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Skip to 0 minutes and 10 seconds SHUNMAY YEUNG: So in this last week, we’ve seen how much progress we’ve made in the last 20 years in terms of reducing child mortality from over 10 million per year to almost half that in 2017. And most of that progress has been made in infectious diseases. And that’s partly because there have been very specific interventions for prevention, like vaccines, and insecticide treated nets, and treatments, specifically in HIV and antimalarials. But looking forward, we’ve got many other challenges. The landscape has changed quite a lot. And so I’m going to be speaking about some of those challenges. So one of the challenges is there are populations who’ve been left behind or neglected.

Skip to 0 minutes and 57 seconds So I’m thinking specifically of very marginalised populations, children in conflict zones, children on the move. And if we look at progress, there have been countries which have been left behind, and then children within countries, specifically, the most poor. And looking forward, we’ve got to try and address some of those equity gaps. Secondly, some of the tools that made us so effective in the last couple of years– last 10 years– we are losing because of drug resistance. I’m thinking specifically of antimalarial drug resistance and antibiotic resistance. So there are threats in terms of our specific tools, and also, insecticide resistance.

Skip to 1 minute and 42 seconds Some of the big emerging challenges where there’s a lot of scope for improvement is in reaching the needs of children in humanitarian crises and children in populations on the move. So children in conflict areas or who are in areas where there’s been a recent natural disaster are subject to huge health needs. They are dying from things that they really shouldn’t be dying of– for example, malaria, measles, other infectious diseases. And they’re not having the level of preventative care, education, environment that will enable them to grow and develop into happy, healthy young adults.

Skip to 2 minutes and 30 seconds So as we look forward through the next 10, 20, 30 years, as well as infectious diseases, I think we have to broaden our focus to other causes of mortality and morbidity in children and young adolescents.

Skip to 2 minutes and 50 seconds So we need to broaden our focus to include noninfectious diseases, non-communicable diseases– for example, asthma– and look at some of the causes– for example, environmental pollution, indoor cooking– that drive some of these important causes of child morbidity and mortality. In the last 10, 20 years, there was a big focus on child mortality. Now as we look forward, we have to look beyond survival. So we have to look at the quality of life of children who have survived and ensure that they are developing and reaching their full potential so that they are happy, productive young people and adults.

Skip to 3 minutes and 33 seconds And that means looking also, at disability, but also, more subtle developmental issues, like learning disability, nutritional deficiencies, which may have an impact later, in terms of learning ability, for example.

Skip to 3 minutes and 51 seconds And I think one of the big challenges as we look forward, we really have to look at more integration– so integrating not just across different diseases– so looking beyond just focusing on malaria, or HIV, or TB– so we have to look across the health sector. We also have to look beyond the health sector. So the health sector has to work with education, housing, transport, environment in order to ensure that children have safe, healthy, secure, upbringings. It also means integration across the life course. So in this series, you would have seen us moving through from before birth, the neonatal period, childhood, and through adolescence. And so we need to integrate the pathways of care across that.

Skip to 4 minutes and 45 seconds And that brings me to the third area of integration, which is integrating care and prevention from level of community, where there’s key players, like community health workers, lay carers, through to primary health centres, where we need to ensure that children are able to access good quality care, through to referral services. In a lot of areas, that pathway is very well integrated. And for all of those things, we need better data. We need data on understanding, where is the burden? Who are the children who are not doing as well as they could do? And why? And how can we make it better? We need data to understand which interventions work and how much they cost.

Skip to 5 minutes and 30 seconds So what’s the cost-effective, sustainable way of trying to make progress in the next 20 years?

Child health in the SDG world: what next?

We have seen how much progress has been made in reducing child mortality, particularly in reducing infectious diseases. Future progress will require a focus on new diseases and challenges.

In this step, Dr Shunmay Yeung will look forwards to the change in approach that will be required to improve child health in the Sustainable Development Goal era.

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Improving the Health of Women, Children and Adolescents

London School of Hygiene & Tropical Medicine