Arikainen, Artur A

Bassat, Quique

Bhutta, Zulfiqar Ahmed

Yount, Kathryn M

English

eCommons@AKU

eCommons@AKU Woman and Child Health Division of Woman and Child Health 10-30-2020 Revisiting child and adolescent health in the context of the sustainable development goals Zulfiqar Ahmed Bhutta Aga Khan University, zulfiqar.bhutta@aku.edu Kathryn M. Yount Emory University, Atlanta, Georgia, United States of America Quique Bassat Barcelona Institute for Global Health, Barcelona, Spain Artur A. Arikainen Public Library of Science, Cambridge, United Kingdom and San Francisco, California, USA. Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_wc  Part of the Diseases Commons, Maternal and Child Health Commons, and the Pediatrics Commons Recommended Citation Bhutta, Z. A., Yount, K. M., Bassat, Q., Arikainen, A. A. (2020). Revisiting child and adolescent health in the context of the sustainable development goals. PLOS Medicine, 17(10), e1003449. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_wc/153 EDITORIALRevisiting child and adolescent health in thecontext of the Sustainable DevelopmentGoalsZulfiqar A. BhuttaID1,2*, Kathryn M. Yount3, Quique BassatID4, Artur A. Arikainen51 Centre for Global Child, The Hospital for Sick Children, Toronto, Canada, 2 Institute for Global Health &Development, The Aga Khan University South-Central Asia, East Africa & London, United Kingdom, 3 EmoryUniversity, Atlanta, Georgia, United States of America, 4 Barcelona Institute for Global Health, Barcelona,Spain, 5 Public Library of Science, Cambridge, United Kingdom and San Francisco, California, United Statesof America* zulfiqar.bhutta@sickkids.caThe year 2020—five years since 189 countries signed the Sustainable Development Goals(SDGs)—has been consumed by the global response to COVID-19. To date, this pandemic hasresulted in over 38 million cases and well over a million deaths [1]. One collateral effect ofCOVID-19 has been the setting aside of many SDGs and efforts to track progress towardsthem. Attention to children during the pandemic has concentrated on school closures, foodinsecurity, and access to care within health systems taxed by COVID-19 mitigation andresponse efforts [2]. The situation of child and adolescent health before COVID-19, and conse-quences of the pandemic on specific health targets for SDG 3, therefore deserve attention.As the Millennium Development Goals (MDGs) ended in 2015, activities and plansaddressed the global compacts for reducing child mortality. A focus was on determinants,such as maternal and child undernutrition, gender inequities, and intersecting vulnerabilities.Because adolescents were largely ignored in the MDG process, advocacy and effort wereinvested to make them central to the SDG agenda. The renewed global strategy for EveryWoman Every Child, launched by the UN Secretary General in 2013, was a segue to the SDGsand an effort to go beyond survival toward a transformative agenda that included healthydevelopment [3]. Advocacy for the integration of health, nutrition, and early child develop-ment led to the development of the nurturing care framework [4].As we examine the situation more than 5 years into the SDGs, several concerns emerge.Despite progress, the field remains fragmented, with limited actions in countries to developintegrated strategies for reproductive, maternal, newborn and child health (RMNCH), orinclusion of adolescent health within national plans [5]. Work on the drivers of adolescenthealth, well being, and empowerment is underway but has yet to translate into a reasonableglobal strategy. This lag stems from complex, multilevel social influences during adolescence[6], insufficient disaggregation of data on adolescents, suboptimal measurement and a lack ofwell-defined indicators [7–9], and limited evidence on the differential impacts of social policiesand programs [8] within adolescence and between adolescence and adulthood. Within healthsystems, many nutrition programs remain poorly integrated with other RMNCH programsand few have substantive links with sectors outside health. With the unfinished agenda formaternal, newborn and child deaths, rigorous studies to address mechanisms and hithertounrecognized causes of excess mortality are just beginning to yield results, albeit with olderpediatric age groups remaining significantly understudied, even at the simplest descriptivePLOS MEDICINEPLOS Medicine | https://doi.org/10.1371/journal.pmed.1003449 October 30, 2020 1 / 3a1111111111a1111111111a1111111111a1111111111a1111111111OPEN ACCESSCitation: Bhutta ZA, Yount KM, Bassat Q, ArikainenAA (2020) Revisiting child and adolescent health inthe context of the Sustainable Development Goals.PLoS Med 17(10): e1003449. https://doi.org/10.1371/journal.pmed.1003449Published: October 30, 2020Copyright: © 2020 Bhutta et al. This is an openaccess article distributed under the terms of theCreative Commons Attribution License, whichpermits unrestricted use, distribution, andreproduction in any medium, provided the originalauthor and source are credited.Funding: The authors received no specific fundingfor this work.Competing interests: I have read the journal’spolicy and have the following conflicts: ZAB is anAcademic Editor on PLOS Medicine’s editorialboard. ZAB, KMY, and QB serve as Guest Editorson PLOS Medicine’s Special Issue on Global ChildHealth: From Birth to Adolescence and Beyond.AAA is a salaried Associate Editor for PLOSMedicine. Outside of this work, ZAB receives asalary from his position as the Inaugural RobertHarding Chair and Director of Research at theSickKids Centre for Global Child Health and also ajoint appointment as the Founding Director of theCenter of Excellence in Women and Child Health ofthe Aga Khan University; the Centre receivesfunding from the Bill & Melinda Gates Foundation,Gates Ventures, Aga Khan University, thelevel [5]. Effort is limited to bring mental-health programming to women and children, espe-cially in conflict settings or emergencies such as the COVID-19 pandemic. These silos inresearch, planning and policy, and service delivery apply equally to other sectors, and to multi-sectoral planning and implementation at country level. To address the SDGs, we must con-sider life in the 21st century—including the disruptions of technological change, economicshocks, climate change, and conflict and security.Thus, as we seek to reposition child health in the context of the SDGs and to eliminate pre-ventable child deaths, we need a life-course perspective that is situated in a broader social andstructural context. This framework recognizes the multilevel social contexts into which chil-dren are born and the long-term health impacts of early exposure to deprivation, inequality,and unsustainable growth. We recognize that healthy trajectories from birth to adolescenceand beyond depend on the extent to which key stakeholders—governments, businesses, andcivil societies—prioritize investments in human capabilities, reductions in inequality, andinclusive, sustainable economies [10]. In conceptualizing the life course from birth to adult-hood in terms of trajectories of healthy growth, learning, and development, there are predict-able touch points where investments can be made and progress monitored—growth before age2 years, readiness for school, developmental and academic milestones in school, and socialmilestones with respect to family, peer, and dating relationships. A contextually situated life-course perspective for human development across childhood, as opposed to early childhoodalone, conceptualizes exposures and opportunities from conception to adulthood, with eachlife stage building on the previous stages in social context. This ‘contextual’ and ‘cumulative’perspective is important for understanding trajectories of survival, health and developmentthroughout childhood and adolescence and the ‘reciprocal’ social and economic contributionsthat healthy, fulfilled adults can make to inclusive, sustainable societies. Recognizing the inter-connectedness of capabilities also allows investments in one domain to attenuate vulnerabili-ties in another (e.g., ensuring that all children receive a high-quality education may attenuatevulnerabilities associated with stunting among the marginalized). Given the strong predictionsof cumulative disadvantage for long-term health, disrupting these trajectories requires collabo-ration among key stakeholders.Some 2 decades after the world embarked on the MDGs, we need to focus on reaching theunreached through cross-sectoral delivery platforms and strategies that prioritize the mostexcluded and vulnerable [11]. Still, high-quality programs within the health system remainimportant, and require redesign to meet the needs of children and adolescents. Achieving thishigh quality will require inclusion of trained providers, competent delivery systems, and anemphasis on dignity and trust in provider–client relationships, especially with the mostexcluded. Today, the quality of services for sick children is substandard, with only 40% of rec-ommended Integrated Management of Childhood Illness (IMCI) clinical interventions deliv-ered in a visit. System-wide deficits include minimal service offerings for adolescents, or evenchildren beyond the age of 5 years, and misplaced services, with many births occurring in facil-ities that cannot care for the very sick newborn. The path forward for improvement is to focuson structural solutions that place the child and family at the center of the health system’s mis-sion, address social inclusion of marginalised groups, and help develop high-quality health sys-tems for improving child health [12]. Health can be an entry point, yet collaboration acrossstakeholders and sectors, such as education, social media, and social protection, are critical toreduce disparities and foster capabilities for health and well-being.The SDGs have a broader agenda, translated into “survive-thrive-transform” in the GlobalStrategy for Women’s, Children’s and Adolescents’ Health 2016–2030, with major targets andindicators in the health sector and beyond. We remain concerned that the gains in early childhealth painstakingly achieved in the MDG period are at risk of slowing down and losingPLOS MEDICINEPLOS Medicine | https://doi.org/10.1371/journal.pmed.1003449 October 30, 2020 2 / 3International Development Research Centre, GlobalAffairs Canada and the University of Toronto. ZABalso serves on the Bill & Melinda Gates FoundationScientific Advisory Committee for which hereceives an annual honorarium; and on otherboards, committees, and advisory groups withvarious organizations in a non-remuneratedcapacity. Outside of this work, KMY carries outresearch funded by grants from Woodruff HealthSciences Centre, Emory Global Health Institute,International Fund for Agricultural Development(through the International Food Policy ResearchInstitute), Bill and Melinda Gates Foundation(through the International Food Policy ResearchInstitute), Kendeda Fund (through Care USA), theUS National Institutes of Health, and theAnonymous Foundation; she is a reviewer for NIH,IDRC, and IFPRI and receives honoraria for thiswork.priority. The global challenges of improving survival and health from birth through adoles-cence remain, and the world needs to redouble its efforts to do better, rather than declare vic-tory prematurely and move on.In a forthcoming PLOS Medicine special issue [13], we are inviting impactful research inthis important area on strategies to monitor and combat child mortality globally from birththrough adolescence, school-age health and welfare, marginalised populations, and the envi-ronmental impacts on children’s health. We hope that this special issue will help to redirectattention to child and adolescent health in years to come.References1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns HopkinsUniversity (JHU). [accessed 13 Oct 2020]. Available: https://coronavirus.jhu.edu/map.html2. Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indi-rect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020; 8: e901–e908. https://doi.org/10.1016/S2214-109X(20)30229-1 PMID: 324054593. WHO. What is the Global Strategy? In: WHO. World Health Organization; [accessed 2 Oct 2020]. Avail-able: http://www.who.int/life-course/partners/global-strategy/global-strategy-2016-2030/en/4. WHO. Nurturing care for early childhood development: Linking survive and thrive to transform healthand human potential. In: WHO. World Health Organization; [accessed 2 Oct 2020]. Available: http://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/5. Diaz T, Rasanathan K, Meribole E, Maina I, Nsona H, Aung KM, et al. Framework and strategy for inte-grated monitoring and evaluation of child health programmes for responsive programming, accountabil-ity, and impact. BMJ. 2018; 362. https://doi.org/10.1136/bmj.k2785 PMID: 300611046. Cappa C, Giulivi S. Adolescence and Social Determinants of Health: Family and Community, in Adoles-cent Health and Wellbeing. Springer; 2019.7. Upadhyay UD, Danza PY, Neilands TB, Gipson JD, Brindis CD, Hindin MJ, et al. Development and Vali-dation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults. J Ado-lesc Health Off Publ Soc Adolesc Med. 2020. https://doi.org/10.1016/j.jadohealth.2020.05.031 PMID:326904688. Grose RG, Chen JS, Roof KA, Rachel S, Yount KM. Sexual and Reproductive Health Outcomes of Vio-lence Against Women and Girls in Lower-Income Countries: A Review of Reviews. J Sex Res. 2020; 1–20. https://doi.org/10.1080/00224499.2019.1707466 PMID: 319022389. Azzopardi PS, Hearps SJC, Francis KL, Kennedy EC, Mokdad AH, Kassebaum NJ, et al. Progress inadolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990–2016. Lancet. 2019; 393: 1101–1118. https://doi.org/10.1016/S0140-6736(18)32427-9 PMID:3087670610. Van Niekerk AJ. Inclusive Economic Sustainability: SDGs and Global Inequality. Sustainability. 2020;12: 5427. https://doi.org/10.3390/su1213542711. Malhotra A. Charting a Pathway to Multisectoral Investments in Adolescent Health in Low- and Middle-Income Countries. J Adolesc Health. 2019; 65: S1–S2. https://doi.org/10.1016/j.jadohealth.2019.04.023 PMID: 3122898412. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health sys-tems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018; 6:e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 PMID: 3019609313. Special Issue: Global Child Health: From Birth to Adolescence and Beyond. [accessed 8 Oct 2020].Available: https://collections.plos.org/s/child-healthPLOS MEDICINEPLOS Medicine | https://doi.org/10.1371/journal.pmed.1003449 October 30, 2020 3 / 3

Revisiting child and adolescent health in the context of the sustainable development goals

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