By Michele Learner
Recently I came across an article from 2018 whose title caught my eye: “The world is much better. The world is awful. The world can be much better.” The author, economist Max Roser, began by noting that all three statements are true. It all depends on frame of reference—in this case, whether one focuses mainly on the past, the present, or the present and near future.
This year has supplied far too much evidence for “the world is awful.” For the past several months, Bread for the World Institute has been drawing attention to the danger of a malnutrition pandemic as the result of the COVID-19 pandemic. Millions of young children are at risk of death or lifelong damage to their health and development because of malnutrition during the critical “1,000 Days” nutrition window between pregnancy and the second birthday. The numbers are far higher this year in part because nutrition and healthcare services have been disrupted by the lockdowns and other measures that were adopted seeking to contain the virus.
Taking a longer-term view, however, brings us to “the world is much better.” As recently as 1800, 43 percent of all children born, no matter where they lived, did not live to celebrate turning 5. If the world had not made immense progress over multiple generations, we would be seeing 60 million children die of preventable causes every year. The actual number, 5.4 million, is not something to be proud of, but it can fairly be described as “much better” than 60 million.
Lack of access to nutritious food and healthcare services—whether the reason is that travel to a clinic or market is forbidden, food and medicine are unaffordable because the economic crisis has destroyed a family’s livelihood, or a combination of these and other problems—can easily cost lives. A deadly disease that illustrates how this happens is measles.
The global progress against measles since 2000 is impressive. In the period 2000-2014 alone, deaths from measles fell by 79 percent. WHO estimated that 17.1 million lives were saved during this time period, solely because of expanded access to the vaccine against measles.
The flip side of this is, of course, that when children do not have access to vaccinations at the right time, as happens during a lockdown, they are at far higher risk of death from a common, highly infectious illness such as measles. Making the matter worse, children who are severely malnourished die from so-called childhood diseases at nine times the rate of well-nourished children. Shortages in the food supply have been caused by many facets of the pandemic—such as farmers forced to stay in their homes rather than work in their fields. The result is that for many families, nutritious foods are simply less available and less affordable.
But there is reason for hope. There has been rapid progress in even the most difficult contexts, so it is not difficult to imagine the world moving rather quickly from an “awful” to a “much better” rate of preventable child death. The countries with the highest child mortality rates in 2017 were Somalia, Chad, and the Central African Republic (CAR). There is still a long way to go, but each of these three countries had reduced its mortality rate by 27 percent since 2005.
The other good news in these statistics is that the goalposts have been moved: the highest mortality rate was 45 percent lower in 2017 than it was in 2000. That year Sierra Leone had the highest rate—an estimated 233 deaths per 1,000 live births. Somalia’s rate in 2017 was 127 deaths per 1,000 live births. As John McArthur and Krista Rasmussen with the Brookings Institution point out, these results translate to “a 3.5 percent average annual rate of improvement in the world’s worst-case situation for child mortality.” Also, in the meantime, Sierra Leone reduced its mortality rate from 233 to 111 deaths per 1,000 live births.
What would child mortality numbers be in an equitable world? The lowest national rates hover around 0.41 percent, or one child in 250, compared to today’s global average of 3.9 percent. If every child lived in a country doing as well as the best are doing now, there would be 577,000 deaths annually rather than 5.4 million. Put another way, global equity in life opportunities could save the lives of 4.8 million babies, toddlers, and preschool-age children every year. That would, without question, make the world “much better.”
Michele Learner is managing editor with Bread for the World Institute.