Summary

The prevention of child mortality should remain a global priority. But beyond sheer survival, children have a right to thrive, develop in a holistic way to their full potential, and enjoy good physical and mental health in a sustainable world. The present report argues that early childhood, a crucial time for effective investments in individual and societal health, must receive significantly more attention and a more adequate response from all relevant actors, including in the post-2015 agenda, which signaled a shift from the survival and health of children under 5 to their survival, health, well-being, and development.

The Special Rapporteur elaborates on the right of young children to healthy development, which in childhood consists of interconnected domains: physical, cognitive-linguistic and social-emotional. The three critical elements of healthy child development are stable, responsive and nurturing caregiving; safe, supportive environments; and appropriate nutrition.

These elements can be safeguarded through good practices such as planned, safe pregnancy and childbirth; exclusive breastfeeding in the first six months followed by appropriate complementary feeding and responsive parenting; preventive interventions such as vaccines for the treatment of diseases; protection of children from all forms of violence, neglect and abuse; and the reduction of environmental risks.

The expert stresses that young children’s rights to health and development are intrinsically linked. First, poor physical or mental health in early childhood can limit the right to optimal development. About 200 million children fail to reach their developmental potential mainly because of poverty, inequality and discrimination; poor health; poor nutrition; a lack of stable, nurturing and responsive environments with learning opportunities; and a lack of safe, supportive physical environments.

Second, the three main domains of early childhood development—physical, social-emotional and cognitive-linguistic—affect lifelong health. All three domains must be given equal attention to promote development in a holistic manner, or healthy development.

The Special Rapporteur also addresses “new morbidities” in childhood which are related to psychosocial environment, including relationships within the family, the community and the broader society. Emotional relationships in early childhood impacts on physical and mental health as well as on morbidity in adulthood. Therefore, modern health systems and modern health policies should address social and other underlying determinants of health by applying modern principles of health promotion, primary care, mental health and integrated health and social services to early childhood.

Recommendations

The Special Rapporteur calls on States to ensure that, in all levels of policy formulation and implementation, investing in the promotion of holistic development is equally important to the prevention of child mortality. We need to modernize existing healthcare systems and medical education, so that “new morbidities” and challenges related to emotional and social development of children are adequately addressed.

Furthermore, health-care services and professionals should be better equipped with relevant knowledge and practical skills to respond to new challenges. Professionals need more knowledge about the negative impact of social determinants and early childhood adversities on the physical and mental health of children.