The history of children is not one any grown-up ought to be especially proud of, and -- from the perspective of some specialists who ought to know -- their lot is not likely to improve at any rapid pace.
A panel of specialists, brought together by the Smithsonian Institution's International Activities section in conjunction with the current exhibition "Generations," took a brief look at child health by the 21st century at a recent public forum. The outlook, they suggested, is pretty bleak.
It is true, as Cornell nutritional epidemiologist Dr. Jean-Pierre Habicht put it, that "a smiling baby makes everybody happy, and we can all empathize with the joy of giving birth to a wanted, healthy baby into a warm and caring family which has the resources to look after it."
And, he noted, "we are fortunate that so many babies are so well born."
Nevertheless, the vast majority are not so fortunate. Demographer Katrina Galway, co-author of "Child Survival: Risks and the Road to Health," a demographic report, noted that of the 2 billion children expected to be born in the last 15 years of this century, 1.8 billion will be born in the developing world, and some 240 million -- 12 percent -- will die before their fifth birthdays at current levels of infant and child mortality.
"That," said Galway, "means 1,700 deaths an hour" until the year 2000.
Dr. Leon Eisenberg, moderator of the forum, opened the session by a kind of declaration of the rights of children. He said, "Although it is important to know what kind of adults children will become, to argue for children solely on the basis of the future is morally unacceptable."
Eisenberg, a pre-eminent child psychiatrist and now chairman of the Department of Social Medicine and Health Policy at Harvard, said that "the future is commonly invoked in support of children's programs, justifying investment on the grounds that it will yield a health result, or a more productive work force or a savings in medical costs for the generation ahead."
But, he said, "the inevitable uncertainty of the outcome provides grounds for denying children what they need today."
There is, for example, "overwhelming evidence of the importance of infant nutrition," he said. "Yet the best-fed baby will not become a healthy adolescent if it is starved in later childhood. Is that an argument against feeding babies?
"Should we not relieve unhappiness in children whether or not such relief prevents mental disorder in later life? Because we can always teach adults to read, is it acceptable to have our children leave school illiterate?
"That," he said, "is why I begin with the proposition that children matter in and of themselves. It should be justification enough for a program to show that it improves the quality of life for the children who participate in them whether or not it has enduring aftereffects.
Not an easy task, he noted, because "children have no vote. Politicians need not take them into account for the next election. Such rights as they enjoy must be freely given. Their claims on us are engendered by love and compassion. They have no power to inspire fear.
"Thus," said Eisenberg, "the care children receive in a society with the means to provide it is a gauge of the morality of that society." ::
The mission of the forum was to identify the major threats facing the world's children in the last years of this century and to say how and where governments should participate in lessening them.
Basically, they agreed on the risks to children: infection and parasites against a background of malnutrition, war, environmental disasters such as the Bhopal, India, chemical spill, and high fertility rates. The shadow of AIDS as a separate threat was also cited as something that "could not be overlooked."
The trouble is, said Dr. Vulimiri Ramalingaswami, "health is marginal still to the whole process of development in general in the Third World. If there are economic turbulences, one of the first things that falls by the wayside is health research and then, of course, health."
Ramalingaswami is the just-retired director general of the Indian Council of Medical Research, Chairman of the Global Advisory Committee on Medical Research for the World Health Organization and currently a visiting professor of International Health at Harvard.
He reminded the group that at an international conference nearly a decade ago, 150 nations signed a declaration pledging to see by the year 2000 a reduction in infant mortality to below 50 per 1,000 births in every country. There are still 57 nations with higher rates, including as many as 20 with rates over 100 per 1,000 births. (The U.S. rate is 11, lagging behind 17 other countries, largely because of enormous rates in inner cities and other poverty-ridden areas. The rate in Washington, D.C. is 21. The lowest rates are in Sweden and Japan with 6 deaths per 1,000 births.)
According to demographer Galway, quoting World Bank figures, only about 4 percent of low-income country expenditures goes to health. Of the rest, slightly more, 8 percent, goes to education, while 19 percent goes to defense and in most of the developing countries, a quarter goes to economic services -- that is, paying the interest on foreign debts.
Generally, the higher the infant mortality, the lower the gross national product per capita. However, Eisenberg said, this does not hold true when education is available, especially for women. "The promotion of the welfare of children," he said, "is, I conclude, inseparable from the liberation of women from ignorance and servitude. The one will not be accomplished without the other."
Both Eisenberg and Galway cited the examples of Sri Lanka and Costa Rica. "The infant mortality rate for Sri Lanka is less than a third that of Saudi Arabia," said Eisenberg, even though the latter has 50 times the GNP per capita. The infant mortality rate for Costa Rica is one fifth that of Iran's even though the Iranian GNP is five times higher. But in Costa Rica and Sri Lanka, virtually 100 percent of the girls attend primary school along with the boys. In Saudi Arabia and Iran, as few as half do so.
Still, the panelists agreed that "we're clearer about our goals than we are about how to reach them." Said Eisenberg, "we need to do what is right, but the problem is that in developing countries where resources are tight, one can't do the right thing for everybody all the time. The question becomes, what is the best thing to do given all the different right things we should do?"
Eisenberg described the dilemma faced every day in one or another part of the developing or even the developed world. A friend of his, he said, a representative of the World Health Organization, "was extremely distressed when he visited a plant that manufactures asbestos, near Mexico City. He was appalled that there was no equipment for measuring fibers in air, no environmental law that could be invoked." He called the workers together and warned them of the dangers of asbestos, not only to them, but to their children they exposed every night when they came home.
"After he finished his presentation, one of the workers said, 'Well, doctor, if I work in this plant, when will I come down with those lung diseases?' The doctor estimated 10 to 20 years, and the worker asked, 'Do you know how long it will be before I die if I don't have any food because I've quit my job?' " ::
"I believe," said Ramalingaswami, "we should bring more health issues into the political arena in the good sense of the word, politics. There is now the beginning of this in many Third World countries where health issues are being incorporated into election manifestos. It is a gentle opening of the door and if it grows and swells, it can create the demand that in a democratic society is the most powerful means of resolving an issue.
And finally, he said, "I recall the words of Winston Churchill, who said, " 'There is no better investment than putting a little milk into babies, even at the time of disaster.' "