Download the new NCD Alliance Publication: A Focus on Childen and NCDs

Download The NCD Alliance Briefing Paper on Children and NCDs: Children in Every Policy: Recommendation for a Lifecourse Approach to NCDs

Introduction

Numerous international and national laws, policies of governments and statements of international institutions and organizations of international civil society recognise the rights of children to adequate health care. Nonetheless, when it comes to addressing Non-Communicable Diseases (NCDs), children are too frequently left off (or insufficiently acknowledged in) the policy agenda. The NCD Alliance seeks to address this inequity and to recommend a framework for improvement.

The NCD Alliance unites a powerful network of like-minded NGOs, associations and individuals with the experience, passion and commitment required to promote the profile of children within the NCD discourse leading into the High Level UN Meetings in 2011, and ensure children are included within discussions, policy development, and tangible outcomes. Only in this way will we fulfil our collective obligation to progressively realise the rights of all children (and paradoxically adults also) to health and life.

This document sets out a justification for a specific focus on children within the NCD discourse and then presents recommendations and a framework for future action.

Why we need to integrate children within NCD policies

Even within a more focused approach to NCDs that concentrates on lifestyle conditions and chronic disease considered by many to be more relevant to adults, there are four important reasons why children, teenagers and young adults (hereafter collectively referred to as “children”) require special attention:

1. NCDs affect children – By definition, NCDs impact the health of children (directly and indirectly) just as much as they do the health of adults. Cancer, diabetes (both type 1 and type 2 diabetes), chronic respiratory diseases (such as asthma), congenital and acquired heart disease and many endemic NCDs all affect children. Children suffer from a wide range of NCDs: some are triggered in childhood by a complex interaction between the child's body, surrounding environment, living conditions, infectious agents, nutritional and/or other factors, with consequent scope for preventive action. Some conditions are congenital: each year an estimated 8 million children (6% of all births worldwide) are born with a serious birth defect or symptomatic genetic abnormality , and heart defects alone contribute about one-third to one-quarter of all birth defects . NCDs are a major cause of preventable mortality, morbidity and disability amongst children in Low- and Middle-Income Countries (LMICs). Many of these children die prematurely because of late diagnosis and/or lack of access to appropriate treatment; those fortunate to survive often experience significant hardship and disability as a result of living with a chronic health condition that is not optimally managed. The global profile of childhood NCDs in LMICs will continue to emerge as infectious conditions are increasingly brought under control.

2. Children have a right to health and life- Children’s right to health requires special attention. Children are especially vulnerable and powerless, with no voice to advocate for their own needs, and yet they face unique challenges and have special needs. The period of rapid growth and development that occurs in childhood has a profound impact on future health and quality of life enjoyed in adulthood, and represents a “golden window” of opportunity in terms of improving the overall lifetime health of populations and promoting rights to health for all. Whilst various international and national laws recognise the importance of the rights of the child to adequate health care and medical assistance, discourse often focuses on adults. The rights of the child however provide an element of accountability to governments and organisations. Attention must be given to addressing health issues specifically related to children.

3. A Lifecycle approach to NCD prevention and Risk Factors is vital– There is now strong evidence for the importance of good maternal health, healthy birth weights and breast-feeding to reduce the future risk of children developing “lifestyle” NCDs as adults. Furthermore, children’s bodies are especially vulnerable to the same risk factors responsible for many NCDs in adulthood (low physical activity, poor diet and tobacco exposure), and the rates of some “lifestyle” NCDs amongst children is already on the rise globally (eg obesity and Type 2 Diabetes), so reducing exposure to these risk factors earlier in life will have a substantial impact on the future health of entire populations. A focus on children promotes generational and population-based change, and empowers an early-onset, lifecycle approach to prevention. Children can often claim a stronger ethical imperative in having these NCDs treated, as a case can rarely if ever be made that voluntary lifestyle choices contributed to their burden of illness (such as with adults who acquire NCDs through alcohol or tobacco consumption). Many NCDs in children are actually caused by adults (for example, through passive smoking; alcohol consumption; inhalation or ingestion of toxic chemicals during pregnancy; and exposure to other environmental hazards such as lead), again justifying the development of strong NCD policies for children as a vulnerable group.

4. Strengthening paediatric health systems is essential - Many NCDs that affect children are poorly managed within health systems of LMICs, with available treatment options inferior even to corresponding adult services. The needs of children with chronic health conditions are complex: they extend beyond the traditional “acute” health context, and involve families, schools and the broader community. Increased capacity of primary, secondary and tertiary health care is required at local and national levels to develop comprehensive chronic care platforms that address the entire lifecycle of humans rather than simplistic silo-approaches to change that risk “forgetting” children, and fail to address the complex and unique health care needs of children. From a purely economic standpoint, children who receive appropriate treatment for their chronic health conditions can go on and make major contributions to society, and return far more than their treatment costs.

Recommendations: A Lifecycle Framework on NCD Outcomes for Children

The 2011 UN NCD High Level Meetings offer a unique opportunity to promote holistic, systematic and sustainable approaches to health-system strengthening by focusing on the entire human lifecycle, and the global health community has a special obligation to integrate children into all policy discussions and decisions that emerge from the meetings.

Effective integration of children within NCD policy development across the human lifecycle will result in large-scale primary, secondary and tertiary prevention of NCDs. Multisectoral efforts (beginning with UN recommendations and other governance statements) must therefore focus on:

I. Pre-conception – supporting gender equity and a rights-based approach to women’s health and wellbeing, nutrition, education and financial security as a means to reducing NCD risk factors and promoting health for all

II. Maternal and newborn health – quality prenatal and perinatal care, healthy birthweights, breastfeeding, newborn screening and immunisation.

III. Child health – rights-based, multisectoral efforts to address the social determinants of health, improve access to quality primary health care, optimise health and development in early childhood and reduce NCD risk factors.

IV. Caring for children currently affected by NCDs and other chronic health conditions – respecting and fulfilling the rights of chronically ill children and promoting community development based action aimed at :
1) Affordable access to essential medicines and equipment;
2) Education (of all stakeholders), research and advocacy;
3) Optimisation of medical management (AAAQ , with a holistic approach to health and a focus on primary, secondary and tertiary prevention) and inclusion of chronic and congenital health conditions within IMCI , the WHO Pocket book and other relevant documents and policies to increase the capacity of paediatric health systems in LMICs;
4) Encouragement of grassroots, community-development approaches to supporting families and children living with NCDs; and
5) Reducing financial burdens on families that lead to poverty and promoting financial independence for those living with NCDs.

V. Recognising the impact of NCDs on parents of young children – so that children are not forced to become caregivers themselves or bear the financial burden for the family.

Some organisations committed to helping children who are living with NCDs in LMICs and/or integrating children within the NCD discourse include :

• Atfaal Welfare Society – improving the lives of children living with diabetes and other endocrine conditions in Pakistan.
• Child Lung Health Division of the International Union Against Tuberculosis and Lung Disease – focused on health services that care for children with asthma and severe lung diseases in low-income countries.
• Children’s Heartlink - partnering with health care centers in underserved regions to strengthen their capacity to diagnose and treat congenital or acquired heart disease in children
• CLAN (Caring & Living As Neighbours) – promoting a strategic grassroots, community development framework for action that supports children living with chronic health conditions in resource-poor countries.
• Cure4kids - a Web site dedicated to improving health care for children with cancer and other catastrophic diseases in countries around the globe, providing continuing medical education focusing on cancer, pediatrics, oncology, and global communication tools to health care professionals and scientists worldwide
• GPED (Global Paediatric Endocrinology & Diabetes) representing members from six major regional paediatric endocrinology societies worldwide, GPED is focused on building the capacity of health professionals to care for children with endocrine conditions (including diabetes) in low-income countries.
• International Insulin Foundation - provides technical support to improve access to diabetes care and medications in the world’s poorest countries.
• International Network for Cancer Treatment and Research (INCTR / Childhood Cancer) - building capacity for cancer research and treatment in developing countries.
• International Pediatric Association (IPA) - an alliance of organizations, with 160 national, regional or sub-speciality pediatric societies as members, all working with other partners to promote physical, mental, and social health for all children, to achieve the highest standards of health for newborns, children, and adolescents in all countries of the world.
• International Society of Paediatric and Adolescent Diabetes (ISPAD) - organizing paediatric diabetes teams from more than a hundred countries, to improve advocacy, education and research on diabetes in children and adolescents
• Life for a Child - of the International Diabetes Federation (IDF), supporting the care of almost 8000 children living with diabetes in 27 countries worldwide.
• My Child Matters of the UICC (Childhood Cancer) - building local capacity to reduce inequities in childhood cancer survival in selected resource-constrained countries.
• Partners in Health – providing a preferential option for the poor in health care, by partnering with poor communities to combat disease and poverty.
• The Public Health Institute - promotes health, wellbeing, and quality of life through research, training, and community building.
• World Child Cancer - saving lives and reducing suffering associated with childhood cancer in developing countries by providing world-class expertise, sustained guidance and essential funding.
• World Heart Federation - focusing on heart disease in children.

If you have an interest in working on issues relating to Children and NCDs ahead of the UN High Level Meetings in September 2011, please contact NCD Alliance Common Interest Group Member, Dr Kate Armstrong at [email protected].

We also welcome your Tweets - please use #NCDChild on Twitter so that our voices can unite for the children.