H+W WEF Dubai 2009

A. Description of the issue

Children are at the heart of the MillenniumDevelopment Goals (MDGs), which includeeradicating extreme poverty and hunger,achieving universal primary education andgender equality, reducing child and maternalmortality, combating HIV/AIDS, malaria andother diseases and ensuring clean water andsanitation.

Nearly 50 years ago it was estimated that some 20 million children died

before they reached their fifth birthday. In 2006, for the first time, the under-

five mortality rate dropped below the 10 million mark to 9.7 million, according

to UNICEF. This represents a 60% decline in child mortality since 1960.

While such progress is encouraging much remains to be done.

Together, Africa and Asia account for 93% of the global burden of under-five

mortality, 96% of maternal mortality and 93% of undernutrition (measured by

children under five who are underweight for their age). India alone accounts

for 21% of the global burden of under-five mortality, 22% of maternal mortality

and 38% of underweight children under five.

1.105 | Summit on the Global Agenda

Welfare of Children

Society, Values & Ethics

B. Dimensions

• Health: Far more needs to be done to increase access to basic

healthcare including prevention and treatment to address the impact of

pneumonia, diarrhoea, malaria, malnutrition and HIV/AIDS. Access to

clean water and sanitation as well as adequate nutrition are key to

overall health. Integrated community-based healthcare is critical for

women, children and their families. How can sustainable health systems

be expanded throughout the developing world? What further measures

can be taken to reduce child and maternal mortality?

• Education: Education is not only a basic human right, it is vital to the

development and to the well-being of individuals and societies. About

72 million primary-school aged children are not enrolled in school.

Around the world, girls are less likely to be enrolled in school and less

likely to complete their basic education than boys. The quality of

education is also an issue in many parts of the world. How can gender

parity in education be achieved? What can be done to ensure that

education and training are relevant and address the skills gap?

• Protection: Protecting children from violence, exploitation and abuse is

an integral component of promoting their survival, growth and

development. An estimated 300 million children worldwide are subject

to trafficking, sexual exploitation, child labour, violence due to armed

conflict, harmful practices such as female genital cutting/mutilation

(FGC/M), child marriage and other forms of abuse or exploitation. How

can legal frameworks and enforcement be strengthened at local and

national levels to protect children? How can cultural norms be changed

to address harmful practices such as FGC/M and early marriage?

Other issues

• How can data collection systems be strengthened to better measure

progress?

• What innovative alliances can be used to accelerate the MDGs –

bringing the power of business to enhance the efforts of governments

and grassroots organizations?

• How can the work of other World Economic Forum Councils support

integrated approaches towards achieving the MDGs for the benefit of

children?


Welfare of Children


With different orders of magnitude, there isan overall consensus that the gap betweentotal health expenditure and GDP growth willcontinue to expand significantly in the nextdecades. Crafting solutions to reverse theseunsustainable trends requires restructuringhealthcare systems to increase the cost-benefit ratio of investment, place agreater emphasis on prevention, define and assess the quality of care and thequality of life, cost-efficiently treat chronic disease, ensure access to care andutilize evolving technologies effectively.

Despite the significant differences in how health systems are financed,organized and provided, all countries face a number of similar challenges. Totackle such a range of issues, it is essential both to work across a widevariety of disciplines and to include a diverse collaboration of stakeholders atall levels of the health system; the public, health practitioners, healthadministrators, policy-makers and politicians, patients, manufacturers and theresearch community must be included.


Healthcare Systems

Health, Science & Technology

B. Dimensions

• Demand side challenges: Various factors will increase the demand

for health services, such as population growth, higher life expectancy,

health awareness and new technologies. Should demand be

controlled? If so, how?

• Challenges to accessing healthcare: Despite growing investment,

access remains a key issue in both developed and developing

countries. What are some of the most innovative approaches to

improve access?

• Capacity building challenges: Fundamental capacity is still missing in

many countries. What can be learned from good examples of public-

private service provision? How can government, academia, NGOs and

industry work in greater partnership? How can this be further

encouraged and developed?

• Health economics and funding: How can the scarce resources of

health and healthcare best be allocated? Can long-term capital

investments in healthcare and results-based financing help achieve

financing sustainability?

• Public health: How can the focus move towards prevention rather

than treatment of a disease through surveillance of cases and the

promotion of healthy behaviours? How can health supportive

environments and socio-ecological approaches be better promoted?

• Health and human development: How can the vast gap in access to

healthcare, and public health initiatives between developed and

developing nations, be narrowed?

• Global governance and the architecture of health: How can

improved systems contribute to levelling the playing field?

• Standards: Could quality standards be implemented along with

evaluation mechanisms for management?


Healthcare Systems


Malnutrition can be defined as under- or over-nutrition. Under-nutrition remains adevastating problem in many developingcountries – affecting over 815 million peopleand causing more than one-half of all child deaths, with irreversible effects inthe first two years of life. Yet, more than half of deaths in the populationworldwide are caused by chronic diseases such as heart disease, stroke,some cancers and adult-onset diabetes. These diseases are caused by theunderlying risk factors of poor diet – normally over-nutrition, physical inactivityand smoking.

The common assumption is that under-nutrition affects developing economiesand that over-nutrition and chronic diseases afflict the rich. This is not thecase. The problems increasingly manifest in the same countries in aphenomenon called the “dual burden”. Among children in developingcountries, underweight is still a greater problem than overweight. But manycountries (such as Morocco, Guatemala, the Dominican Republic) haveexperienced a rising trend in the prevalence of overweight children.Malnutrition and chronic disease can also appear in the same individual –foetal malnutrition is shown to impact health later in life.

The burden of these intertwined health trends is significant at a macro- andmicro-level and yet our understanding and awareness of the problem, thelevel of investment at a global level and the level of coherence in approachesto addressing the problem are insufficient.


Chronic Diseases and Malnutrition


B. Dimensions

• Nutrition and changing diets: A dual burden in developing countries

exists between the increased demand for meat due to rising incomes

and changing diets and a deficit in nutritional balance and fortification of

food supplies.

• Globalization: With the globalization of food markets, developing

countries have larger quantities of low-cost, high-calorie foods being

aggressively marketed towards poorer households.

• Economic impact: The impact at a macro- and micro-level of both

malnutrition and chronic disease has been shown to be significant, yet

the full extent of that burden is unknown and under-appreciated.

• Healthcare systems: Healthcare systems, presently oriented towards

treating infectious diseases, might need to shift resources to chronic

diseases, weakening already overburdened systems. The role of

government, the corporate sector and other actors within the

healthcare system needs to be re-examined.

• Behavioural change: The key risk factors behind most chronic

diseases are poor diet, lack of physical activity and smoking, changes

in all of which require education and a supportive environment.

• Child and maternal health: There is increasing understanding of the

significant impact of poor foetal health and poor health in early

childhood on later development across a spectrum of chronic diseases.

• Sport: Regular physical activity, which is declining among adults

worldwide, reduces people’s risk of heart attack, colon cancer, diabetes

and high blood pressure and may reduce their risk for stroke.

• Ageing: Declining birth rates, combined with increases in life

expectancy, are leading to population ageing. This phenomenon, which

took place in some developed countries in the 1990s, is presently

increasingly evident in developing countries.

• Urbanization: Since most population growth over the next three

decades is expected to occur in developing countries’ urban areas,

special attention is needed on the impact of urbanization on dietary

habits.


Chronic Diseases and Malnutrition


Over the next two decades, ageing populations inthe developed world – and beyond – will increasesubstantially. By 2030, 19% of Americans, 23% ofEuropeans and 31% of Japanese will be older than65, the traditional retirement age. Some experts alsopredict the average human lifespan in developedcountries may reach 100 by 2060; others say it willpeak at 85 by 2100.

The economics and demographics of an ageingpopulation are tantalizing. Chronic diseasesassociated with ageing, such as cancer,cardiovascular disease, diabetes and theconsequences of physical inactivity, account for 75% of healthcare costs each

year in developed countries.1

Understanding the facts behind these varying predictions is critical tobusiness and political leaders who base today’s decisions on retirementprogrammes and strategies. Biogerontologists have already produced a largebibliography of descriptive data that sets some general principles of ageing.Although their research has not yet uncovered any universal indicators ofageing, the findings could lead to the development of practical and effectiveanti-ageing strategies and products. From geopolitics to business tohealthcare, the implications of longevity will certainly be far-reaching.


Challenges of Gerontology


B. Dimensions

• Gerontology: What predictions have been made regarding global

population growth? What are the societal implications of an “older”

citizenry? Will changing demographics affect the global balance of

power?

• Geriatric diseases: What are the consequences of geriatric diseases –

when is a longer life a better life?

• Urbanization and gerontology: The environmental context of ageing,

and issues related to place and location in particular, has resurfaced as

a major theme. What infrastructure is needed to preserve an

independent, normal lifestyle despite physical and mental impairments

related to ageing?

• Family and community support: The continued high involvement of

families in caregiving is well documented. However, as the age structure

of society and the family change, so do the availability and capacity of

healthcare.

• Prediction of demographic trends: Why do experts differ so widely

in their projections? Are there any genetically defined limits to the

human lifespan?

• Ageing in the developing world: Changes in the population’s age

structure are particularly marked in the developing world; the greatest

increases in both total numbers and proportions of older people will

occur in Asia and Africa.

• Implications for business: What do current trends tell us, and why

must businesses be prepared? What opportunities are on the horizon

and who will benefit?

1 National Center for Chronic Disease Prevention and Health Promotion, USA


Challenges of Gerontology

Documents

H+W WEF Dubai 2009