Subj: Children

Date: 27 April 2001

Ah, the child mortality goal, yes, it would seem to be some kind of safeguard. I'm saying it's the only one, because all welfare indices (even health ones) are subject to the problem that if the poor die early the index looks better.

Of course no policy aim should measure anything without seeing how many people in that group die off, and analysing it before saying any conclusions about benefit. But really this is the closest there is in the goals.

As child mortality is concentrated among the poorest and is related to adult mortality, you'd expect bad progress on child mortality to show bad progress (or negative progress) on poor adults dying early. The reverse is a bit implausible. In practice some things you have to do in order to make progress on child mortality will at the same time reduce adult mortality for the same families.

I have a couple of ideas on this.

1) poor get benefit last, so bad c.m. = very bad c.m., and adult mortality, among poor

The child mortality goal is about all children among 5 billion, at all income levels. The poverty goal relates currently to the poorest 1.3 billion. (This is one of the general problems - they've jumbled the statistics up.) I think when progress towards the goal is slow (as now) the richer people get more benefit, and more poor children and adults are dying; and if child mortality progress is good, that would show you have worked on the rate among the poor.

Now the poor are of course harder to work on, but then that was what the rich countries signed up to. The difference between the intended and achieved rates in child mortality is so big it may show much worse health services overall than what was intended by the goal. Basically, maybe they're doing the easy bit, and the progress graph stops at the hard bit. There's an emphasis in development on privatisation, and making people pay for things (I don't know much detail).

2) the human cost is more if you leave child mortality till the end, even with the same statistic at the end

If the poor die off now (at the required rate to reach the poverty goal) without the brake on deaths of the poor provided by adequate progress on child mortality, then more poor children and adults die but it's easier to work on child mortality towards 2015 because the poor have already died. If enough poor die, even child mortality itself looks better (because of my main point about averages).

So I think child mortality is a safeguard at the start, but less so at the end.

Even though halving-the-poor-people is in front in terms of progress, Clare Short and all the rich countries treat it as if it's the main goal, and commission studies on it, and the Bank has poverty reduction plans (proportion of people reduction) for the poor countries. They talk about them as if they're a kind of scorecard and they're scared of getting a score of 0 out of 7, rather than about the merits of balanced progress (which every actual statement of the goals emphasises)

I would prefer not to meet any of them but to have an idea of what might be a good idea given various balances in outcomes along the way. Of course you then have to look at individual countries, but to me overall the balance makes no sense at all.

They say how great it is getting the countries to help devise the poverty reduction plans, but that avoids the bizarre nature of the goal.

They don't commission studies on the child mortality goal, and I haven't found anyone who has thought about the statistical or policy relationships between the goals and what the statistics mean.