Celebrating Milestones

Milestones help us chart our lives: university graduation, first professional position, getting married, birth of a child, and many, many others.

For my team at the Institute for Health Metrics and Evaluation (IHME) this month has marked an important milestone: publishing a study where we have mapped child deaths in 99 low- and middle-income countries. Not at the national or provincial level, but at the district level.

Our study, published open access on 16 October in Nature, includes maps that illuminate in precise detail health disparities within countries and regions. How precise? There are nearly 18,000 districts among those 99 nations. We identified important improvements in lowering child deaths, but also found that levels of inequality vary between and among districts.

The bottom line: despite major gains in reducing child deaths over the past 20 years, the highest rates of death in 2017 were still largely concentrated where rates were highest in 2000. Where you are born matters.

I believe it is as reprehensible as it is tragic that, in 2017, about 15,000 children under age 5 died every day. Many of those deaths are from preventable illnesses. Diseases still flourish in the absence of easily accessible primary care, poverty, poor water quality and sanitation, and high levels of undernutrition.

Globally, approximately 5.4 million children died before their fifth birthdays in 2017, as compared to 9.7 million in 2000. That is remarkable progress. Our Local Burden of Disease Team here at IHME estimates that if every district in the low- and middle-income countries studied had met the Sustainable Development Goal (SDG) target of at least as low as 25 child deaths per 1,000 live births, 2.6 million fewer children would have died.

That’s 2.6 million reasons to be optimistic that our study will be read by health ministers in those 99 countries, as well as public health officials in each of those nearly 18,000 districts, and that the leaders in those countries and districts would have the political will to provide the resources needed to prevent child deaths.

I would be the first to celebrate such a milestone.

doi: 10.1038/s41586-019-1545-0