Herman D. Stein Lectureship in International Social Welfare
The Well-being of Children as a Global Public Good
By Kul C. Gautam
Deputy Executive Director, United Nations Children’s Fund (UNICEF)
At the Mandel School of Applied Social Sciences
Case Western Reserve University
18 November 2002
It is truly a great honour to be invited to deliver the annual Herman D. Stein Lecture in International Social Welfare. The topic I have chosen to speak on today, the well-being of children as a global public good, comes straight out of the work and contribution of Herman Stein for over 2 decades with UNICEF and the United Nations.
Although Professor Stein may not have visualised it as such at the time, a roundtable conference he helped organise on planning for the needs of children in developing countries, in Bellagio, Italy, in April 1964, became a milestone for changing the way the world views children and their well-being.
Until that time, the well-being of children was largely seen as a charitable enterprise.
And UNICEF was seen as a good, small UN agency providing relief aid for children in emergencies and campaigning against some infectious diseases.
The Bellagio conference changed all that. Attended by some of the sharpest minds of the time with world-class expertise in the fields of economic planning, health, nutrition, education, demography and social policy, the outcome of the conference firmly established that the well-being of children was the essential foundation of national development. It also transformed UNICEF from a relief fund into a development agency.
The good work of UNICEF, under the capable advisement of Professor Stein, earned it the Nobel Peace prize in 1965. In the 1970s UNICEF pioneered a “basic services” approach to development. Its most practical manifestation was the Primary Health Care approach launched jointly with the World Health Organisation at Alma Ata, Kazakhstan in 1978.
In 1979 UNICEF served as the secretariat for the International Year of the Child and was designated as the world’s lead agency for children.
The International Year of the Child helped mobilise children’s activists all over the world to increase momentum towards the drafting of a UN Convention on the Rights of the Child. Although it took another decade for the Convention to come into being, the Herman Stein-inspired Bellagio conference paved the ground for UNICEF to eventually throw its weight behind the movement to lift the status of children from being objects of humanitarian concern, to subjects of national development planning, and eventually to the holders of inalienable human rights.
By the time Professor Stein left UNICEF in 1981, having served as senior advisor to its first three Executive Directors, he had personally trained and nurtured a whole generation of its future leaders and managers, including yours truly.
The graduates of the Herman Stein school of inter-regional staff training seminars are a breed apart in UNICEF. They have shaped the policies, priorities and management of this organisation, often regarded as one of the finest entities of the UN system.
On behalf of UNICEF and the children of the world, I want to thank Herman Stein for helping us to get to the path of recognition of the wll-being of children as a global public good.
The Well-being of Children as a Global Public Good
We have become increasingly a market-driven world. Indeed, the market is an efficient way to produce and trade many goods and services. But there are many goods and services that are need to be provided by non-market or modified market mechanisms. This is especially the case for what are known as public goods.
Public goods are recognised as having benefits that cannot easily be confined to a single “buyer”. These are sometimes referred to as “collective consumption goods” that society needs but which the private sector may have inadequate incentives to provide.
These range from traffic lights, street names, a clean environment, national parks, to global peace.
Global public goods are outcomes or intermediate products whose benefits are universal or extend to more than one group of people or countries. Surveillance and control of infectious diseases are examples of global public goods. With globalisation, increased travel and migration, it is no longer possible to stop spread of many infectious diseases through border control. Efforts to prevent and control diseases such as HIV/AIDS, tuberculosis and malaria should therefore be considered as provision of global public goods.
With today’s capacity for information flows, global marketing campaigns such as those of tobacco companies, fast food chains, among others, can influence lifestyles of millions of people and rapidly spread ‘global public bads’.
Efforts to counter these can be considered global public goods.
I would like to argue that we extend the concept of global public goods to encompass the well-being of the world’s children.
Yes, raising children is the business of families. And well-functioning market mechanisms help in this respect. But as the African proverb says, “it takes a village to raise a child”. And raising children to their full human potential ought to be not just the work of market forces, but the mark of human civilisation.
Whether a child is born in a poor family in Niger or an affluent one in Norway, whether it is a girl in Afghanistan or a boy in Cleveland, Ohio, the Universal Declaration of Human Rights, to which every nation in the world subscribes, says that they all have a right to a standard of living adequate for their health and well-being, including food, clothing, housing and medical care and other necessary social services, including the right to education.
Furthermore, the Declaration proclaims that childhood is entitled to special care and assistance.
And such assistance is to be provided through national efforts and international co-operation.
Thus if the vagaries of private market mechanisms are not able to provide special care and assistance to children, providing them as global public goods would not only be the right and wise thing to do, but also the fulfilment of a global public obligation.
Even from a strictly utilitarian point of view, investment in children has proven returns not only for themselves and their families, but also for their communities, societies and nations. Thus investment in children qualifies as direct investment in national public goods.
Furthermore, we see that the well-being of children in any part of the world can have outcomes and benefits extending far beyond individual countries and geographic regions.
If we take the three types of global public goods identified in the book, “Global Public Goods: International Co-operation in the 21st Century”, we can see that investment in children yields outcomes and results in all three categories, and is often a prerequisite for their success:
- Ensuring that children receive education that prepares them to be responsible managers and preservers of our natural environment is a direct contribution to natural global commons, a manifestation of global common good.
- Investment in children’s education also contributes to the world’s knowledge stock, which constitutes the human-made commons. Likewise, upholding universal norms and standards through investment in the fulfilment of children’s rights, builds the foundations for respect of all human rights, a public good and cherished goal of all humanity.
- Policy outcomes, which are considered public goods, such as public health, peace and security, environmental sustainability and equity, are achieved through direct investment in children’s health and well-being, which are the front end as well as the foundation of all human development and human rights.
To illustrate even more concretely, we can look at campaigns to eliminate childhood diseases such as smallpox and polio, among others, which are classic examples of global public goods in the policy outcome category.
Four decades ago the United Nations launched a campaign to eradicate smallpox. The annual cost of smallpox vaccination, quarantine and treatment was about $300 million per year when the eradication campaign began. Today the success of that campaign has meant not only the saving of $300 million (much more in today’s dollars, of course) per year, but the cumulative prevention of 350 million people from contracting smallpox and 40 million people from death.
The total US investment in the global campaign to eradicate smallpox was $32 million – an amount that is returned to US taxpayers every 26 days in savings from eliminating vaccination and screening programmes.
Or let us take the case of the on-going world-wide effort to eradicate polio. When the global polio eradication campaign began in 1988 we had 350,000 children being infected in 125 countries every year. Last year that number had gone down to less than 1,000, in fewer than a dozen countries. The number of polio cases has dwindled to such a level now that it would actually seem cost-ineffective for a very poor country to continue to invest in polio, instead of, say, malaria or pneumonia, which affect far more people and cause far greater damage to its economy.
Yet, the eradication of polio benefits not just the poor, polio-endemic countries of the South, but it benefits all countries, including the rich industrialised countries of the North, which have been polio-free for many years. At present industrialised countries have to spend hundreds of millions of dollars every year to vaccinate their children, because until polio is eradicated everywhere, children are not safe anywhere.
But once polio is eradicated in the next few years, the world stands to save $1.5 billion every year. The United States alone could save $350 million. Europe and other industrialised countries could save $500 million; and the rest of the world $650 million per year. And these gains would continue accruing for many years to come.
A recent report by the World Health Organisation entitled Macroeconomics and Health: Investing in Health for Economic Development, estimates tremendous gains from investment in a programme of essential health services, mainly interventions against infectious diseases and nutritional deficiencies These known health measures could result in 8 million deaths prevented and approximately 330 million disability-adjusted life years (DALYs) saved per year by 2010.
Investment in children’s education in developing countries also has many positive spillover effects internationally. Higher education levels can lead to slower population growth, better disease control, stronger democracy, more stable governments, and more peace and security. The international community as a whole benefits from any one nation’s strong human development.
At an even broader level, programmes of poverty alleviation, especially aimed at children in developing countries, can be considered global public goods. This is because by meeting the basic needs of impoverished populations, they contribute to better global health, reduction of environmental degradation, prevention of conflicts and generation of a sense of global solidarity.
Thus investment in programmes to prevent or eliminate childhood diseases, and other health, education and environmental measures and poverty alleviation can be true global public goods, and win-win propositions for all.
Challenges and opportunities facing children today
If ever there was a dire need, as well as a promising opportunity, for investing in the well-being of children as a global public good, the time is now.
At this dawn of the 21st century, children of the world are living in what might be called the best of times as well as the worst of times.
Why? Well, to most people, this characterisation as the “worst of times” is probably fairly obvious. We have all seen the horror stories of grinding poverty, inequity, violence, neglect, abuse and exploitation of children. Yet the scale of the problems is oftentimes not fully grasped. Let me list for you some of the negatives:
- Children under the age of 5 are still dying at the rate of 11 million a year, most from easily preventable causes like diarrhoea, measles, and acute respiratory infections. This means over 30,000 children a day or over 1,000 children dying in the course of this lecture;
- Some 150 million children under-five are malnourished, often at a cost of developmental handicaps that last a lifetime;
- Nearly 600,000 women are dying each year of complications in pregnancy and childbirth;
- 120 million children of primary-school age are not in class, about 60 per cent of them girls;
- HIV/AIDS has grown into a catastrophic pandemic in several parts of the world in the 1990s. It is unravelling decades of positive progress in child survival and development in large swathes of sub-Saharan Africa, and is spreading like wildfire in several other regions.In an unprecedented reversal, the young generation of many countries in Africa today can expect to live a shorter life than their parents and grand parents. A dramatic illustration of the impact of HIV/AIDS unfolding right before our eyes is the food crisis that is engulfing southern Africa today. While drought is the apparent reason for this crisis, our assessment is that the gravity of the situation is attributable to the devastation caused by HIV/AIDS in people’s health, education and productivity;
- In addition, hundreds of millions of children are suffering and dying from war, violence, exploitation, neglect, and all forms of abuse and discrimination. Perhaps more children have become victims of armed conflicts and violence during the past decade than at any comparable period in history; and
- Many countries and agencies mention investment in children as high priority in policy statements, but resource allocations and commitments tell a different story. Throughout the 1990s, developing countries invested only about 12-14 per cent of their national budgets and donors allocated only 10-11 per cent of their aid budgets for basic social services. These investments fell far short of the internationally agreed target of 20/20 (i.e. 20 percent of national budgets and 20 percent of donor support to be allocated to primary health care, basic education, nutrition, drinking water and sanitation, etc.) which are considered essential to meeting the most pressing needs of children.
Yet for all the setbacks and uncertainties in the world, we are also living in the best of times for children. As the UN Secretary-General, Kofi Annan has pointed out, in a $30 trillion plus global economy, the necessary knowledge, resources, and strategies all exist to give children the chance they need to grow in peace, health and dignity.
The global community has what it takes to give children the best possible start in life; quality primary education for all; and provide adolescents with opportunities to develop their capacities in a safe and supportive environment.
All this was reaffirmed at the recently held Special Session of the General Assembly on Children in May of this year, which reviewed progress made since the 1990 World Summit for Children. Quite a few of the ambitious goals of the World Summit were achieved or nearly achieved in the 1990s and we can build on these foundations for further progress. These include:
- A reduction in under-5 mortality by one-third in 63 countries, and by one-fith in over 100 countries in the course of the last decade;
- Major progress in family planning with two-thirds of couples in developing countries now using modern contraceptive methods. Although total world population in 2000 was some 800 million higher than in 1990, 13 million fewer children were born and 4 million fewer children died at the end of the last decade compared to the beginning;
- High rates of vaccination coverage in most regions, protecting some 3 million children every year from major child-killer diseases;
- Polio is on the brink of eradication, with a 99 percent reduction in the number of polio cases in the world compared to a decade ago;
- There was dramatic progress in tackling the world’s major cause of mental retardation – iodine deficiency disorders – with 1.5 billion more people having access to iodised salt, resulting in more than 90 million newborns being protected from a significant loss in learning ability;
- There are more children in school in all developing countries today than ever before. The advent of modern communications technology is bringing about dramatic changes in teaching and learning methods even in many poor countries;
- The Convention on the Rights of the Child that came into effect in 1989 has become the most widely and rapidly ratified human rights convention ever, with commitments not just on paper, but with real efforts to implement it, as can be seen in national legislation and implementation measures in many countries;
- Child protection issues (such as child labour, sexual exploitation of children, better care of children with disabilities, etc.) have gained a much higher profile, and are increasingly better understood and addressed;
- NGOs and civil society organisations have become more activists and stronger partners in promoting the cause of child rights and well-being;
- A human- and child rights-based approach is being taken more systematically in development planning and international co-operation;
- Overall, children are much higher on the political agenda, as seen by the facts that:
Ø In many countries children figure prominently in election campaigns. A growing number of countries have seen it fit to incorporate children’s rights and concerns in their constitutions;
Ø At the UN, it is not just UNICEF that puts children at the centre of its debates – the Economic and Social Council and the General Assembly itself have child-related items on their agenda quite regularly; and
Ø Even the Security Council has taken up children’s issues, particularly in the area of children and armed conflict.
Given these positive developments, and in the larger scheme of things, the resources needed to meet the basic needs of children are modest and affordable. With modest amounts of external support, even the poorest countries of the world would be in a position to afford basic social services.
The missing ingredient often is therefore not the lack of resources but the lack of vision, unwise priorities and commitment of leadership. Consideration of the well-being of children as a global public goods might perhaps help us summon such vision, commitment and leadership to pursue the goals and targets for children and development agreed at the recent major UN conferences and Summits.
The two most recent United Nations conferences of greatest relevance to children were the historic Millennium Summit of 2000 and the Special Session on Children of the UN General Assembly of 2002.
UN Millennium Summit
The United Nations Millennium Summit, held in September 2000, which brought together the largest assembly of world leaders in history adopted the following eight Millennium Development Goals, targeted for achievement by 2015.
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
The specific targets and indicators for measuring progress towards these MDGs relate heavily to interventions in child health, nutrition, basic education, safe drinking water and sanitation, and general respect for human rights and promotion of partnerships.
UN Special Session on Children
In May 2002, the General Assembly held a Special Session on Children at the United Nations. Attended by a large number of world leaders, it adopted an ambitious agenda for children. Entitled A World Fit for Children, this agenda is set within the larger scope of the Millennium Declaration, and contains specific goals and strategies that contribute directly to the realisation of the Millennium Development Goals.
Six out of eight of these Millennium Development Goals relate directly to children and women. The Declaration and Plan of Action adopted at the recent UN General Assembly Special Session on Children, builds on these and provides further targets, strategies and actions under the rubric of: a) promoting healthy lives, b) providing quality basic education, c) protecting against abuse, exploitation and violence, and d) combating HIV/AIDS.
The Special Session on Children, for which UNICEF was the substantive secretariat, was a major milestone in international co-operation for children.
- It was an extraordinary gathering of leaders from all walks of life, including Presidents and Prime Ministers, personalities such as Nelson Mandela and Bill Gates, parliamentarians, religious leaders, paediatricians, mayors, and NGOs;
- It was the culmination of a year-long campaign called “Say Yes for Children”, that garnered around 95 million pledges, many from young people, reaffirming the importance of the issues to be tabled at the Special Session and pledging commitment to take action to turn commitments for children into reality;
- It was the launching pad for a new 10-year agenda, aptly entitled “A World Fit for Children”, with specific goals and targets for children.