The lottery of life and death

The great German composer and pianist Ludwig van Beethoven (1770-1827) once stopped performing when a group of military officers in the front row were talking and laughing. The often fiery Beethoven – who loathed the trappings of social rank – publicly berated the officers, stating they were nothing more than “accidents of birth,” born into families of power and privilege.

Over the past few weeks, untold millions of people have been caught up in the expectation of a royal child born to England’s Prince William and his wife Catherine. Infant George Alexander Louis is an accident of birth, as are we all. Throughout our lives we make countless decisions, yet no one has the capacity to decide where, when and to whom he or she will be born.

While His Royal Highness Prince George of Cambridge will want for nothing during his life (with the likely exception of privacy), tens of thousands of other accidents of birth who have recently come into this world will have short, miserable, obscure lives.

The United Nations reports that approximately 19,000 children under 5 years of age (almost all residing in the developing world) die every day, mostly from preventible maladies: diarrhea, malnutrition-related illnesses, pneumonia, AIDS, malaria and tuberculosis. Approximately 40 percent of these deaths occur in the first month of life, and almost one-half of all child deaths are in sub-Saharan Africa, the poorest economic region in the world. One in 14 children die before the age of 5 in impoverished countries, compared to one in 147 children born in the world’s wealthy nations.

The World Heath Organization cites a number of reasons for high rates of child mortality:

1. Poverty-stricken parents cannot afford the most basic health care for their children, with marginal or delayed health care a factor in 70 percent in all under-5 child deaths.

2. Of the 12 nations with the highest rates of child mortality, nine have been engaged in a recent armed conflict. Armies, weapons and wars quickly consume scarce monetary resources that could be used for health care.

3. The lack of adequate nutrition, clean water and sanitation facilities is a significant factor in child mortality. The death of mothers as a result of these shortcomings also reduces a child’s chances of survival.

4. As many as 500,000 preventible malaria-related deaths occur annually among children under 5.

Even though child death rates remain unacceptably high, significant progress has been made in lowering these rates over the past 20 years. Following the United Nations Millennium Summit of 2000, that organization put forth eight Millennium Development Goals. Goal No. 4 was the reduction of child mortality rates by two-thirds between 1990 and 2015.

Although this milestone will not be realized (as of 2011, the global child mortality rate was reduced by one-third), nine low-income countries dramatically reduced their under-5 mortality rates between 1990 and 2011: Bangladesh, Cambodia, Ethiopia, Liberia, Madagascar, Malawi, Nepal, Niger and Rwanda. While child mortality has declined substantially in these mostly African nations, one in nine children in sub-Saharan Africa does not reach his or her fifth birthday.

Dr. Christopher Murray of the University of Washington’s Institute for Health Metrics and Evaluation cites three reasons for the decline in child mortality rates: improved maternal education, sustained efforts to limit mother-to-child HIV/AIDS transmission, and increased disease intervention, including the distribution of mosquito nets and drugs. According to Murray, spending on global health has increased more than $200 billion in recent years.

Anthony Lake, executive director of the United Nations Children’s Fund, notes the world has the technology and know-how to reduce child mortality rates even further.

“The challenge,” Lake argues, “is to make these available to every child.”

While being born into a family mired in poverty is an “accident of birth,” the likelihood that so many of these children will die before their fifth birthday is hardly an accident. Rather, it is largely a matter of resource allocation decisions made in the world’s wealthiest nations. For example, should rich countries continue squandering their tax dollars on bullets, bombs and wars, or should they allocate a significantly larger percentage of their monetary resources toward the distribution of tropical disease medicines and mosquito nets in sub-Saharan Africa?

Bill Gates of the philanthropic Bill & Melinda Gates Foundation states, “If we say as a world we care about saving children, and tackle the problem systematically … we can make progress, and it’s really important for people to know that.”

P.S. Some evidence suggests that declining child mortality is one of a number of factors that contributes to lower fertility rates. What has been dubbed the “survivability hypothesis” posits that as parents see fewer of their children die and “survive” to adulthood they (the parents) are more likely to have smaller families.

George J. Bryjak lives in Bloomingdale, retired after 24 years of teaching sociology at the University of San Diego.


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McKay, B. (May 24, 2010) “Child deaths decline amid better care,” The Wall Street Journal, online.wsj

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