TIME health

How to Save More Than 14 Million Newborns By 2030

YEMEN-HEALTH-CHILDREN
A Yemeni mother holds her malnourished infant at a therapeutic feeding centre in the capital Sanaa on December 9, 2014. Over one million Yemeni girls and boys under 5 suffer from acute malnutrition, including 279,000 who suffer from severe acute malnutrition (SAM), in a situation exacerbated by political instability, multiple localized conflicts and chronic underdevelopment, according to UNICEF. MOHAMMED HUWAIS—AFP/Getty Images

Bjorn Lomborg is president of the Copenhagen Consensus Center, a think tank ranking the smartest solutions to the world's biggest problems by cost-benefit.

We would be wise to target neonatal deaths and cervical cancer

In a world where there are so many worthwhile targets demanding our attention, we need to focus on those for which we have the best chance of doing the most good. How about saving more than 14 million newborns by 2030? That’s a pretty eye-catching figure, but one which the author of a new analysis for the Copenhagen Consensus believes is not only achievable, but also highly cost-effective.

Günther Fink, from the Harvard School of Public Health, is a one of more than 60 expert economists my think tank has asked to make the case for a wide range of key targets that the world’s governments and the UN are currently debating, the so-called Sustainable Development Goals. These will shape global progress over the next 15 years, so it’s important to get them right.

Is it really possible to make such a dramatic difference in the survival of newborn babies? Past experience would suggest that it is. UN figures show that nearly 18 million children round the world died before reaching the age of 5 in 1970, while in 2013 that figure had come down to just above 6 million. This is still way too high, of course, but it’s nevertheless a very impressive figure when we realize that the number of children born annually has increased during those 40 years. The headline is that the number of under-5s dying per 1,000 live births fell from 142 to 44, a 70% drop.

The problem is that the more progress you make, the harder the remaining targets are to reach. Much of the progress in controlling infant mortality since 1970 has been in areas such as controlling infectious diseases and improving nutrition. Progress in this should and will continue, but this won’t be as rapid as before. It’s a sobering thought that, with the current birth rate, under-5 mortality would still exceed 4 million each year even if all infectious diseases were eradicated. One of the biggest challenges going forward will be providing high quality care to newborns, particularly to those born too early and with low birth weight. Deaths in the first seven days after birth are virtually one-third of all under-5 deaths, and premature birth is the biggest single cause, accounting for half of these.

As well as the perils of prematurity, birth complications and sepsis are significant causes of deaths of young babies. Proper care can have a really big impact, but it costs money to build more clinics and train and pay more doctors and nurses: about $17.3 billion a year to hit the target of a 70% reduction in neonatal deaths, according to estimates. That sounds like a lot, but the benefits are much bigger at more than $120 billion annually. Using standard health economics methodology, every dollar invested yields $9 in benefits.

Reducing infant mortality is not the only good target, of course. One that gets a lot of attention is access to contraception, which enables women to have children when the time is right for them, gives them better employment prospects and enables them to invest more in their children’s future. A dollar spent on this could pay back perhaps 120-fold.

But while family planning is high profile, there are other good ways for the international community to invest in women’s health. This was analyzed in another paper from Dara Lee Luca and colleagues from Harvard University. The fourth most common cancer among women globally is cervical cancer, with half a million cases diagnosed annually and more than 200,000 deaths each year. Eighty-five percent of cases occur in the developing world, where it is the second deadliest cancer among women, after breast cancer. Its impact is particularly great because it also affects younger women who are raising and supporting families.

Fortunately, many of these cases are preventable, because nearly all are associated with a viral infection, and a vaccination is available. The vaccine is more expensive than most and three doses are needed, but in total, a course of treatment in developing countries would cost $25 per girl. Vaccinating 70% of girls in one cohort throughout most of the developing world would cost about $400 million and would save 274,000 women from dying, often in the prime of their lives, from cervical cancer. For each dollar spent, we would do more than $3 worth of good.

Health is obviously high on everyone’s agenda, but the escalating costs in rich countries shows there are no easy answers. Choosing the best targets for the international community to support between now and 2030 is going to be important if we are to do the most good with the resources available. Dealing with neonatal deaths and cervical cancer could be two of the smart targets we should choose.

Bjorn Lomborg is president of the Copenhagen Consensus Center, a think tank ranking the smartest solutions to the world’s biggest problems by cost-benefit.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME infant mortality

Saving 3 Million Babies Is Easier Than You Think

Melinda Gates: it's time to save the rest of the babies
Melinda Gates: it's time to save the rest of the babies Thomas Imo; Photothek via Getty Images

The news on the childhood mortality front is both very good and very bad. Millions have been saved, but millions are still dying. Melinda Gates, in an address to the World Health Assembly, offers some smart solutions.

No one will ever know the names of the 17 million babies who didn’t die last year. Nearly all of them live in the developing world and nearly all of them would have been lost to preventable conditions like measles, cholera or malaria. But that didn’t happen. Instead, they were born healthy and most of them stayed healthy and will be celebrating their first birthdays sometime this year.

That’s part of the very, very good news about childhood mortality, defined as the death of children before their fifth birthday. Since 1990, when the United Nations drafted its Millennium Development Goals—eight broad targets for human health and equality—childhood mortality rates have fallen 47%, which, when corrected for population growth, yields those 17 million lives saved last year. But that means that 6.6 million babies and small children still died. That’s the equivalent of 18,000 every day, day after day, until the year ended. Unless things change, that pattern will repeat itself in 2014, 2015 and beyond.

The answer, however, isn’t simply doubling down on the strategies that have worked so far, like getting vaccines, antimalarial bed nets, cholera rehydration fluids and more to the people who need them. Those interventions must continue, but as Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, made clear in an address to the World Health Assembly in Geneva today, they’ve worked so well that the overwhelming share of the remaining deaths are caused by other problems entirely—ones that occur far earlier in the babies’ very short lives.

Each year, Gates said—citing, in part, exhaustive new studies by The Lancet—2.9 million children die in the first month of life and 1 million of those die almost immediately after birth. Worse, an additional 2.6 million babies each year are stillborn at some point in their third trimester—a death toll that is not even counted in the 6.6 million figure.

But, Gates stressed, the majority of newborn deaths are preventable. “I want to be very clear about what I mean when I say preventable,” she added. “I don’t mean theoretically preventable under ideal but unrealistic circumstances. I mean preventable with relatively simple, relatively inexpensive interventions.”

In most cases, actually, those interventions are entirely free. There are five protocols neonatal health experts recommend to cut newborn mortality dramatically and three of them are simply drying the baby completely after birth to prevent hypothermia, breastfeeding within the first hour of life and breastfeeding exclusively for the first six months if possible, and practicing what’s known as kangaroo care—or skin-to-skin contact between a baby and its mother or at least another adult caregiver as much as possible. Even in the developed world, kangaroo care is only now being broadly appreciated and adopted, particularly in neonatal intensive care units, where studies show that respiration, heart rate, blood pressure and a whole range of other vitals strengthen and stabilize when babies are held. Kangaroo care also increases the flow of breast milk in the mother, thanks mostly to elevated levels of the hormone oxytocin—colloquially known as the cuddle chemical.

Also important is the availability of resuscitation masks for babies who stop breathing at birth or shortly after. A mask and basic training in its use cost only about $5—nothing at all compared to the cost of caring for a sick or dying baby over the longer term. Finally, health specialists call for universal availability of the antiseptic chlorhexidine—at a cost of just a fews cents per application—to clean the end of the umbilical cord after it’s been cut and prevent what can be fatal infections.

“These are the best practices that work everywhere,” Gates said, “but that aren’t being used optimally anywhere.”

Inevitably, questions of cost are raised, but as with nearly all preventive measures, intervening early is almost always cheaper than dealing with problems later. In the U.S., an estimated $10 billion is spent each year to help babies deal with the health effects of not being sufficiently breast-fed. In the developing world, studies show that every $1 of neonatal intervention pays back $9 down the line, as families grow healthier, countries grow more stable, and economies are allowed to flourish.

Money, of course, is only one of many considerations—and a lesser one at that. It’s the moral component, the human component that we’d like to think will govern our choices. Even if saving the lives of babies were more expensive than it is, can you name a way that that money could be better, more humanely spent? The policymaker who can answer that question ‘yes’ is perhaps a policymaker who needs another job.

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