver, St John's, Iqaluit, Kinshasa, Calcutta are all part of our family and need our attention. Finally, these topics are important for Canadian paediatricians because they will appear in our offices, clinics and hospitals as children and families immigrate to Canada. The extent of the suffering of children throughout the world is staggering – the numbers speak for themselves. Yet more action is needed. Every single day, 30,000 children die from the effects of extreme poverty. The infant mortality rate in the Democratic Republic of Congo where we had worked is 129 deaths per 1000 live births compared with five deaths per 1000 live births in Canada; similarly, the mortality rate for children younger than five years of age in the Congo is 205 deaths per 1000 live births compared with seven deaths per 1000 live births in Canada (1). A recent report in The Lancet (2) stated that in 2000/2003, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than five years of age: pneumonia (19%), diarrhea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%) and asphyxia at birth (8%). Undernutrition is an underlying cause of 53% of all deaths in children younger than five years of age. Most of these deaths occur in developing countries in the southern hemisphere and most are preventable. In the current issue we have attempted to highlight some of the health and social issues impacting children throughout the world. Overwhelmingly, infectious diseases are of greatest importance and HIV/AIDS is the best example. The epidemic of HIV/AIDS is a new and unprecedented social issue because with parents dying of HIV/AIDS, many children, most of whom do not have HIV, are now left as orphans. Children also suffer because of the lack of health professionals and health care – as illustrated by the problems of children with disabilities. Despite the fact that the United Nations' Convention on the Rights of the Child (3) has been signed by all but two countries in the world, in many countries, children have few rights and are forced to work as labourers, soldiers or prostitutes. Whether we take a humanitarian or justice perspective, this is not right. But things are changing and Canadian paediatricians are contributing around the world; for example, Canadian paediatricians are contributing to education and community development at the Mbarara University of Science and Technology in Uganda. Unfortunately, space does not permit inclusion of additional papers in this area in the current issue. More papers will be published in upcoming issues. One example is a paper by Dr Stanley Zlotkin who has been influential in improving the health of children in Canada and around the world. Dr Zlotkin has studied iron deficiency anemia and has put this research effectively into action, helping improve the nutrition of children around the world (4). We hope this issue of the Journal on global health will provide food for thought and help stimulate action. Nelson Mandela's plea to “make poverty history” (5) is a rallying cry for all those who care about the world's children – what we choose to do or not do about extreme poverty as individual paediatricians, as the Canadian Paediatric Society and as a country will be a reflection of whether we truly care about all children.

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