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The role of advocacy in promoting better child health
  1. Delan Devakumar1,
  2. Nick Spencer2,
  3. Tony Waterston3
  1. 1Institute of Epidemiology and Health Care, University College London, London, UK
  2. 2Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
  3. 3Retired paediatrician
  1. Correspondence to Dr Delan Devakumar, Institute of Epidemiology and Health Care, University College London, Mortimer Market Centre, London WC1E 6JB, UK; d.devakumar{at}

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Despite the many recent gains in child health, approximately six million children still die worldwide of mostly preventable causes. Mortality rates in the poorest countries are orders of magnitude higher than the richest and inequalities in health are also profound within the same country, as the richest groups across countries have similar health outcomes.1 The causes are numerous and include birth-related conditions, infectious disease, malnutrition and increasingly non-communicable diseases. In addition to these, children have always been, and sadly will continue to be, victims of abuse. This may take active forms, such as physical or sexual violence, or passive forms, such as neglect.

As child health specialists, we have a duty of care to our patients to help manage their diseases, but we also have a role in preventing these diseases from arising in the first place. Advocacy is important in both these respects, speaking out for unwell children and also in attempting to deal with determinants of health that underpin the biomedical causes, in the communities in which they live. Achieving optimum child health however, is much more than this, it is seeking a state of well-being where a child is able to grow and develop, while being nurtured and protected.

As a potentially vulnerable group in society, children require others to support their voice or advocate on their behalf. This matters because the differences in health outcomes are generally preventable and are inequities, that is, are unfair, rather than purely inequalities.2 ,3 Children do not have political power or a democratic voice, and generally have actions done to them, often without their consent. Without others advocating for a child, powerful organisations can act in their own best interests, which may work against the health and well-being of children. An example of this would be the …

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  • Contributors DD wrote the first draft. NS and TW wrote the case studies. All authors read and modified the manuscript.

  • Funding DD's academic post is funded by NIHR.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.