The Millennium Development Goals Fail Poor Children: The Case for Equity-Adjusted Measures

The Declaration is operationalised through eight Millennium Development Goals (MDGs), each of which provides the blueprint and targets for addressing prioritised social needs. A tension arises, however, between the broad social principles of the Declaration, and the refined targets of the MDGs. Using the fourth MDG as an illustrative example, we highlight the potential to neglect equity in the race to achieve the set targets. MDG4 aims to reduce the under-five child mortality rate (U5MR) by two-thirds by the year 2015 [2]. Arguments analogous to those presented here are, however, applicable to all the MDGs. As a goal, in and of itself, reducing child mortality by two-thirds is laudable. There is a significant strain, however, between an isolated MDG4-oriented outcome, and outcomes that also take account of the broader spirit of the Declaration. The problem arises because MDG4 is presented in terms of the raw, average U5MR for a country. While this makes for simple reporting, the figure masks distributional information about which parts of society contribute most (or least) to the magnitude of that rate. In other words, the measure is equity-blind, unable to distinguish between a fair and an unfair social distribution of the burden of under-five mortality [3,4]. As a consequence, countries can achieve MDG4 (an apparent success), but fail to address the problem of under-five child mortality amongst their society’s most vulnerable groups (a Millennium Declaration failure). Even where this tension has been officially recognised, there has been a failure to alter the indicators of MDG4 success [5]. To illustrate some of the issues, we present data on a hypothetical country with a U5MR around 200—that is, 200 child deaths per 1,000 live births per year. This child mortality rate, while very high, is not unheard of, and was recorded in Chad in 2004 [6], Malawi in 2000 [7], and Burkina Faso in 2003 [8]. From empirical data we know that child mortality is not equally distributed across the population and that the wealthiest groups tend to experience the lowest child mortality rates. Thus, the average U5MR may be 200, but the rate amongst the wealthiest will often be a half or a quarter of that amongst the poorest [9].