Poor children around the world may get the short end of the stick if critics are to be believed regarding the UN's Millennium Development Goal of reducing the under-five child mortality rate by two-thirds by 2015. They say that such an initiative could leave poverty-stricken children worse off.
According to Daniel Reidpath (Centre for Public Health Research, Brunel University, Uxbridge, UK) and colleagues, while this goal is laudable, the problem arises because the child mortality goal (Millennium Development Goal 4) is presented in terms of the raw, average under-five mortality for a country.
"While this makes for simple reporting," they say, "the figure masks distributional information about which parts of society contribute most (or least) to the magnitude of that rate."
"In other words, the measure is equity-blind, unable to distinguish between a fair and an unfair social distribution of the burden of under-five mortality," they added.
Reidpath and colleagues argue that a country could achieve the goal of reducing the average under-5 mortality by two thirds by 2015, but fail to address the ongoing problem of high under-five child mortality amongst the country's most vulnerable groups.
Such a failure, they say, would violate the spirit of the Millennium Declaration that the world's leaders have agreed upon, which states:
"We recognize that, in addition to our separate responsibilities to our individual societies, we have a collective responsibility to uphold the principles of human dignity, equality and equity at the global level. As leaders, we have a duty therefore to all the world's people, especially the most vulnerable and, in particular, the children of the world, to whom the future belongs."
According to Reidpath and colleagues, the focus on the average or raw under-five mortality rate in Millennium Development Goal 4, without regard to the social distribution of the burden of under-five mortality, "will likely result in resource allocation being driven by expedience and lead to an increasing inequity."