In 1982, an academic paper presented at the University of Birmingham unleashed a chain of events that dramatically reduced the global child mortality rate.
The paper synthesised all available data on childhood disease, with razor-sharp precision. Globally, 14 million children were lost each year to a handful of preventable diseases. Wealthy industrial countries had disrupted and reversed the transmission of these diseases through universal public health interventions, including vaccines. Advances in science meant low-cost delivery systems could replicate these interventions in poorer countries that lacked robust health systems. They could, in fact, reach every child everywhere. If the political will could be mustered of course.
At the time, a handful of leaders within UNICEF, WHO, and other global organisations were so inspired by the paper that they proposed a ‘Child Survival Revolution’ to halve child deaths within a decade, by making vaccines and other preventive solutions available everywhere. Many thought they had taken leave of their senses.
The quest for a global vaccine
Against all odds and an ocean of sceptical resistance, between 1982 and 1990 global vaccine coverage soared from 20% to 80% overall, as well as the coverage rates for global diphtheria, pertussis and tetanus vaccine. Another lifesaver, oral rehydration salts (ORS) became available to about two-thirds of children in the developing world. The goal of halving under-five deaths was met. As had already happened in high-income countries, global child health shifted from fragmented and reactive services in some places to universal prevention in all places.
Vaccines and ORS were galvanising ‘accelerators’ delivering multiple gains for child survival and public health in general. Progress has stalled in recent years and is in danger of regressing through the multiple impacts of COVID-19. Despite this, this year and every year, millions of children are alive because of the shift that the child survival revolution brought.
Could we also shift our approach to child mental health from fragmented and reactive services for some to universal primary prevention for all? There are three reasons why the answer may be yes.
We know where and how widespread the problem is and how much it costs
The study of adverse childhood experiences has shown that the risk factors for life-derailing developmental trauma are much more prevalent than we previously knew – substantially affecting a third or more of the diverse populations surveyed. There is a dose-response correlation between high levels of adversity and much worse lifelong outcomes in almost every single area of well-being: physical and mental health, addiction, violence, employment, education, and crime. At a very conservative estimate, this costs at least 8% of global GDP annually and causes untold misery and pain. There is clear well-being and economic argument for universal primary prevention.
We know the galvanising accelerators
While the science on vaccines and ORS in the 1980s was more conclusive than we have on addressing developmental trauma risk today, we do have our galvanising accelerators. Parenting programmes that strengthen primary attachment and school-based programmes that promote secondary attachment are the most evidenced and cost-effective ways we know of to disrupt the transmission of inter-generational trauma and adversity. The return on the investment case for making both interventions universally available is compelling
We can track the impact and transform outcomes
Currently our child protection models focus on reaching a fraction of children suffering from developmental trauma in a fragmented and reactive way. By recognising the much greater prevalence of risk in our population and applying universal prevention we are de-stigmatising the issue and recognising it as something that affects all of us in one way or another. At a population level, we can take an epidemiological approach. For instance, we can set targets and baselines on coverage of parenting and school programmes. We can also measure performance against other population-level outcome data on child well-being.
We need the humility to recognise this is an evolving science. But we know enough to act, and we should act with urgency. It is time for governments to invest in making parenting and school programmes universally available in every corner of the world. They must be culturally sensitive and co-created with communities and families. The investment should be underpinned by a communications drive to spread awareness of developmental trauma, toxic stress, attachment and neglect and the protective role of connection and belonging in building resilience and recovery. We should invest in ensuring the conversation is free of stigma or judgement, bathed in compassion and focused on solutions and empowerment.
This is as crucial for individual human well-being and dignity as it is for our shared economic, social and democratic development.
Benjamin Perks is the Head of Campaigns & Advocacy at UNICEF. Benjamin is also a senior fellow at the University of Birmingham Jubilee Centre.
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