The Lancet Child Survival Series
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In June and July 2003, The Lancet published a series of articles on child survival, authored by a group of global child health experts who had met earlier that year in Bellagio, Italy, under sponsorship of the Rockefeller Foundation.

In the series, the Bellagio Child Survival Study Group calls child survival “the most pressing moral dilemma of the new millennium" and urges “major shifts in policy and funding at international and country levels” to reverse the world’s annual toll of 10.8 million under-5 child deaths.

“Nearly all of these deaths will be concentrated in the world’s poorest countries in sub-Saharan Africa and South Asia. Within each country, children from the poorest families are most likely to die," the group warns. "Effective low-cost interventions are available that can prevent two-thirds of these deaths. The challenge is how to deliver these interventions to children who need them most, children who are bypassed by existing health services' delivery strategies."

The Lancet series:

Lancet Editorial:

"The World’s Forgotten Children." Lancet 2003; 361: 1

Lancet Articles:

1. Black R, Morris S, and Bryce J. "Where and why are 10 million children dying every year?" Lancet 2003; 361: 2226-34.

Provides updated information on the main causes of child deaths in 42 countries that account for 90% of global child mortality. Shows that diarrhea, pneumonia, and neonatal causes of death are important throughout the world, with malaria and HIV infections also causing deaths in some countries.

2. Jones G, Steketee R, Bhutta Z, Morris S. and the Bellagio Child Survival Study Group. "How many child deaths can we prevent this year?" Lancet 2003; 362: 65-71.

Shows that current levels of coverage with low-cost, effective interventions are unacceptably low, and that extending access to all children would prevent two in every three deaths. Interventions that have been available for many years, such as oral rehydration therapy and promotion of exclusive breastfeeding, have the greatest life-saving potential.

3. Bryce J, El Arifeen S, Pariyo G, Lanata C, Gwatkin D, Habicht JP and the Multi-Country Evaluation of IMCI Study Group. "Reducing child mortality: Can public health deliver?" Lancet 2003; 362: 159-64.

Discusses how weak health systems preclude reaching the neediest children, and asks for a rethinking of global child health strategies. Delivery systems must be appropriate to local epidemiological and health services.

4. Victora C, Wagstaff A, Armstrong Schellenberg J, Gwatkin D, Claeson M, and Habicht JP. "Applying an equity lens to child health and mortality: More of the same is not enough." Lancet 2003; 362: 233-41.

Addresses the major challenge of reducing inequities in child health. Socioeconomic inequalities affect child health through many pathways, including increased exposure to disease, reduced resistance, and lack of appropriate health care. Inequities must be documented and specifically addressed when delivering health interventions, to avoid the risk of increasing rather than decreasing existing differentials.

5. "The Bellagio Study Group on Child Survival. Knowledge into action for child survival." Lancet 2003; 362: 323-27.

Summarizes key messages from the series. The Child Survival Revolution, launched in the 1980s, resulted in remarkable achievements, but momentum was lost in the 1990s and several earlier gains have been reversed. Child survival slipped down in the global agenda, and is no longer a priority for development strategies. One major reason is the lack of clear international leadership. Available funding for child survival is also going down, at least in relative terms.

Lancet Commentary:

Venis S. Child survival. Lancet 2003; 361: 2172.

Lee JW. Child survival: a global health challenge. Lancet 2003; 362: 262.

Members, Bellagio Child Survival Study Group

Bellagio residency and The Lancet series of papers were coordinated by Jennifer Bryce (WHO), Cesar Victora (Federal University of Pelotas, Brazil), and Sarah Venis (The Lancet).

Other participants included:

S el Arifeen (ICDDR, Dhaka, Bangladesh)
Z Bhutta (Aga Khan University, Pakistan)
R E Black (Johns Hopkins University, USA)
M Claeson (World Bank)
T Evans (Rockefeller Foundation)
D Gillespie (David and Lucile Packard Foundation, USA)
D Gwatkin (World Bank)
J-P Habicht (Cornell University, USA)
G Jones (UNICEF)
C F Lanata (Instituto de Investigación Nutricional, Peru)
S S Morris (London School of Hygiene and Tropical Medicine, UK)
H Mshinda (Ifakara Health Research and Development Centre, Tanzania)
G Pariyo (Makerere University Institute of Public Health, Uganda)
G Perkin (Bill and Melinda Gates Foundation)
J Armstrong Schellenberg (London School of Hygiene and Tropical Medicine, UK)
R Steketee (Centers for Disease Control, USA)
H Troedsson (WHO)
A Wagstaff (World Bank)