Guest Essay by Kip Hansen – 18 October 2020
I grew up in a medical household. My father was one of the leading pediatricians of the Greater Los Angeles, California area. Every single day I was greeted with pragmatic, practical news on the advances being made in medicine, public health, and especially in the treatment and care of children and their diseases. And every day, it was plain, when my father came home, if he had lost a patient that day – he was stoic and realistic, but every baby lost, every child that died, crushed part of him. That was in 1950. There was a vaccine for smallpox but almost nothing else. Children were expected to suffer through measles, mumps, chicken pox and German Measles (Rubella). We almost all did. The worst was the dreaded risk of polio.
Most kids in the United States got through the raft of childhood diseases just fine. But the death toll of the 1950s would be considered terrifying in the world of 2020.
“Despite the crises of 2020, parents can realistically expect that children born today will outlive them. That wasn’t always the case. “
1800: Demographic research suggests that through to at least the year 1800 more than one-third of children failed to reach the age of five. Despite estimates in 1800 coming with substantial uncertainty, it’s expected that in some countries rates could have been as high as every 2nd child. Let’s think about what this meant for parents of this period. The average woman in 1800 had between 5 to 7 children.1
Parents probably lost 2 or 3 of their children in the first few years of life. Such loss was not a rare occurrence but the norm for most people across the world.
— “From commonplace to rarer tragedy – declining child mortality across the world” by Hannah Ritchie
In the North America of the 1950s, 4% of children died before their 5th birthday – that seems awful today, but in Europe it was over twice that. In many parts of the world, one-in-five or even one-in-four was common – and in Africa, one out of three died before they were five years old.
What a difference one generation makes.
Today, less than 1% (0.68%) of U.S. children fail to reach their 5th birthday – and two thirds of those failures are neonatal deaths (newborns aged 0–27 days). That means if a baby lives through her first month, she will most likely be one of the 998 out of 1000 to make it to elementary school age.
The majority of those neonatal (newborn) deaths are from two causes. Low Birthweight and Congenital Malformations. Sadly, often here is little to be done about congenital malformations; something has gone wrong in the genetic material or in fetal growth – some of these are repairable, some not. For example, there has been substantial progress in surgical correction of heart problems in neonates saving many infants that would have died in the past. Premature babies get support in life-saving Neonatal Intensive Care Units (NICUs). There has been success with prevention of low birthweight and premature birth through better and more intense prenatal care for mothers and this has been especially important for very young mothers (under 20), older mothers (40 and above), poor and socially disadvantaged mothers and those mothers with mental and/or emotional problems, such as depression, alcoholism and other substance abuse.
Postneonatally, the most common causes of death are: Congenital Malformations (like heart valve problems, internal organs that don’t function right, etc), Sudden Infant Death Syndrome (SIDS) and Unintentional Injuries (accidents). There are continuing advances dealing with postneonatal congentital malformations with surgical and other interventions. The American Academy of Pediatrics issued a policy statement making recommendations about prevention of SIDS reinforced the Back-to-Sleep Campaign and SIDS deaths have been reduced by about 40%. Aggressive action on safety issues affecting children have reduced accidental deaths – such things as safer crib designs, high chair design, car seats and age-appropriate toys.
As Dr. Klass summaries it:
“Collectively, as human beings, we changed the game. It took science, medicine and public health, it took sanitation and engineering and safety legislation, and it took many different kinds of education and parent advocacy. And it took vaccines and antibiotics, those 20th century game-changers.”
Vaccines and Antibiotics
Many readers here are of the “pre-vaccines” generation. We attended elementary schools (kindergarten through 6th grade) in the early 1950s – we are the post-World War II Baby Boomers. The oldest of us got only small pox vaccinations and then received polio vaccines as they were developed. We gained our immunity against the five common childhood disease from having them — but our children benefited from the new protective vaccines.
In 1950, the only effective antibiotics were sulfa drugs and penicillin – and both were “miracle drugs” saving untold numbers of lives. Most of today’s antibiotics, or their precursors, were developed from 1940-1962. These drugs keep our children alive when their bodies are attacked by infections against which they have not yet developed adequate defenses. Where these antibiotics are not readily and affordably available, child mortality is unacceptably high.
The role of Public Sanitation in preventing child mortality is seldom understood by the general public in modern Western societies, such as Europe, Japan, ANZO and the United States. One needs to have experienced the conditions found in the poorer areas of Third World countries to really “get it.” My local water department issued a “boil water order” last week because some water pipe had broken lowering general pressure in the mains, which “might have” allowed some tiny amount of ground water to enter the water system. Compare this to: No clean safe drinking water (unless purchased in a plastic bottle), no flushing toilets, no running water (cold or hot) for hand washing, dish washing, or bathing. Privies and animal waste washed into the local drinking water supply with every rain. Rampant childhood under- or mal-nutrition and homes with no windows or window screens thus open to mosquitoes and all the diseases they spread, worsen the situation. These factors coupled with no or few local health clinics – or a health clinic with no medicines available – lead to the still sadly high child mortality in less developed areas, despite improvements over the last 70 years.
Those interested in humanitarian efforts to “save the children” should concentrate their giving to organizations that work specifically on these issues: safe drinking water, local health clinics and childhood vaccination, public sanitation and anti-mosquito-borne disease programs.
But for the vast majority of those reading here, those living in North America, Europe, Japan and Australia/New Zealand and the more developed parts of other nations:
“Because, believe it or not, even in 2020, parents in the United States and in many other countries, and not just the very richest, are among the luckiest parents in history. We can, for the most part, hope and even expect to see our children live to grow up, and we live in a society shaped and colored by that expectation. And for all of the anxieties and terrors of this present moment, as parents, we are actually on the lucky side of a divide that separates us from the parents who came before.” — Dr. Perri Klass
It is, indeed, a Good Time to Be Born
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I welcome each and every newborn child I meet with the salutation: “Welcome Aboard!” with the knowledge that the ship-of-life they’ve boarded is far safer and kinder and fairer than the one I climbed aboard so many years ago. It’s not a perfect world, but with faith and hard work, almost all of them will make a go of it and have a good life.
The madness of the moment will eventually pass, probably soon after the upcoming U.S. Presidential election, and things will return to their pre-pandemic boom conditions.
My father, the pediatrician, told every new mother with a new baby in her arms, “That’s a fine baby!” I do the same, in his honor, because it is true – every baby is a “fine baby”.
Yes, there are other worthy projects that help children: Poverty Vitamins, Deworming Medications and Vitamin A programs, supporting basic educational programs with school kits and program materials and childhood vision programs. I have been involved in all of these and witnessed a great deal of success.
If your comment is meant for me, please start it with “Kip – “ so I don’t miss it. Thanks.
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