Progress on child mortality slowed. Here's why

The ideas and innovators shaping health care

Jan 30, 2023 View in browser   By Carmen Paun, Ben Leonard, Erin Schumaker and Ruth Reader WORLD VIEW Africa has made strides against child mortality, but still accounts for half of the deaths below age 5. | Stephanie Aglietti/AFP/Getty Images The world has seen great progress in reducing child mortality this century. The death rate has fallen by 50 percent since 2000. But declines in child mortality have slowed since 2010 because many governments have run out of what Lu Wei Pearson, UNICEF’s associate director for maternal and newborn child health, calls “low-hanging-fruit” health interventions. Those include vaccinations and basic treatment delivered by community health workers with minimal training. While the basic interventions remain important — especially given the backsliding in routine vaccinations triggered by the Covid-19 pandemic — strengthening primary health care systems is crucial to further reducing child mortality, Pearson told Carmen. A new report by representatives from UNICEF, the World Health Organization, the World Bank and the U.N. Department of Economic and Social Affairs says countries can take steps to further reduce child mortality, such as: — Increase investment in primary health care. — Scale up prevention and treatment of the leading causes of child mortality, such as newborn complications, pneumonia, diarrhea, malaria and noncommunicable diseases. — Provide sufficient food. — Ensure water, sanitation and hygiene in health facilities. — Establish peace and security. Despite the progress, the death toll is still grim. Globally, 5 million children under age 5 died in 2021. Where they lived mattered greatly: Of the children who died, more than half, or 2.7 million, lived in Sub-Saharan Africa. They faced a risk of death 15 times higher than kids in Europe and North America, according to the recent United Nations report. Central and southern Asia came in second with more than 1.3 million deaths. Many deaths occurred because children didn’t have access to quality health care, vaccinations, proper food and clean water and sanitation, said the report. The top reasons for the disparities were: — Unequal distribution of health care facilities and workers — The remoteness of the areas the children lived or the conflicts there — The cost of inpatient care   JOIN POLITICO ON 2/9 TO HEAR FROM AMERICA’S GOVERNORS: In a divided Congress, more legislative and policy enforcement will shift to the states, meaning governors will take a leading role in setting the agenda for the nation. Join POLITICO on Thursday, Feb. 9 at World Wide Technology's D.C. Innovation Center for The Fifty: America's Governors, where we will examine where innovations are taking shape and new regulatory red lines, the future of reproductive health, and how climate change is being addressed across a series of one-on-one interviews. REGISTER HERE.     WELCOME TO FUTURE PULSE Garden of the Gods, Colorado | Shawn Zeller This is where we explore the ideas and innovators shaping health care. We have good news for women struggling with period pain: a bodysuit is on the way to ease your suffering. The only downside is that it may not be available anytime soon in the U.S. Share any other thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, Ben talks with Katherine Ellen Foley about what we know and don't know about what the FDA has in mind for future Covid-19 vaccines. Listen to today’s Pulse Check podcast FORWARD THINKING Ugandan officials and international public health workers are mulling the lessons learned from Uganda's Ebola outbreak. | AP Can some people infected with the Sudan strain of the Ebola virus survive without any treatment? That’s one of the big research questions remaining after the recent outbreak of this rarer Ebola strain in Uganda, said Jason Rizzo, Doctors Without Borders’ Ebola emergency coordinator in Uganda. He told Carmen about a man who buried his father after he died from Ebola, thus putting himself at high risk of infection. Authorities couldn’t track him down to isolate him. When he reappeared three weeks later, he said he had been sick. He tested negative for Ebola but was found to have antibodies against the virus. “Which means that at one point, he was positive. He was never treated, he was never in a treatment center and he survived,” Rizzo said. He wondered how many other people had gone through a similar experience and what it meant. “Does that increase immunity and for long?” he asked. “And is this only unique to the Sudan strain?” Rizzo hopes researchers will investigate it. The outbreak, which killed at least 56 people and infected at least 142 people, was the first one caused by the Sudan strain in a decade. The Ugandan government managed to quash it in about three months without any vaccines. The rapid response from the government and international organizations and lockdowns limiting people’s movements in the epicenter of the outbreak helped, Rizzo said. Experimental vaccines arrived in the country too late for testing. Henry Kyobe Bosa, Uganda’s Ebola incident manager, called for people at risk for infection in central and west Africa to be vaccinated preventively before an outbreak starts. Rizzo said that standardizing response protocol in the case of an outbreak, from stocking up on personal protective equipment to designing clinical trials to testing experimental drugs and vaccines, would help governments be better prepared against future Ebola outbreaks. And preparing a team of first-line responders in Uganda and other countries prone to Ebola outbreaks is also a priority for preparedness, he said. His organization is working with the Ugandan health authorities to convert an Ebola treatment center in the capital city of Kampala into a training facility for health workers in those countries, Rizzo said.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     CHECKUP Some states did better than others at keeping cancer screening rates up during the pandemic. | Getty Images Millions of patients missed cancer screenings during the Covid-19 pandemic, but a new report from health care advisory Trilliant Health found significant regional differences. The research examined screening rates for breast, colorectal and cervical cancers in the fourth quarter of 2021. It found that:  — Alaska, Utah and Idaho were the only states that had below-average screening rates for all three cancer types. — Michigan was the only state with above-average rates for all types. — Screening rates were more often average or above-average in the midwestern and northeastern regions of the country than in the West. “The observed regional variation could be attributed to provider availability, intentional avoidance of medical care (e.g., COVID-19 fear, rising healthcare costs, and growing provider mistrust), and awareness of recommended screenings,” the researchers wrote. They added that the three below-average states had each lost doctors between 2019 and 2022. Parts of Michigan, by contrast, had among the highest ratios of primary care doctors to population.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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