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The Lancet Commissions a Future for the World's Children? A The Lancet Commissions A future for the world’s children? A WHO-UNICEF-Lancet Commission Helen Clark*, Awa Marie Coll-Seck*, Anshu Banerjee, Stefan Peterson, Sarah L Dalglish, Shanthi Ameratunga, Dina Balabanova, Maharaj Kishan Bhan†, Zulfiqar A Bhutta, John Borrazzo, Mariam Claeson, Tanya Doherty, Fadi El-Jardali, Asha S George, Angela Gichaga, Lu Gram, David B Hipgrave, Aku Kwamie, Qingyue Meng, Raúl Mercer, Sunita Narain, Jesca Nsungwa-Sabiiti, Adesola O Olumide, David Osrin, Timothy Powell-Jackson, Kumanan Rasanathan, Imran Rasul, Papaarangi Reid, Jennifer Requejo, Sarah S Rohde, Nigel Rollins, Magali Romedenne, Harshpal Singh Sachdev, Rana Saleh, Yusra R Shawar, Jeremy Shiffman, Jonathon Simon, Peter D Sly, Karin Stenberg, Mark Tomlinson, Rajani R Ved, Anthony Costello Executive summary costs are not prohibitive: an analysis of the SDGs suggests Published Online Despite dramatic improvements in survival, nutrition, and a financing gap of US$195 per person. To ensure stronger February 18, 2020 education over recent decades, today’s children face an economic and human development, each government https://doi.org/10.1016/ S0140-6736(19)32540-1 uncertain future. Climate change, ecological degradation, must assess how to mobilise funding using instruments *Commission co-chairs migrating populations, conflict, pervasive inequalities, that help the poorest proportion of the population to meet †Dr Bhan died in January, 2020 and predatory commercial practices threaten the health this gap for children, and frame these as the most The Helen Clark Foundation, and future of children in every country. In 2015, the powerful investments a society can make. But investments Auckland, New Zealand world’s countries agreed on the Sustainable Development are not just monetary: citizen participation and com­ (H Clark MA); Partnership for Goals (SDGs), yet nearly 5 years later, few countries have munity action, including the voices of children them­ Maternal Newborn & Child recorded much progress towards achieving them. This selves, are powerful forces for change that must be Health, Geneva, Switzerland (H Clark); Senegal Presidency, Commission presents the case for placing children, aged mobilised to reach the SDGs. Social movements must Dakar, Senegal 0–18 years, at the centre of the SDGs: at the heart of the play a transformational role in demanding the rights (A M Coll-Seck MD); Department concept of sustainability and our shared human endeavour. that communities need to care for children and provide of Maternal Newborn Child and Governments must harness coalitions across sectors to for families. Adolescent Health (A Banerjee MD, N Rollins MD, overcome ecological and commercial pressures to ensure J Simon DSc), Department of children receive their rights and entitlements now and a Government has a duty of care and protection across all Health Systems Governance liveable planet in the years to come. sectors and Financing, WHO, Geneva, Countries that support future generations put a high Switzerland (K Stenberg MSc); Health Division (S Peterson MD, Invest in children’s health for lifelong, intergenerational, priority on ensuring all children’s needs are met, by D B Hipgrave PhD, and economic benefits delivering entitlements, such as paid parental leave, free J Requejo PhD), HIV, Data, and The evidence is clear: early investments in children’s primary health care at the point of delivery, access to Analytics Division UNICEF, health, education, and development have benefits that healthy—and sufficient amounts of—food, state­funded New York, NY, USA (J Requejo); Department of International compound throughout the child’s lifetime, for their future or subsidised education, and other social protection Health, Johns Hopkins School of children, and society as a whole. Successful societies measures. These countries make sure children grow up in Public Health, Baltimore, MD, invest in their children and protect their rights, as is safe and healthy environments, with clean water and air USA (S L Dalglish PhD, evident from countries that have done well on health and and safe spaces to play. They respect the equal rights Y R Shawar PhD, Prof J Shiffman PhD); School of economic measures over the past few decades. Yet many of girls, boys, and those with non­conforming gender Population Health, politicians still do not prioritise investing in children, nor identities. Policy makers in these countries are concerned University of Auckland, see it as the foundation for broader societal improvements. with the effect of all policies on all children, but especially Auckland, New Zealand Even in rich countries, many children go hungry or live in those in poorer families and marginalised populations, (Prof S Ameratunga MBChB, P Reid MBChB); Department of conditions of absolute poverty, especially those belong­ starting by ensuring birth registration so that the govern­ Global Health and ing to marginalised social groups—including indigenous ment can provide for children across the life course, and Development, London School populations and ethnic minorities. Too often, the potential help them to become engaged and productive adult of Hygiene and Tropical of children with developmental disabilities is neglected, citizens. The rights and entitlements of children are Medicine, London, UK (D Balabanova PhD, restricting their contributions to society. Additionally, enshrined within the UN Convention on the Rights of the T Powell-Jackson PhD); Health many millions of children grow up scarred by war or Child (CRC) ratified by all countries, except the USA. Systems Transformation insecurity, excluded from receiving the most basic health, Countries might provide these entitlements in different Platform, Tata Trusts, Mumbai, educational, and developmental services. ways, but their realisation is the only pathway for countries India (M K Bhan MD); Centre for Global Child Health, Hospital Decision makers need a long­term vision. Just as good to achieve the SDGs for children’s health and wellbeing, for Sick Children, Toronto, OT, health and nutrition in the prenatal period and early years and requires decisive and strong public action. Canada (Prof Z A Bhutta PhD); lay the foundation for a healthy life course, the learning Since threats to child health and wellbeing originate in Global Financing Facility, World Bank, Washington, DC, USA and social skills we acquire at a young age provide the all sectors, a deliberately multisectoral approach is needed (J Borrazzo PhD, M Claeson MD); basis for later development and support a strong national to ensure children and adolescents survive and thrive Health Systems Research Unit, polity and economy. High­quality services with universal from the ages of 0–18 years, today and in the future. South African Medical Research health­care coverage must be a top priority. The benefits Investment in sectors beyond health and education— Council, Cape Town, South Africa (Prof T Doherty PhD, of investing in children would be enormous, and the such as housing, agriculture, energy, and transport—are www.thelancet.com Published online February 18, 2020 https://doi.org/10.1016/S0140-6736(19)32540-1 1 The Lancet Commissions S S Rohde MPH); Department of needed to address the greatest threats to child health and performance, housing, and environmental security, Health Management and Policy, and wellbeing. Political commitment at executive level among other entitlements. Harnessing the power of (Prof F El-Jardali PhD) Knowledge is needed to coordinate across sectors and leverage citizen accountability mechanisms will be essential to fill to Policy Center American University of Beirut, Beirut, synergies across the life course, ensuring universal health the data gaps. We also propose the development of Lebanon (Prof F El-Jardali, coverage; good nutrition and food security for all; user­friendly country dashboards to assess the effects on R Saleh MPH); School of Public thoughtful urban planning; safe and affordable housing child ren’s wellbeing and sustainable development. Given Health, University of Western Cape, Bellville, South Africa and transport; clean energy for all; and equitable social the urgency for action, regular reports on the SDGs to the (Prof A S George DPhil); welfare policies. Multisectoral governance might take UN General Assembly must be the anchor of strong Financing Alliance for different forms in each country, but it will require advocacy on action for children everywhere. Health, Nairobi, Kenya strategic partnerships, cabinet­level coordination across (A Gichaga MBChB); Institute for Global Health (L Gram PhD, ministries, and management of diverse partners, with Adopt a new protocol to the UN CRC to regulate against Prof D Osrin MRCPCH), clear roles for each, including for non­state actors and commercial harm to children Department of Economics, the private sector. Heads of state or prime ministers Although we recognise the role business plays in wealth (Prof I Rasul PhD) University must designate a cross­cutting government ministry or and job creation, the commercial sector’s profit motive College London, London, UK (Prof A Costello FMedSci); equivalent to ensure joined­up action and budgeting for poses many threats to child health and wellbeing, not Health Policy and Systems pro­child policies and to demand harmonised assistance least the environmental damage unleashed by unregulated Research Consultant, Accra, from global stakeholders, whose support is currently industry. More immediately, children around the world Ghana (A
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