The State of the World's Children 1996
By Carol Bellamy Oxford: Oxford University Press (for UNICEF), 1996
ISBN 0-19-262747-3

A recent editorial in a public health journal on the incarceration of mentally ill people in the United States described the deinstitutionalization of mentally ill patients as the largest failed social experiment in 20th century America. In other contexts, social commentators with an eye on the approaching millennium have described people's inability to eradicate mass poverty as the greatest humanitarian failure of the 20th century. The recently released UNICEF document The State of the World's Children 1996 makes no such claim. On the contrary, after providing various extremely disturbing details about the state of children in various war-torn countries, it argues that the report "is not a counsel of despair."

The document is divided into three chapters. The first contains a description of children in war, the second chapter deals with UNICEF's and the world's response to the needs of children over the last 50 years and the last chapter consists of statistical tables describing health, social and economic states in each country.

The details of how children are affected by war are prefaced by the fundamental purpose of the United Nations charter: "... to save succeeding generations from the scourges of war." Facts provided include the estimate that 2 million children have been killed and 4-5 million left disabled as a consequence of war during the last decade. More children tend to die as a result of present-day war because civilians are more frequently targeted, better technology allows the recruitment of child soldiers (apparently, the AK-47 can be stripped and reassembled by a child of 10) and because "expendable children" are sometimes sent ahead to clear mine fields. In 64 countries there are 110 million land mines lodged in the ground, while no international law bans the sale and export of land mines. Total annual military expenditure by developing countries increased from $27 billion US in 1960 to $121 billion US in 1991, with the steepest increases occurring in the poorest countries. The top five arms suppliers are the five permanent members of the United Nations Security Council; France displaced the United States as the single largest supplier in 1994.

The second chapter traces the history of UNICEF from the creation of the United Nations International Children's Emergency Fund in 1946 and its subsequent transformation into the United Nations Children's Fund in 1953. The 1950s saw UNICEF predominantly involved in mass campaigns against diseases such as tuberculosis, yaws, trachoma, leprosy and malaria. The focus over the next 10 years-labelled the decade of development-was a "quest to eradicate poverty" globally. The lessons learned from these attempts led to the realization that alternative methods of meeting basic health needs were required.

In 1978 the ambitious goal of "Health for All by the Year 2000" was adopted at Alma Ata. Then the 1980s were characterized by campaigns for child survival and development using low-cost technologies. Growth monitoring, oral rehydration, breast feeding and immunization were the key elements of this strategy. By the end of the decade, this approach is estimated to have saved the lives of over 10 million children. In the 1990s the focus is on the rights of children. The 1990 World Summit for Children and the passage of the Convention on the Rights of the Child have served to consolidate the presence of children in the worldwide political debate.

Mortality rates for children under five years of age have dropped substantially over the last five decades. The total number of children who die before their fifth birthday is also continually declining, except in sub-Saharan Africa. Immunization coverage rates among children in many developing countries have risen dramatically, from about 15% in the early 1980s to levels above 60%. In 1995, 146 countries had reported no cases of poliomyelitis for at least one year. On the other hand, more than 12 million children die each year from the "silent" emergencies of preventable diseases and malnutrition. A collapse of the political structure in various countries has pushed entire nations into conditions of near-total breakdown. Clearly, children in many parts of the world have little reason for hope, and there is no reason to believe that the situation will improve in the near future.

The last chapter of the UNICEF report contains tables providing details on health development and related variables for 150 countries (and limited information on 40 less populous countries). Countries are ranked by their rates of under-five mortality, an indicator the UNICEF has been using for some years now instead of the traditional "social mirror," the infant mortality rate. This alternative index was chosen for its more comprehensive nature in comparison with the restricted one-year focus of the infant mortality rate.

Canada places 12th in this ranking with an under-five mortality rate of 8 per 1,000 live births, while Sweden gets first place with a value of 5 per 1,000 live births. The data refer to calendar year 1994; at the time of writing, Statistics Canada has yet to release infant mortality and other child mortality statistics for that year. According to the UNICEF report, the number of Canadian births in 1994 was 435,000, an excess of some 47,000 births over 1993. A check of the State of the World's Children 1995 shows a difference of about 10,000 births between the UNICEF report and Statistics Canada's tally for 1993. Obviously, the UNICEF numbers for Canada represent estimates rather than actual figures (the report states that reported statistics are often estimates). This is surprising and leaves one wondering about the validity of the estimates for some of the less developed nations with poorer health information systems.

In summary, the report provides a mixed message on the state of the world's children. Significant successes have been achieved in controlling diseases and reducing child mortality globally over the last few decades. On the other hand, the contemporary situation for many of the world's children is depressing. Is the State of the World's Children 1996 worth reading/owning? The chapter on the history of UNICEF provides a good perspective on the policy changes directed at improving conditions for children since World War II. On the other hand, being a UNICEF document, it fails to acknowledge criticisms directed at its organization and policies, including charges of financial mismanagement. The uncertainty of estimates notwithstanding, the statistical tables provide the latest available information on each country. Whereas the distressing chapter on children in war underscores the reader's sense of helplessness, it is required reading insofar as it depicts reality with regard to a critical topic.

Overall rating: Very good

Strengths: Important topic Authoritative Latest health information on all countries

Weaknesses: Restricted perspective, i.e. UNICEF's