A future for the world’s children A Future For The World’s Children? A WHO-UNICEF-Lancet Commission A future for the world’s children

Commission co-chairs

H.E. Helen Clark, MA Awa Coll-Seck, MD Helen Clark Foundation & PMNCH Minister of State, Senegal A future for the world’s children

The Commission This Commission is a science-led, multi- disciplinary international collaboration, aiming for transformational change. A future for the world’s children

“Our house is on fire” ‒ Greta Thunberg A future for the world’s children

Children are at risk today like never before - Recent years have seen improvements in children’s health, education, and survival - But millions of children around the world still suffer from hunger, sickness, and violence - New threats have also emerged:

ENVIRONMENTAL COMMERCIAL THREATS THREATS to children’s current health via targeted marketing and future well-being of harmful substances Photo Credit: World Bank A future for the world’s children Children and COVID19

HEALTH: Kawasaki syndrome, anxiety, stress, loss of relatives, reduced health service availability and access to first responders, decline in immunisation rates EDUCATION: Lack of schooling, widening of educational divide ECONOMIC: Insecurity and poverty-related stress, risk of worldwide depression and mass unemployment NUTRITION: Food insecurity and malnutrition DOMESTIC ABUSE: Inability of women and children to temporarily escape abusive partners CONFLICT: Unrest and instability in fragile states and others if food riots break out. GOVERNANCE: Political instability and its SARsCo-V2 consequences. Photo Credit: World Bank A future for the world’s children

Progress on the child- related SDGs is stalled - More than 2 billion people, including half the world’s poorest, live in countries affected by political fragility and conflict, problems increasingly linked with climate change - Many countries are not reporting data on child-related SDG indicators A future for the world’s children

Why now? - Under business-as-usual scenarios, there is a 93% chance that global warming will exceed 4°C by the year 2100 - The effects would be devastating:

RISING DISRUPTION INUNDATION ocean of water and of coastal cities and levels ecosystems small island nations

INCREASED MORTALITY A CRISIS OF from heatwaves MALNUTRITION because of disruption to PROLIFORATION food production systems

of vector-borne disease Photo Credit: World Bank A future for the world’s children

It’s an Emergency: This event is low-carbon. A future for the world’s children

Children need protection from every sector (1/2)

Photo Credit: DFID Photo Credit: World Bank Photo Credit: World Bank Photo Credit: World Bank

TRANSPORT AGRICULTURE URBAN ENVIRONMENT road injury is the leading & TRADE PLANNING air pollution exposure reduces lung cause of death for children function; and increases the risk of subsidies, trade rules, and lack of “playable” spaces and young people aged cardiovascular disease, obesity, food policies expose children reduces physical activity 5–29 years to under-nutritious and/or type 2 diabetes, and metabolic obesogenic diets syndrome A future for the world’s children

Children need protection from every sector (2/2)

Photo Credit: World Bank Photo Credit: World Bank Photo Credit: World Bank

FAMILY SERVICES HOUSING EDUCATION violence against children violates their 40% of children live in informal libraries, schools, and recreation centres are rights and is strongly linked with anti- settlements, with risks of overcrowding, positively associated with child physical health, social behavior as an adult health hazards, poor access to services, social competence, and wellbeing, and negatively poverty and social exclusion with vulnerability to developmental delay A future for the world’s children

Commercial marketing of harmful products The commercial sector exploits children’s developmental stage to sell harmful products: alcohol, tobacco, & unhealthy foods

51M 68% 24M Children in of 5- and 6-year- Adverts for Australia viewed olds in Brazil, China, India, e-cigarettes 51M alcohol Nigeria, and Pakistan could reach 24M adverts in a identify at least one children in the single year cigarette brand logo USA each year A future for the world’s children

Industry self-regulation does not work Studies in Canada, Mexico, New Zealand, the US and Australia – among others – have shown that self-regulation has not hampered the ability or propensity of businesses to advertise to children

Photo Credit: World Bank A future for the world’s children

What children told us they value

FAMILY TOGETHERNESS

CLEAN ENVIRONMENTS

ACCESS TO EDUCATION AND CULTURE

THE OPPORTUNITY TO PLAY Photo Credit: Paula King (personal communication from work in preparation of Doctoral thesis, "Oranga Mokopuna - ethical co-designing for the pluriverse", February 7, 2020) A future for the world’s children

Children are rarely consulted in decisions that impact their current & future well-being

It’s fun to When people [Being healthy] is When other be a kid because people are happy, know each other, you have the playing with my there’s less extended family we are happy. opportunity violence to play

Maōri boy, Young girl, Boy in poor community, Hearing impaired child, New Zealand Lebanon Argentina Nigeria A future for the world’s children

A Plan of Action A future for the world’s children

1 Children at the centre of the SDGs Governments, civil society and communities must put child health & well-being at the centre of the SDGs

COST OF CURRENT INACTION ESTIMATED not improving child FINANCING development through universal preschool, home GAP visits, and improved nutrition, just US$195 per could reach >10% of GDP in capita in low-income some contexts countries A future for the world’s children

Benefit cost ratios very high returns on every dollar invested … across the lifespan & across generations A future for the world’s children

2 Unified, multi- sectoral action Heads of state and government must take leadership & have a long-term view Coordinated multi-sectoral policies for children are needed across government Children must be involved in decisions about their current and future well-being. A future for the world’s children

3 Act on climate – now No sense working toward children’s health today – if they won’t have a future tomorrow Stopping greenhouse gas emissions as quickly as possible is our most urgent priority Collective action on climate is the duty of everyone who cares about children "Fridays 4 Future protest inside COP25 final action Dec 13 - IMG_7324” by John Englart (Takver) is licensed under CC BY-SA 2.0 A future for the world’s children

4 Measure & rank country progress Excess CO 2 emissions relative - Countries that do well on indicators of child to 2030 targets (%) health and well-being have the highest excess CO2 emissions, threatening 1-40 <0 children’s future – and vice versa. 41-80 1-100 81-120 101-200 - The Child Flourishing & Futures Profile charts the performance of 180 countries on 121-160 201-300 1) a composite measure of children’s health 161-180 >300

& well-being and 2) excess CO2 emissions Rating system of Child Flourishing & Futures profile - No country does well on both A future for the world’s children A future for the world’s children

5 Protection from commercial marketing - To protect children from marketing of tobacco, alcohol, formula milk, sugar- sweetened beverages, gambling, and the inappropriate use of their personal data …

Photo Credit: UN Photo/Milton Grant - The Commission proposes a binding

Children meeting the U.N. Secretary-General as the General Assembly treaty – an Optional Protocol to the U.N. adopts the CRC in November 1989. Convention on the Rights of the Child A future for the world’s children

Call To Action: A Global Movement A future for the world’s children

A Call to Action To ensure a healthy future for all children, collective action is needed: Working together - From political leaders, towards the SDGs, with children - From civil society, at the centre! - From international agencies, - From communities, - From families, - And from children. A future for the world’s children

Read the Report

www.thelancet.com/futurechild A future for the world’s children Commissioners

Anshu Banerjee Mariam Claeson Quinyue Meng Imran Rasul Yusra R Shawar WHO, Geneva, Switzerland Global Financing Facility, Peking University, China University College London, UK Johns Hopkins School of World Bank, USA Public Health, USA Stefan Peterson Raúl Mercer Papaarangi Reid UNICEF, NYC, USA Tanya Doherty Latin American School of Social University of Auckland, New Zealand Jeremy Shiffman South African Medical Sciences, Argentina Johns Hopkins School of Sarah L Dalglish Research Council Jennifer Requejo Public Health, USA Johns Hopkins School of Sunita Narain UNICEF, NYC, USA Public Health, USA Fadi El-Jardali Centre for Science & Environment, Jonathon Simon American University of Beirut, India Sarah S Rohde WHO, Geneva, Switzerland Shanthi Ameratunga Lebanon South African Medical University of Auckland, New Jesca Nsungwa-Sabiiti Research Council Peter D Sly Zealand Asha S George Uganda Ministry of Health University of Queensland, University of Western Cape, Nigel Rollins Australia Dina Balabanova South Africa Adesola O Olumide WHO, Geneva, Switzerland London School of Hygiene University of Ibadan, Nigeria Karin Stenberg and Tropical Medicine, UK Angela Gichaga Magali Romedenne WHO, Geneva, Switzerland Financing Alliance for Health, Kenya David Osrin West and Central Regional Office, Maharaj Kishan Bhan Mark Tomlinson Lu Gram University College London, UK UNICEF, Senegal Tata Trusts, India Stellenbosch University, South Africa University College London, UK Timothy Powell- Harshpal Singh Sachdev Zulfiqar A Bhutta Rajani R Ved David B Hipgrave Jackson Sitaram Bhartia Institute of Science Hospital for Sick Children, Canada and Research, India National Health Systems Resource UNICEF, NYC, USA London School of Hygiene Centre, India and Tropical Medicine, UK John Borrazzo Aku Kwamie Rana Saleh Global Financing Facility, American University of Beirut, Anthony Costello* Health Policy and Systems Kumanan Rasanathan World Bank, USA Lebanon University College London, UK Research Consultant, Ghana WHO, Cambodia

*Corresponding author A future for the world’s children

In memory of …

Maharaj Kishan Bhan (1947-2020) Paediatrician, scientist, and tireless advocate for the health of children A future for the world’s children

Thank You This report was made possible by the support of the Bill & Melinda Gates Foundation. A future for the world’s children Recommendations

Heads of state/government should create Local government leaders should Children should be given high-level a high-level mechanism to coordinate establish cross-cutting teams for platforms to share their concerns and work across sectors and assess the effect child health and wellbeing, ideas and claim their rights of all policies on children involving civil society Country leaders should work Heads of state/government should track Global children’s advocates towards an Optional Protocol to the budget allocations to child wellbeing should mobilise for child-friendly UN CRC to protect children from and mobilise domestic resources for wellbeing and sustainability harmful commercial practices additional investment policies The UN should work towards a Government officials and research Leaders should reframe their simplified, effectively multisectoral institutions should develop strategies to understanding of the SDGs UN architecture improve data reporting for SDG around children and the threat to indicators measuring child wellbeing, their future from greenhouse gas Heads of UN agencies coordinate equity, and carbon emissions emissions action to support countries to achieve the SDGs, with children at the center