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Paediatric training and the practise of paediatrics is built on the bedrock of ensuring best possible health outcomes for all children, optimising opportunity for those without full health and contributing to a voice, in advocacy, for children. In the world’s high-income countries (HICs), child health outcomes are comparatively good, and the paediatric workforce well trained to manage the health issues of children. Paediatric training and continuing professional development is generally under the authority of paediatric societies or colleges. Such organisations are well funded and supported, have long traditions of curriculum and resource development with supervisors trained in postgraduate training and supervision. They have a history of matching training needs to the health needs of their children. Some attempt at supporting advocacy and a voice for children is made, and a sense that paediatricians do all they can for the underprivileged is instilled during training. Such approaches are right and proper, but do they miss something fundamental?
The global context of child health is somewhat different from that in the HICs. Mortality is far greater in the low-income and middle-income countries (LMICs), and morbidity is also much higher, not just from communicable disease but increasingly from non-communicable disease. Newborn deaths make up half of childhood deaths. Much has been made of the fall in under-5 mortality rates during the Millennium Development Goal (MDG) era, implying that we are on a steady trajectory to eliminating under-5 deaths. However, rates of improvement have slowed, indeed in some countries there has been a decline in survival rates. We know that under-5 mortality is around 6 million, which is too many, let alone the enormous morbidity which is not counted or measured.1 There are many excellent publications such as the recent paper by Liu et al, 2 which analyses data and provides statistics to the global community on …
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.