Statement by Mr Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health at the 70th session of the General Assembly

22 October 2015

Mr. Chairperson,
Distinguished Delegates,
Ladies and Gentlemen, 

It is a pleasure to be here with you today. This year, I am presenting a report which focuses on the right to the highest attainable standard of health (“right to health”) and its relationship to the right of young children to survival and development. These rights are indivisible, interdependent, and interrelated.

The prevention of child mortality should remain a global priority. But beyond sheer survival, children have a right to thrive, develop in a holistic way to their full potential, and enjoy good physical and mental health in a sustainable world. Early childhood is a crucial time for effective investments in individual and societal health and it must receive significantly more attention, and a more adequate response from all relevant actors, including in the post-2015 agenda.

While in my report I raise many important challenges and opportunities related to implementation of the right to health in early childhood, in this statement, I would like to highlight several issues.
 
Distinguished delegates,
The reduction of under-5 mortality has been at the heart of the global development and public health agendas. The Millennium Development Goals (MDGs) called for a reduction of under-5 mortality by two thirds between 1990 and 2015 (goal 4). 

The MDGs provided impetus for global strategies to accelerate progress, most notably the Secretary-General’s Global Strategy for Women’s and Children’s Health (2010), and Every Newborn: An Action Plan to End Preventable Deaths, issued by WHO in 2014.

Significant progress has been made in reducing deaths among children under five, from 12.7 million deaths in 1990 to 6.3 million deaths in 2013. However, progress has been insufficient to meet goal 4, particularly in Oceania, sub-Saharan Africa, the Caucasus and Central Asia and Southern Asia.

In many countries and among disadvantaged groups of the population, mortality and morbidity rates in early childhood remain unacceptably high. I am concerned at what I see as the “the unfinished business” of goal 4, especially the slow progress in reducing preventable new-born deaths and the alarming prevailing rates of stillbirths.

The MDGs have been transformed in a set of sustainable development goals, that include a target to end of preventable deaths of newborns and children under five, and which will be the focus of the international development agenda for the next two decades.

In 2014, the Technical Guidance on the Application of a Human rights-based approach to the Implementation of Policies and Programmes to Reduce and Eliminate Preventable Mortality and Morbidity of Children under 5 years of age (A/HRC/27/31) was issued and became a major contribution.  In addition, a new and ambitious Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) has been launched.

This is all positive but, clearly, more needs to be done to eliminate deaths from preventable causes in early childhood. Efforts should be doubled to strengthen human rights based approach in all measures aimed at elimination of these deaths, and the healthy development of our children.

Mr. Chairperson,

The right of young children to healthy development is crucial to promote and protect the right to health throughout life as well as to foster sustainable human development; however it has yet to receive adequate attention.

Development in childhood consists of interconnected domains: physical, cognitive-linguistic and social-emotional. The three critical elements of healthy child development are stable, responsive and nurturing caregiving; safe, supportive environments; and appropriate nutrition.
 
These elements can be safeguarded through good practices such as planned, safe pregnancy and childbirth; exclusive breastfeeding in the first six months followed by appropriate complementary feeding and responsive parenting; preventive interventions such as vaccines for the treatment of diseases; protection of children from all forms of violence, neglect and abuse; and the reduction of environmental risks.

Young children’s rights to health and development are intrinsically linked in two main ways. First, poor physical or mental health in early childhood is among several interconnected factors that can limit the right to optimal development. About 200 million children fail to reach their developmental potential mainly because of poverty, inequality and discrimination; poor health; poor nutrition; a lack of stable, nurturing and responsive environments with learning opportunities; and a lack of safe, supportive physical environments.
 
Second, the three main domains of early childhood development —physical, social-emotional and cognitive-linguistic —affect health throughout life. All three domains must be given equal attention to promote development in a holistic manner, or healthy development.

Research from neuroscience shows how the quality of emotional relationships in early childhood impacts on physical and mental health as well as on morbidity in adulthood. It also shows the detrimental impact of toxic stress and early childhood adversities on the quality of brain architecture and the health status during the life span as developmental stages build on one another.

Despite the very large number of children that fail to reach their development potential, the issue has not been the focus of global attention. Particularly, in low-and middle-income countries, even if awareness of child development is increasing, progress is far too slow.

The post-2015 development agenda signals a shift from the focus on the survival and health of children under-5 to their survival, health, well-being, and development. Sustainable development will require healthy, productive, creative, emotionally competent, confident and capable individuals, meaning that early childhood interventions must focus on development as well as survival.

We should seize this opportunity and ensure that, in all levels of policy formulation and implementation, investing in the promotion of holistic development is equally important to prevention of child mortality.

Distinguished Delegates,

In order to seize this opportunity, we need to modernize existing healthcare systems and medical education so that “new morbidities” and challenges related to emotional and social development of children are adequately addressed.

Health systems are central to the care of pregnant women, childbirth, postnatal care of the mother and child and the care of young children. But health systems are important not only in relation to specific biomedical interventions.  It is because they often constitute the only infrastructure that reaches young children, particularly those under 3 years of age, and can initiate and foster health promotion and social service support to promote early child development and prevent risks.

Health systems are therefore in a good position to take a lead in providing integrated care for young children.  And health workers and other related professionals play a crucial role in supporting positive and responsive parenting.  However, I am concerned that the training and practice of medical doctors, nurses and other health professionals continues to focus predominantly on the biomedical determinants of health.

There is increasing evidence of “new morbidities” in childhood which are related to psychosocial environment, including relationships within the family, the community and the broader society. Modern health systems and modern health policies should address social and other underlying determinants of health by applying modern principles of health promotion, primary care, mental health and integrated health and social services to early childhood.

But for this, primary health care and paediatrics need to be equipped not only with modern lifesaving medicines and vaccines. They need to be able to apply modern interventions beyond the biomedical ones using psycho-educational and psychosocial methods based on new research in neuroscience, psychology, developmental paediatrics and child psychiatry.

These interventions are not a luxury, they protect children from the detrimental effects of violence and other early childhood adversities, and their value should be equated to that of lifesaving essential medicines and vaccines. .

Mr. Chairperson,
Distinguished Delegates,

The promotion and protection of emotional health and social development from the very start of life should be given priority as an investment in human development and global health.  Particular attention should be given to those sectors of the population in situations of vulnerability.

Amongst other recommendations in my report, I urge States to comply fully with the standards contained in the Convention on the Rights of Persons with Disabilities, and eliminate outdated practices based on institutional care and excessive medication of young children with developmental and other disabilities.

I advocate for the elimination of institutional care for children during the first five years of life, and to promote investments in community-based services for families at risk, including for families living in poverty and those with young children with developmental and other disabilities.

Discrimination against intersex people, including young children, should end.  To contribute to this, I recommend the banning of unnecessary medical or surgical treatment, and the adoption of measures to overcome discriminatory attitudes and practices.

Health-care services and professionals should be better equipped with relevant knowledge and practical skills to respond to new challenges and knowledge about the negative impact of social determinants and early childhood adversities on the physical and mental health of children.

To conclude, the health, survival and healthy development of young children must be placed at the centre of the implementation of post-2015 agenda and other global, regional and national commitments and actions.There is a momentum now for a new decade of focus on child development.  Building on the progress made on child survival we should take it to the next step so that our children can thrive, develop to their full potential, and thus contribute to healthier and resilient societies.

Thank you.