Black – 2007 Lancet Series

The first series was published in 2007. That series was undertaken because we had seen a tremendous improvement in child survival. In other words child mortality had dropped dramatically and we were very interested in what happens to those children who survive. At that time there was really no estimate of early child development, and so we struggled to look for indicators, imperfect indicators but indicators of children’s development or of threats to early child development. 

We needed something that would be an indicator that would be available in every country, that would be measured the same way and that would be associated with children’s development. So we came up with stunting as an indicator of chronic under-nutrition. That’s children’s linear growth or height for age that is two standard deviations below the median set by WHO. And we came up with poverty, which was if I recall $1.25 a day. 

So using those two indicators we estimated that there were 200 million children, actually 219 million children in low and middle-income countries under aged five who were not reaching their developmental potential. In that first series in 2007, we also looked at the risks for children not meeting their potential and the primary risks were nutritional, so that’s under-nutrition, iron deficiency, an iodine deficiency and lack of stimulation. 

Then we also looked at interventions and we found that in low and middle-income countries there were interventions for young children that were effective, but they were not scaled up and they were generally not very available. So in that – in that series we talked about the need for political will to implement interventions that we knew worked.