Living Dangerously

By Gro Harlem Brundtland (*)

GENEVA/IPS - The world is living dangerously, either because it has little choice or because it is making wrong choices. On the one side are the millions who are dangerously short of the food, water and security they need to live. On the other side are the millions who suffer because they use too much. All of them face high risks of ill-health.

A child in the poor half of our world has a one-in-five chance of dying before she is five. She, and millions of others like her, have no choice. They march into life like soldiers into killing fields. It is a massacre. Almost 11 million die each year, far more than died from all wars during the past decade.

We must break the silence and confront the complacency. Deaths of poor children are not ''inevitable''. They should not be happening. They are a blot on our collective conscience.

Heads of state, ministers, and senior officials made major commitments to change at the World Summit for Children in 1990.

Child mortality in many countries around the world has fallen over the past 30 years. We have demonstrated the impact of combating polio, and immunising children against other childhood
diseases. We have seen the effectiveness of oral re-hydration and basic hygiene in saving lives.

But the progress over the last decade is nowhere near good enough. We need to focus more on the most vulnerable children - the newborns. Many conditions that result in a newborn dying can
be easily prevented or treated. We need a combined approach to the mother and baby during pregnancy: someone with knowledge and skills present during childbirth, and effective care for both afterwards.

This does not mean sophisticated, expensive technology but functioning health facilities that can handle complications in the first weeks of life and during the delivery and post-partum period.
A newborn needs a healthy mother.

We need to focus more on the fifth of the global population - 1.2 billion - who are in their teens. They have survived childhood and are rapidly becoming adults. This is when patterns of behaviour take root and lifestyle choices are made that will affect their chances of a long and healthy life. Tobacco, diet, and alcohol choices in the teen years have massive implications: at least two thirds of premature adult deaths result from behaviours developed at this time.

The World Health Organisation has introduced an integral approach towards reducing the suffering from HIV/AIDS, malaria and tuberculosis through programmes that combine prevention,
diagnostics, treatment and care. We are better able, now, to fight for more resources to tackle these devastating conditions. We have moved a long way towards making essential medicines accessible to a much larger number than we could have envisaged only three years
ago. But it is not enough. We need continued reduction in prices of medicines and other commodities, and expansion of quality services to the millions in need. We must scale up our effort even if the struggle seems beset with political and institutional minefields.

HIV/AIDS is, essentially, a disease of children and young people. The majority of those who are newly infected with HIV are aged less than 24. Their infection rates are increasing. We can
confront this pandemic and stop it in its tracks.

We need to focus more on the realities of teenage lives, rather than on our views about how young people should live. This applies when we are working with teenagers to reduce pregnancy rates, HIV nfection rates and the incidence of unsafe sex.

It means providing adult support to young people as they handle the thoughts, feelings and experiences that come with growing up. Helping them develop skills for developing relationships and dealing with sexuality provides a foundation for responsible adulthood. It helps promote good health. It contributes to a health environment for their children, when they chose to have them.

We need to focus more on the rights of everyone, young or old, that relate to their own sexuality. They may need help: we cannot offer what's needed if we shy away from sex matters.

That means having zero tolerance for the use of violence by those who seek sex. It is an offence against human rights and can never be excused.

While there has been significant progress for child health in the last decade --alliances within which the different parties forget their differences and pursue agreed goals using common
strategies-- it is not enough. We must work harder to reach and empower poor people and their children. Only then can we truly say that we are preparing our world for the generations of the
future. Only thus can we confront inequity, promote social justice, and create the foundations for lasting peace. (

(*) Gro Harlem Brundtland is director-general of the World Health Organisation.