In 2022, almost 5 million children under five died around the world – equivalent to one death every six seconds. Each one of those deaths is a story of grief and of unfulfilled potential; of the farmers, scientists, labourers, poets and traders who will not be. The large majority of these deaths, tallied in a UN report published this week, were entirely preventable. Those growing up in the highest-mortality country face a risk of dying before age five that is 80 times greater than in the lowest-mortality country.
Yet as grim as the figure is, it is also cause for optimism. This was a historic low. More children are surviving today than ever before. The global mortality rate for this age group has declined by 51% since 2000. There is no one simple explanation for this fall: it came from sustained hard work across a range of measures, from support in childbirth to vaccination drives to nutrition programmes.
That same determination will be required if the sustainable development goal of ending preventable deaths of children aged under five by 2030 is to be met. That would save 9 million lives. But progress in reducing neonatal and young child mortality has slowed, compared to the leaps of the millennium development goal era.
That largely reflects the fact that many of the easy wins available have already been made, such as increasing vaccine coverage and basic treatment. If current trends continue, 59 countries will miss the SDG target.
And that is not the worst case scenario. The impact of the climate crisis, the economic effects of the pandemic and its disruption of vaccinations, and wars in Gaza, Sudan, Ukraine, Myanmar and elsewhere, are painful reminders that the risk is not only of health gains stagnating; they could well go into reverse. Children in conflict-hit countries are, unsurprisingly, much more likely to die. The global food crisis means that the number of people going hungry rose by 122 million, to 735 million, between 2019 and 2022. The report notes that “uninterrupted mortality decline is precarious, requiring unyielding commitment and investment.” It also warns of “the possibility that crisis, fragility and conflict become more frequent in the years to come”.
The five countries with the highest child mortality rates are all in sub-Saharan Africa, with south Asia also showing high rates. Yet progress has not only come in relatively wealthier places. Three low-income countries – Malawi, Rwanda and the Democratic People’s Republic of Korea – and four lower-middle-income countries – Cambodia, Mongolia, Sâo Tomé and Principe, and Uzbekistan – have reduced under-five mortality by more than 75% since 2000.
Hans Rosling, the late Swedish physician whose book Factfulness argued that most of us fail to recognise global progress, once wrote: “Does saying ‘things are improving’ imply that everything is fine, and we should all not worry? Not at all: it’s both bad and better. That is how we must think about the current state of the world.”
To say that millions of children are dying preventable deaths is to face a horrifying truth. But it need not mean succumbing to despair: though they have not been prevented, such future losses can be. Commitment to, and investment in, the health of children yields dramatic results. We must recognise and celebrate the resulting gains. We should also use them as a spur to redouble efforts.
