Poverty is the greatest threat to children’s health, regardless of a country’s level of development.
Rates of disease and health threatening behaviour are closely linked to socioeconomic factors, which include poor neonatal health (from malnutrition, for example), lack of access to health care, unhealthy or unsafe environments, and behavioural factors such as early smoking, drinking or drug taking.
maternal health. The mother’s living circumstances fundamentally influence the health of the child. Further, initial work to protect and promote children’s health – through, for example, adequate newborn care and exclusive breastfeeding – can only be supported within the framework of maternal health and care.
As indicated, the basis for good health is established even before conception, and is decisive in the first, formative years. For example, congenital anomalies can be prevented through various interventions:
1. women’s taking folic acid supplements around the time they conceive, which has a strong protective effect against the development of neural tube defects in fetuses (59);
2. extending programmes to vaccinate babies and/or young girls against rubella;
3. ensuring the best clinical care of pregnant women with epilepsy or diabetes and implementing a strategy to combat the risk related to maternal obesity;
4. strengthening the testing of pharmaceuticals before they are marketed and surveillance of them afterwards;
5. reducing parents’ abuse of recreational drugs such as cocaine and alcohol;
6. providing genetic counselling services; and
7. adopting a precautionary approach to exposure to factors in the environment: reducing high exposure to by-products of drinking-water chlorination, endocrine-disrupting chemicals, releases from waste disposal sites and pesticides.
A healthy diet and a clean water supply are crucial to every stage of development, from before conception through to later life. Poor nutrition is associated with a reduced resistance to disease, impaired physical and psychological development, and infant morbidity and mortality.
The neonatal period is critical. Experience shows that sophisticated technology is not the main factor. Neonatal health depends largely on socioeconomic circumstances, access to appropriate antenatal and delivery services, and parental education. Improvements in the socioeconomic circumstances of those at greatest risk are effective, combined with measures to promote health and prevent disease. While the survival of the newborn does not depend primarily on expensive medical facilities, access to basic health care is crucial.
Low birth weight (below 2500 g) increases the risk of ill health in the newborn child and in later life. It is associated with increased rates of coronary heart disease, stroke, hypertension and non-insulin-dependent diabetes. Its prevalence ranges from around 4% to around 16%
across the Region. Young mothers have a greater tendency to produce low-birth-weight babies.
Such babies are also more frequent among mothers who smoke, and this appears to be the main factor in the Region. In addition, low birth weight may indicate inadequate maternal nutrition.
Breastfeeding
Breastfeeding is an effective means of improving infants’ well-being at low financial cost. Low rates and early cessation of breastfeeding:
Fig. 10.
Proportion of at least partially breastfed children aged 6 months in 32 countries in the WHO European Region, 2000
95 87 81 80 79 72 72 71 71 67 63 51
50 48 44 42 41 41 40 40 39 37 37 33 32 32 30 27 26 25 21 17
0 10 20 30 40 50 60 70 80 90 100 Uzbekistan
Albania Republic of Moldova Norway Kyrgyzstan Tajikistan Sweden Turkey Kazakhstan
Iceland Armenia Finland Belarus Hungary Georgia Estonia Ukraine Israel TFYR Macedoniaa Spain Romania Slovakia
Italy Russian Federation Serbia and Montenegro
Czech Republic Azerbaijan Lithuania Latvia Netherlands United Kingdom Croatia
Percentage
a The former Yugoslav Republic of Macedonia.
Source: European health for all database (17).
•
have important adverse health and social implications for women, children and the community;•
result in greater national expenditure on health care provision; and•
increase inequalities in health (60).In all Member States, too few mothers breastfeed their babies until the age of 6 months (Fig. 10);
WHO recommends exclusive breastfeeding during this period.
Breastfeeding can be supported through a variety of measures, such as counselling, enlightened employment practices and paid maternity leave. The mass media and education authorities can play their part by encouraging social norms that support these activities. A review of the evidence indicates that all forms of extra support for mothers have beneficial effects on the duration of both exclusive and partial breastfeeding. Extra professional support is beneficial for any breastfeeding, and lay support is effective in reducing the cessation of exclusive breastfeeding. Professional support from appropriately instructed personnel showed benefits to health including a significant reduction in the risk of gastrointestinal infections and atopic eczema. Research indicates that general support for breastfeeding increases both the number of mothers involved and the duration (61).
There is consensus on how best to encourage breastfeeding. A Blueprint for Action (60), funded by the European Commission, builds on the WHO Global Strategy for Infant and Young Child Feeding (26). It calls for national strategies that emphasize the translation of policy into practice. Vigilance is required, for instance, to ensure that the International Code of Marketing of Breast-milk Substitutes (62) continues to be followed.
Feeding practices
Poor feeding practices can be a major cause of malnutrition in young children. The main sign of this in the Region is low height for age (stunting). The proportion of stunted children aged under 5 in the period 1997–2003 (see Annex Table 2) was highest in Albania and Tajikistan (over 35%), but considerable in several other countries with large child populations. Suboptimal growth patterns are also found among poorer groups in more affluent countries, such as the United Kingdom.
Stunting increases the risk of ill health, and is associated with impaired cognitive development and reduced work capacity later in life. Stunting is also a sensitive measure of poverty. Low-birth-weight infants are more likely to be stunted (63). Poor nutrition in early life is associated with an increased susceptibility to hypertension, diabetes and CVD. Low-birth-weight girls are more likely to become stunted mothers, who in turn are at greater risk of producing low-birth-weight babies (49).
Dietary practices are a function of economic circumstances and social norms. Social norms can be influenced through education, and communication initiatives reinforced by community action and professional advice. Changes in the food supply may require governments to take action at the national level and involve the food-processing industry, education sector, civil-society organizations and the mass media.
HIV infection
As the number of HIV-infected women in the European Region steadily rises, so does the transmission of the infection to the newborn. Nevertheless, the Strategic Framework for the Prevention of HIV Infection in Infants (64) provides an opportunity to eliminate this problem
from the Region. Prevention goes beyond clinical care and needs to include a range of care and protective work, both in health institutions and in the community. The Framework is based on the experience of countries in the Region. It outlines strategies for implementation at the country level to achieve the goals set out in the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia (65). The Framework calls for: