The future is now

Imagine 10 World Trade Centre attacks happening every day, except the victims are children. The number of children that die each day is 10-fold for every person who died on September 11, 2001. Would you allow 10 World Trade Centre attacks to occur every day? What an incredible outcry should occur in response to those deaths. Yet, we remain professionally passive in response to this preventable tragedy. What magic we could weave in this world with the amount of money being spent to fight terrorism. Around 11 million children younger than five years of age will die this year (1). Over 75% of deaths in children are caused by the five ‘big killers’ – measles, pneumonia, malaria, gastroenteritis and perinatal diseases – easily preventable causes of mortality and morbidity (2). Overarching all of these is the spectre of malnutrition and its consequences, and the great new global burden, HIV/AIDS. Simple solutions of less than $6/person/year could prevent 75% of these deaths (3). The cost is no more than $50 billion/year globally, or one-twentieth of the global defense budget (4). It is indeed a drop in the bucket. The problems are not simply ‘over there’. We have international problems at our doorstep. Many children in our Aboriginal and Inuit communities suffer higher mortality and morbidity than those in the rest of Canada. MacMillan et al (5) identify that infant mortality rates for 1986 to 1990 were 16.3 per 1000 live births for Inuit children, 13.8 per 1000 live births for Aboriginal children, while only 7.3 per 1000 live births for all Canadian infants. Conditions in some of these communities rival those of developing countries. Alcohol and drug use, suicide, teenage pregnancies, family violence, and medical problems such as diabetes, obesity, sexually transmitted diseases, infectious diseases, pneumonia and tuberculosis run rampant in our own ‘third-world’ children (5). The 1996 Royal Commission on Aboriginal Peoples determined an important link between health promotion and the empowerment of Aboriginal Peoples. We must understand the social, historical and political contexts by which health problems arise. For example, refocusing child protection efforts to increase family support rather than apprehending children by child-welfare authorities proved to be more effective in addressing child health care problems within the Aboriginal community (6). Yet, there has been marginal, if any, progress made in empowering and improving the health and welfare of Aboriginal and Northern populations. Key child health areas need to be addressed. One such area is alcoholism. This single problem leads to fetal alcohol syndrome in children, and parental neglect may lead to solvent abuse in teenagers. We need better techniques to treat children who are affected by alcohol. However, more importantly, we need solutions to treat parents and communities, and to prevent fetal alcohol syndrome. The solutions are not unidimensional. They require commitments within our profession, communities and government, and must address cultural rights, socioeconomic disparities, political grievances and inequitable access to services. First and foremost, we need more data and need to become better informed about the issues that affect disadvantaged children. We need to become aware of why marginalized populations have a worse health status. Is it poverty, education, or are we failing to provide health care services? The paucity of Canadian data leads to poor policy. Second, we need to partner with disadvantaged populations in researching issues and providing the best possible clinical care. Our research should not be ‘voyeuristic’ in nature, but should involve communities in designing, implementating and turning research into practice. In Canada, we should increase funding for training young Aboriginal students in scientific and programmatic research. Initiatives such as Manitoba's Special Premedical Studies Program and the Professional Health Program are models relevant to this issue. Internationally, we must develop training and research capacities with our partners abroad. Alliances such as the Global Forum for Health Research increase our research collaborations with ‘developing’ country partners. Third, we must engage public opinion about the plight of our disadvantaged communities. We have a moral obligation to inform friends, neighbours, churches and media –anyone who will listen – that children are dying and their voices are not being listened to. We should start a fifty-cent per person per day program in Canada, and get government matching to fulfill our United Nations commitment of 0.7% of gross domestic product (Canada provides 0.25% of gross domestic product presently) (7). Canada's role in the global aid budget would be $10 billion, a step toward achieving true global health. Fourth, we must hold our governments accountable for their inaction. Instead of targeting specific programs, the Commission on Macroeconomics and Health has been espousing improvements in funding for basic health care services and relating improvements in health to the economics of countries. The inability of governments in developing nations to provide basic health care service has caused the majority of childhood deaths globally. Similarly, we need to increase the availability and accessibility of resources to our indigenous populations, in terms that Aboriginal Nations can accept. Although funding is around $1.2 billion/year (8), the increased funding has not corresponded with improvements in health. The funding needs to go not only into service provision, but also into research, training and successful community solutions, such as Head Start, targeting our young Aboriginal population. Finally, we need to improve paediatric training to strengthen our capacity to advocate. We need paediatric training to incorporate issues of disadvantaged populations, including such nontraditional topics as economics, politics, international development and cultural sensitivity. Gabriela Mistral, the Chilean Nobel Prize winner once wrote: We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. This is the time his bones are being formed, his mind is being developed. To him, we cannot say ‘tomorrow’, his name is ‘today’.

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