"Each day, 40,000 children die from malnutrition and disease, including AIDS, from the lack of clean drinking water and inadequate sanitation, and from the effects of the drug problem," participants noted at the World Summit for Children, held in New York in 1990. Here, heads of state and other leaders from more than 150 countries considered the problems of all children, but focused in particular on the victims of poverty, illiteracy, homelessness, violence, environmental degradation, war, and discrimination. In their final Declaration, these world figures stated: "Together, our nations have the means and knowledge to protect the lives and to diminish enormously the suffering of children, to promote the full development of their human potential, and to make them aware of their needs, rights, and opportunities."
The Summit's universal appeal-"to give every child a better future"-has since been transformed into a series of specific, measurable benchmarks to achieve this goal by the year 2000. In the Americas, the cornerstone for action has been the Interagency Coordinating Committee (ICC), an international partnership of specialized agencies of the inter-American and U.N. systems formed to support the work of governments.
Over the past few decades, the winds of social change have profoundly altered Latin America and the Caribbean's political, economic, and demographic landscape. As countries put the economic recession of the 1980s behind them, the gap between rich and poor is wider than ever before. This exacerbation of preexisting inequalities has had its most adverse effect on society's most vulnerable-women, particularly of childbearing age, adolescents, and children-who together make up more than 70 percent of the total population and play a crucial role in the Region's socioeconomic development.
On the other hand, during this same period maternal and infant mortality rates have gone down and life expectancy has gone up, signaling a generalized improvement in health and living conditions, even if not benefiting all social groups equally. These hopeful signs are perhaps a response to the Summit's original primary focus-child survival and basic needs-and have spurred progress toward the next step: child protection and development, and the satisfaction of these needs as a right belonging to all children. Also, the Summit's follow-up process over the past eight years has solidified political resolve to legitimize these goals at the highest levels of leadership and ensure that the moral commitment to children and women transcends changes in political power.
For the Pan American Health Organization, the goals of the World Summit for Children not only reinforce PAHO's permanent commitment to improve the health and living conditions of the peoples of the Americas, but also provide it with the opportunity to promote the indelible contribution of health to equitable and sustainable human development.
Efforts are now underway to incorporate health promotion as an integral part of the primary school curriculum and personal development process. One in five children in Latin America is a child laborer, a poverty-related situation that negatively affects their health, deprives them of a basic education, and often denies them economic opportunities later in life.
Above: In 1991, Luis Fermín Tenorio Cortez (photo on the left) became the last case of polio reported in the Americas. Today, four out of five children in the world are immunized against polio during the first year of life-a significant change from the early 1970s when only one in 20 infants was immunized. This remarkable advance was achieved through sustained political commitment to child vaccination programs.
In rural underserved areas, many children are born at home and family members need access to basic, life-saving information that ensures the health of the mother and teaches family members how to prevent and treat common childhood illnesses.
Left: Indigenous children, among the Hemisphere's most disadvantaged, require special political attention. They often live in communities lacking basic water and sanitation infrastructure and are
characterized by higher levels of communicable diseases, malnutrition, maternal mortality, and illiteracy, and high numbers of childbirths and deaths.
Below right: Boys and girls will soon be of reproductive age with sexual and emotional decisions to make. Early education, taking into account the needs of both groups, can enhance knowledge of their bodies and sexuality as components of human development and self-esteem.
A volunteer cradles an HIV-positive infant in an AIDS clinic for children in Port-au-Prince. Many have been abandoned by young mothers too poor to care for them. In the countries most seriously affected by HIV/AIDS, such as Haiti, the disease threatens to offset the gains of child survival programs. According to the U.S. Census Bureau, if the spread of HIV is not contained, by the year 2010 AIDS may increase infant mortality by as much as 75 percent and mortality in children under 5 by more than 100 percent in countries like Haiti. In the absence of a vaccine, the only cure is education and prevention for people of all ages.
Vaccinations against childhood killers--polio, measles, diphtheria, neonatal tetanus, whooping cough, and tuberculosis--are the most basic and cost-effective of all health interventions. The success of PAHO's polio eradication strategy has fostered a culture of prevention among politicians, health workers, and community members, and is paving the way for the elimination of measles and neonatal tetanus, with provisional data for 1997 indicating overall vaccination coverage levels in the Americas at 80 percent or higher.
Millions of children in this Hemisphere live under especially difficult circumstances-as orphans and street children, as refugees or displaced persons, as victims of war and natural and man-made disasters, as children of migrant workers, as child laborers or youth trapped in the bondage of prostitution or sexual abuse. It is they who bear the brunt of poverty. By defining the agenda for children for the next millenium-the provision of safe drinking water, clean air, and nourishing food, within a safe and supportive social environment of families and other caregivers committed to their welfare-we are investing in a healthier future for families and nations alike.
Roberta Okey is the Editor of Perspectives in Health
magazine.
