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Child Deaths: We Must Look at Disparities Within Countries Too

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The latest report on child deaths around the world makes a very brief reference to disparities in mortality within countries; it is vital that these disparities becomes a focus for development.

The report, from Unicef, notes 'alarming disparities in under-five mortality at the sub-national level in many countries. Children are at greater risk of dying before age five if they are born in rural areas, poor households, or to a mother denied basic education.'

Health Poverty Action works with marginalised communities across the world and our experience shows us that living rurally, being poor and lacking education are not the only circumstances that correlate with early deaths. Coming from an ethnic or cultural minority does too.

In many countries, including those deemed middle income, certain groups are discriminated against and marginalised because of their ethnicity and culture - they have no political voice and their cultural practices are not taken into consideration in the planning and implementation of health services. Their health suffers because they are from an ethnic or cultural minority group.

Take Ethiopia for example; which the report says has already reduced the under-five mortality rate by two-thirds. This is, of course, excellent news which should not be underrated. But this statistic obscures significant variations within the population, such as among cultural minorities like pastoralists.

There are approximately 12-15million people belonging to 29 different ethnic groups in the pastoral regions of Ethiopia. These pastoralists face many obstacles to accessing health and public services, obstacles that are specifically related to their unique culture. They are dependent on nomadic livestock production, and their mobile lifestyle means they are often far from the static government services and support. Moreover, because of their distinct culture many pastoralist groups have low social status, which means they face discrimination and marginalisation and lack a voice over public services. In Ethiopia's 2011 DHS survey the national under-five mortality rate was 88 per 1000 live births, but in the Somali region it was much higher, at 122. This figure is actually closer to the national average given in the Unicef report for the year 2000, and underscores the huge disparities in improvements in health outcomes between different groups within a country.

The question, then, is how to tackle these disparities. The new framework for international development aims to go beyond the percentage targets of the Millennium Development Goals and 'leave no one behind.' To achieve this we must ensure the most marginalised communities are prioritised, and to do that there must be robust data on which to base national health plans.

Currently there is a dearth of statistical information around the health outcomes of marginalised ethnic and cultural groups. Most health surveys either do not collect information on ethnicity, or if they do they do not disaggregate health data by ethnicity.

Health Poverty Action is calling for health data to be broken down by ethnicity.

If health information was broken down by ethnicity, action could be taken to target resources in the areas that need them most, and importantly, we would uncover the underlying causes of health inequality. This would help strengthen some of the world's most marginalised communities and be a step towards truly leaving no one behind.

To read the full report from Health Poverty Action click here.

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